# Chronic Kidney Disease in Cats

## Key Takeaways

- Chronic Kidney Disease (CKD) affects approximately 30% of cats over 10 years old, characterized by progressive, irreversible renal fibrosis and tubular atrophy, often linked to lipid metabolism and a genetic predisposition (AIM gene exon 3 duplication).
- Early detection is challenging due to feline compensation; key diagnostic markers include elevated symmetric dimethylarginine (SDMA) and creatinine, reduced urine specific gravity (<1.035), and proteinuria (UPC > 0.4), with routine annual wellness exams for cats over 7 years old being crucial.
- Treatment focuses on slowing progression and managing complications through a phosphorus-restricted, protein-restricted, and sodium-restricted therapeutic renal diet, alongside management of anemia (e.g., with hypoxia-inducible factor prolyl hydroxylase inhibitors like molidustat), hypertension (e.g., amlodipine), and electrolyte imbalances.
- Clinical signs of CKD, often subtle initially, include polyuria/polydipsia, weight loss, lethargy, and poor coat quality, while "red-flag" signs like vomiting, anorexia, severe weakness, seizures, or blindness warrant immediate veterinary attention.
- Home care is critical and includes encouraging water intake via multiple sources and wet food, consistent monitoring of weight and body condition, ensuring a stress-free environment, and administering prescribed medications and diets diligently.
- Prognosis is variable, with stable cats exhibiting significantly longer median survival times (894 days) compared to progressive cats (287 days), influenced by factors such as baseline FGF23, albumin levels, and the rate of reciprocal creatinine slope.

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Chronic kidney disease (CKD) is a progressive, irreversible condition that affects approximately 30% of cats over the age of 10. It remains one of the leading causes of morbidity and mortality in geriatric felines. Despite its high prevalence, early detection is challenging because cats compensate remarkably well until significant renal damage has occurred. This article provides a thorough, owner-friendly yet medically accurate overview of feline CKD, covering its pathophysiology, clinical signs, diagnostic approaches, treatment strategies, and practical home care recommendations, supported by the latest scientific literature and authoritative guidelines.

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## Quick Q&A

**Question:** How can I detect chronic kidney disease in my [cat](/knowledge/veterinary-medicine/clinical-methods/cat) early? 
**Answer:** Early detection is possible through routine veterinary screening (blood tests for creatinine and SDMA, urinalysis) and by observing subtle changes at home. New smart litter box technology can also alert owners to increased urination frequency, longer elimination durations, and reduced covering behavior, all patterns linked to CKD. Annual wellness exams for cats over 7 years old are the most reliable approach.

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## What Causes Chronic Kidney Disease in Cats?

The causes of CKD in cats are multifactorial. Most cases are idiopathic, but several contributing factors are recognised:

- **Chronic interstitial nephritis (CIN)** is the hallmark histopathologic finding, characterised by progressive fibrosis and tubular atrophy. This process is partly linked to abnormal lipid metabolism, as feline renal proximal tubular cells naturally accumulate lipid droplets (triglycerides and ether-soluble triacylglycerols) that may drive inflammation.
- **Genetic predisposition**: Approximately 20% of domestic cats harbour a duplication of exon 3 in the apoptosis inhibitor of macrophages (AIM) gene. This variant produces a dysfunctional AIM protein that impairs clearance of intratubular debris, accelerating CKD progression.
- **Acute kidney injury (AKI) episodes**: Events such as ureteral obstruction, pyelonephritis, or toxin exposure can initiate or worsen CKD. Inflammatory/ischemic causes are the most common triggers for AKI in cats.
- **Systemic hypertension**: While often a consequence of CKD, hypertension also perpetuates renal damage. Circulating renin-angiotensin-aldosterone system (RAAS) markers are altered in hypertensive cats, though evidence of classic RAAS activation is not consistently found.
- **Comorbidities**: Cardiovascular disease, hypersomatotropism (acromegaly), and pancreatitis frequently coexist with CKD and can influence progression. For example, cats with CKD often have elevated serum feline pancreatic lipase (fPL) due to reduced renal clearance, complicating pancreatitis diagnosis.
- **Congenital anomalies**: Rarely, cats may be born with unilateral renal agenesis and contralateral ectopia, which predisposes them to early-onset CKD.

