2026 iCatCare consensus guidelines on the diagnosis and management of chronic kidney disease in cats

Chronic kidney disease (CKD) is common in senior cats. Early diagnosis can facilitate interventions to slow progression and minimise clinical signs. Management according to the International Renal Interest Society (IRIS) staging system for CKD can lead to prolonged survival and an excellent quality of life for affected cats.

The '2026 iCatCare consensus guidelines on the diagnosis and management of chronic kidney disease in cats' provide information on the pathogenesis of CKD, guidance on making a diagnosis and staging of disease, and practical content on medical and nutritional treatment. They also discuss optimising the home and veterinary clinic environment to positively influence mental wellbeing and, in turn, physical health, as well as working with the whole veterinary team and caregivers to slow disease progression and maximise quality of life.

Affected cats may show minimal or no clinical signs in the early stages of CKD, which can result in a delay in diagnosis. The condition is generally progressive and management requires consideration of multiple factors in order to address clinical signs. Complications such as hypercalcaemia, hypertension, proteinuria and anaemia may develop, requiring treatment. Moreover, as advancing age is a risk factor for CKD, cats may have important comorbidities that need to be balanced, with impacts on the kidney. Caring for a cat with CKD can result in caregiver burden. Hence, supporting caregivers, contextualising monitoring to the individual cat, and involving both the veterinary and nursing teams is important.

These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society. Information is based on the available literature, expert opinion and the panel members' experience.Specific abbreviations:ACE = angiotensin-converting enzyme; ACKD = acute-on-chronic kidney disease; AKI = acute kidney injury; ARB = angiotensin receptor blocker; CKD = chronic kidney disease; CKD-MBD = CKD-mineral and bone disorder; FGF23 = fibroblast growth factor 23; GFR = glomerular filtration rate; iCa = ionised calcium; ICGN = immune-complex glomerulonephritis; IRIS = International Renal Interest Society; PTH = parathyroid hormone; SDMA = symmetric dimethylarginine.