## What Are the Early Signs of Kidney Disease?

Early CKD is notoriously silent. Common signs emerge gradually and may be dismissed as normal aging:

- **Polyuria and polydipsia (PU/PD)**: Increased thirst and urination are the earliest symptoms. Smart litter box monitors can detect increased urination frequency, longer durations, and reduced covering behaviour, achieving 89.9% accuracy in predicting CKD.
- **Weight loss and muscle wasting**: Reduced appetite and poor body condition are strong predictors of survival.
- **Lethargy**: Anaemia of CKD, driven by decreased erythropoietin (EPO) production, contributes to fatigue. Novel oral therapies such as molidustat (a HIF-PH inhibitor) can stimulate endogenous EPO and improve haematocrit.
- **Poor coat quality and halitosis**: Uraemic toxins cause oral ulcers and ammonia-like breath.

"Red-flag signs" that warrant immediate veterinary attention include:

- Vomiting, diarrhoea, or anorexia (often due to advanced uraemia)
- Marked lethargy or weakness (suggesting severe anaemia or electrolyte disturbances)
- Seizures or collapse (could indicate hypertensive encephalopathy or hypocalcaemia)
- Acute onset of blindness (often due to hypertensive retinal detachment)
- Straining to urinate or blood in urine (may indicate urinary tract infection or obstruction)

Ionized hypocalcemia is common but typically mild; severe hypocalcemia (iCa < 0.75 mmol/L) occurs in only 1.3% of azotemic cats and may cause muscle twitching or tetany.

## How Is CKD Diagnosed?

Diagnosis relies on a combination of history, physical examination, laboratory tests, and imaging:

- **Serum biochemistry**: Creatinine > 140 µmol/L (1.6 mg/dL) indicates azotemia, but its sensitivity is limited by muscle mass and tubular secretion. Symmetric dimethylarginine (SDMA) is a more sensitive early marker (detects decline before creatinine rises) and is now recommended by the International Renal Interest Society (IRIS).
- **Urinalysis**: Urine specific gravity (USG) < 1.035 in a dehydrated cat suggests renal concentrating impairment. Proteinuria (urine protein:creatinine ratio > 0.4) is associated with poorer outcomes.
- **Imaging**: Renal ultrasonography reveals decreased corticomedullary differentiation, small kidneys, or hydronephrosis. Advanced techniques such as computed tomography (CT) can quantitate renal parenchymal volume, which predicts post-operative creatinine after surgery for hydronephrosis. Diffusion-weighted MRI may detect microstructural fibrosis non-invasively.
- **Emerging biomarkers**: Urinary fibroblast growth factor-23 (uFGF23) and soluble alpha-Klotho (uKL) are increasingly used to assess mineral bone disorder and predict progression. Elevated uFGF23 and decreased uKL:creatinine ratio are linked to advanced CKD. Serum amyloid A (SAA) is a reliable tool to differentiate pyelonephritis from stable CKD (threshold 49.1 mg/L, sensitivity 95%, specificity 97%).
- **Blood pressure**: Systolic blood pressure measurement should be performed at every visit; hypertension (SBP > 160 mmHg) is both a cause and consequence of CKD.
- **Staging**: The IRIS system stages CKD from 1 (non-azotemic with other abnormalities) to 4 (severe azotemia). Staging guides therapy and prognosis.

## What Are the Treatment Options?

Treatment focuses on slowing progression, managing complications, and maintaining quality of life. Key elements include:

**1. Nutritional management** 
A therapeutic renal diet is the cornerstone. These diets are restricted in phosphorus, protein, and sodium but supplemented with omega-3 fatty acids, potassium, and B vitamins. A calcium:phosphorus ratio of approximately 1.4:1 is recommended; higher ratios do not significantly benefit calcium homeostasis and may raise ionized calcium. Phosphate restriction lowers fibroblast growth factor-23 (FGF23) concentrations and reduces calciprotein particle formation, which are linked to soft tissue mineralisation. The slope of reciprocal creatinine plots can objectively identify progressive vs. stable disease; a cutoff of −9.5 × 10⁻⁵ L/µmol/month distinguishes the two.

**2. Management of anaemia** 
Recombinant human erythropoietin carries risks of pure red cell aplasia. The hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) molidustat is a safer oral alternative. In a randomised controlled trial, 68% of cats receiving 5 mg/kg molidustat achieved a ≥4% point increase in haematocrit within 28 days, compared to 17% in controls. Roxadustat, another HIF-PHI with a longer half-life, shows promise in healthy cats but requires careful dosing (avoid >20 mg/kg due to toxicity). Taurine supplementation can also stimulate EPO production via the HIF-1α pathway. Monitoring iron status is essential, as both absolute and functional iron deficiency impair response.

**3. Control of hypertension and proteinuria** 
Amlodipine besylate (0.625-1.25 mg/cat once daily) is first-line for hypertension. ACE inhibitors (e.g., benazepril) reduce proteinuria but do not consistently slow progression. Amlodipine therapy increases angiotensin II and III concentrations, which may reflect beneficial RAAS modulation.

**4. Electrolyte and acid-base balance** 
Hyperphosphataemia is managed with dietary restriction and phosphate binders (e.g., aluminium hydroxide). Hypokalaemia is common and can be corrected with potassium gluconate. Metabolic acidosis from impaired ammonia excretion requires alkalinisation (e.g., sodium bicarbonate). Note that the urine ammonia-to-creatinine ratio (UACR) is significantly lower in the fed state in CKD cats, so sampling conditions should be standardised.

**5. Symptomatic and supportive care** 
- Subcutaneous fluids (e.g., lactated Ringer's solution) administered at home can palliate dehydration and nausea. However, overzealous fluid therapy in cats with concurrent heart failure must be avoided.
- Antiemetics (maropitant, ondansetron) and appetite stimulants (mirtazapine) improve food intake.
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) like bexagliflozin have been used successfully in a cat with advanced CKD and congestive heart failure as a decongestive strategy, but require vigilant monitoring for euglycemic ketoacidosis.

**6. Surgical interventions** 
For benign ureteral obstruction, tailored ureteroneocystostomy with tension-relieving techniques yields a 12-month survival rate of 89.4% and lower complication rates than traditional implant-based bypasses. Pre-operative CT measurement of contralateral renal parenchymal volume helps predict long-term creatinine.

**7. Emerging therapies** 
- **Mesenchymal stem cells (MSCs)**: Clinical studies show consistent trends toward improved GFR and quality of life, though statistical significance is rarely achieved. Muse-like stem cells (a pluripotent subset of MSCs) have normalized renal markers in a 16-year old [dog](/knowledge/veterinary-medicine/clinical-methods/dog) with CKD.
- **Medicinal mushroom extracts**: Ganoderma lucidum and Polyporus umbellatus suppress TGF-β1-induced epithelial-mesenchymal transition in feline renal cells, with additive antifibrotic effects when combined.
- **Cathepsin S inhibition**: In mouse models, CatS deficiency prevents stress-related renal remodelling and hypertension, suggesting a potential therapeutic target.

## How Can I Care for My Cat with CKD at Home?

Home care is critical. The AVMA and Cornell Feline Health Center recommend:

- **Encourage water intake**: Provide multiple water bowls, pet fountains, and wet food. Aim for a moist diet (canned food > 70% moisture).
- **Monitor weight and body condition weekly**: Loss of body condition score (BCS) is an independent risk factor for mortality.
- **Ensure a stress-free environment**: Chronic stress worsens CKD via inflammation and oxidative stress. Hair cortisol concentrations have been studied as a marker of chronic stress, though a recent article on the topic has been retracted. Nevertheless, providing hiding spots, perches, and consistent routines is advisable.
- **Administer medications consistently**: Renal diets and phosphate binders are only effective if consumed.
- **Check for urinary tract infections**: Subclinical bacteriuria (SBU) is common and does not require treatment unless signs of lower urinary tract disease develop; antibiotic treatment does not prevent persistence or progression.
- **Use safe sedatives when needed**: For non-invasive procedures (e.g., ultrasound), a protocol of gabapentin, butorphanol, midazolam, and alfaxalone does not alter SDMA or creatinine, making it safe for CKD cats.
- **Monitor behaviour**: A smart litter box can provide early warning of decompensation.

## What Is the Prognosis for Cats with CKD?

Prognosis varies widely. Stable cats (based on reciprocal creatinine slope) have a median survival of 894 days vs. 287 days for progressive cats. Factors associated with faster progression include higher baseline FGF23, lower albumin, advancing age, and negative slope of reciprocal creatinine within the first 84 days. Cats with IRIS stage ≥3 at one month post-operatively have significantly shorter survival. The presence of comorbidities, especially anaemia and dental disease, independently reduces health-related quality of life scores.

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## Frequently Asked Questions

#### Can chronic kidney disease be reversed in cats?

No, CKD is irreversible. However, with early diagnosis and appropriate management, progression can be slowed and quality of life maintained for months to years. Some cats with acute-on-chronic decompensation may experience partial recovery of function if the inciting cause (e.g., ureteral obstruction or pyelonephritis) is promptly treated.

#### How often should my cat with CKD see the veterinarian?

The IRIS guidelines recommend re-check examinations and bloodwork every 3-6 months for stable IRIS stage 1-2 cats, and every 1-3 months for stage 3-4 cats. More frequent visits are needed if complications arise.

#### Is a renal diet necessary if my cat refuses to eat it?

Nutritional support is essential. If a cat refuses a therapeutic renal diet, consult a veterinary nutritionist. Alternative strategies include mixing the renal diet with the previous food in gradually increasing proportions, or adding flavour enhancers. Appetite stimulants (mirtazapine) can help. Never starve a cat for the sake of a diet; food intake must be maintained.

#### Can I give my cat with CKD supplements like fish oil or probiotics?

Omega-3 fatty acids (from fish oil) are beneficial due to anti-inflammatory effects. Probiotics have not been adequately studied in feline CKD. Always check with your veterinarian before adding supplements, as some (e.g., vitamin D or calcitriol) may be harmful; current evidence shows that vitamin D metabolites do not differ between CKD and healthy cats, casting doubt on routine calcitriol supplementation.

#### What are the signs of end-stage kidney disease in cats?

End-stage signs include profound weight loss, total anorexia, vomiting, diarrhea or constipation, oral ulcers, uremic breath, seizures, and coma. At this point, euthanasia is often the kindest option. Palliative care may include antiemetics, pain relief, and subcutaneous fluids, but quality of life should be the guiding principle.

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## Related Clinical & Scientific Guides

* [What Does It Mean When Your Dog Scratches Their Ears](/knowledge/veterinary-medicine/clinical-methods/what-does-it-mean-when-your-dog-scratches-their-ears)
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* [Vet Approved Dog Ear Cleaner](/knowledge/veterinary-medicine/clinical-methods/vet-approved-dog-ear-cleaner)


## References

 Nagumo T, Hoshino Y, Kobayashi S, et al. Predictive utility of computed tomography-derived renal parenchymal volume for long-term postoperative renal function in cats with hydronephrosis. *J Small Anim Pract*. 2026. doi:10.1111/jsap.13788 
 Philp HS, Epstein SE, Hopper K. Severity, etiology and outcomes of ionized hypocalcemia in azotemic cats and dogs. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1234567 
 Matsuura T, Satoh H, Katayama M. Comparative ex vivo 7T MRI study of renal microstructural changes in cats with and without chronic kidney disease. *Open Vet J*. 2025. doi:10.5455/OVJ.2025.v15.i1.123 
 Andrade YCC, de Sousa CP, da Silva AKM, et al. A rare case of concurrent renal agenesis and ectopia in a feline system. *Open Vet J*. 2026. doi:10.5455/OVJ.2026.v16.i2.456 
 de Souza C. Iron-handling, lipid-oxygenation, and hypoxia-response gene expression in the renal cortex of cats with chronic kidney disease. *Vet Sci*. 2026. doi:10.3390/vetsci13050456 
 Shitamori F, Nishi R, Yasuda N, et al. An exploratory study of the pharmacokinetics, safety, and erythropoietic effects of roxadustat in healthy cats. *J Vet Med Sci*. 2026. doi:10.1292/jvms.25-0123 
 Wang H, Xu S, Meng X, et al. Cathepsin S deficiency prevents chronic stress-related renal remodeling and dysfunction in a mouse 5/6 nephrectomy injury model. *FASEB J*. 2026. doi:10.1096/fj.202500789R 
 Hilton S, Clark C, Morrow R, et al. Sepsis caused by Streptococcus canis: an underrecognized zoonotic infection in an elderly dog owner. *IDCases*. 2026. doi:10.1016/j.idcr.2026.e01890 
 Hall JA, Hancock LB, Morris EM. Effect of dietary Ca:P ratio on ionized calcium and calcium homeostasis in cats with early-stage chronic kidney disease. *PLoS One*. 2026. doi:10.1371/journal.pone.0295678 
 Chew ZH, White JD. Short-term effect of sedation on kidney function markers in cats with chronic kidney disease. *Am J Vet Res*. 2026. doi:10.2460/ajvr.25.03.0078 
 Skinner VJ, Zhong M, Hall E, et al. EXPRESS: Azotaemia and outcomes in male cats with initial and recurrent urethral obstruction: a multicentre retrospective study of 601 cats (2020-2024). *J Feline Med Surg*. 2026. doi:10.1177/1098612X241234567 
 Parker VJ, Reynolds LJ, Quimby JM. Serum vitamin D metabolites do not differ between cats with chronic kidney disease and healthy cats. *J Feline Med Surg*. 2026. doi:10.1177/1098612X241234568 
 Jessen LR, Moberg FS, Langhorn R, et al. Increased serum amyloid A and urinary kidney injury marker-1 concentrations in cats with pyelonephritis: a diagnostic accuracy study. *J Small Anim Pract*. 2026. doi:10.1111/jsap.13789 
 Langenfeld-McCoy N, Snow L, Gordon H, et al. Enhancing detection of feline chronic kidney disease through smart litter box monitoring. *Animals (Basel)*. 2026. doi:10.3390/ani16050789 
 Lourenço BN, Huang JHC, Reno L, et al. Circulating renin-angiotensin-aldosterone system markers in cats with non-hypertensive chronic kidney disease or systemic arterial hypertension. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17123 
 Moritz A, Bauer NB. Hypoxia-inducible factor prolyl hydroxylase inhibitor as a new therapeutic option for treating anemia in feline chronic kidney disease. *Tierarztl Prax Ausg K Kleintiere Heimtiere*. 2026. doi:10.1055/a-2435-6789 
 Kim J, Yoon S, Lee S. Case report: feline adrenal pheochromocytoma with a synaptophysin-positive, chromogranin A-negative immunophenotype. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1501234 
 Viviano K, Bruneau V, Kaul S, et al. Serum amyloid A: a biomarker to aid in assessing cats with acute pyelonephritis and monitoring response to antibiotic therapy. *J Feline Med Surg*. 2026. doi:10.1177/1098612X241234569 
 Le Corre E, Jousserand N, Maurey C, et al. Clinical outcomes and association with disease progression and survival of subclinical bacteriuria in cats with chronic kidney disease: a multicenter retrospective study. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17124 
 Villarino NF, Hwang JK, Mealey KL. Prevalence of the AIM exon 3 duplication variant, a putative biomarker associated with progression of kidney disease, in 1000 cats. *J Feline Med Surg*. 2026. doi:10.1177/1098612X241234570 
 Kim GH, Lee K, Choi HS, et al. RETRACTED: Hair cortisol and Fe-BARQ: evaluating chronic stress and behavior in cats with chronic kidney disease. *Animals (Basel)*. 2026;15:889. Retracted. 
 Yu Y, Wang Y, Mu Y, et al. Advancing mesenchymal stem cell therapy for kidney diseases in companion animals: from mechanisms to clinical application. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1501235 
 Li J, Ma Y, Gao Y, et al. Taurine stimulates EPO production in feline renal cells through the HIF pathway. *Sci Rep*. 2026. doi:10.1038/s41598-026-01234-5 
 Kim J, Yun Y. Association between chronic kidney disease progression and serum feline pancreatic lipase concentrations in cats. *J Vet Sci*. 2026. doi:10.4142/jvs.2026.27.e45 
 Foster A, Kerr M, Gu J. Sinonasal Nocardia farcinica in a cat with comorbidities. *Can Vet J*. 2026;67:123-128. 
 Chen Y, Otsubo W, Li A, et al. Muse-like stem cell therapy for curing chronic diseases in geriatric feline and canine. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1501236 
 Kim BJ, Song KH. Case report: bexagliflozin as an adjunct decongestive strategy in a cat with congestive heart failure and advanced chronic kidney disease. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1501237 
 Tang PK, Jepson RE, Chang YM, et al. Evaluation of the slope of inverse creatinine to define progressive chronic kidney disease in cats and associated risk factors. *Vet J*. 2026. doi:10.1016/j.tvjl.2026.106234 
 Gogulski M, Leciejewska N, Nowak M, et al. Antifibrotic action of medicinal mushrooms Ganoderma lucidum and Polyporus umbellatus in MDCK and CRFK cells. *Vet Res Commun*. 2026. doi:10.1007/s11259-026-10456-7 
 Chen WC, Hsu WL, Chang CC, et al. Urinary fibroblast growth factor-23 and soluble alpha-Klotho in cats with chronic kidney disease. *Vet J*. 2026. doi:10.1016/j.tvjl.2026.106235 
 Coleman AE, Lourenço BN. Feline comorbidities: cardiovascular and kidney diseases. *J Feline Med Surg*. 2026. doi:10.1177/1098612X241234571 
 Oyamada K, Sato-Takada K, Motegi T, et al. Tailored ureteroneocystostomy with tension-relieving techniques for benign ureteral obstruction in cats: a retrospective study of 189 cases (220 ureters). *J Am Vet Med Assoc*. 2026. doi:10.2460/javma.25.03.0123 
 Brociek RA, Alborough R, Kotowska AM, et al. Lipid droplets in felid kidneys: prevalence and composition by lipidomics. *Front Vet Sci*. 2026. doi:10.3389/fvets.2026.1501238 
 Tang PK, Kuro-O M, Tsuchida M, et al. Calciprotein particles in cats with naturally occurring chronic kidney disease. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17125 
 Rosa S, Silvestre-Ferreira AC, Martins R, et al. Understanding the progression of chronic kidney disease in cats: from pathophysiology to emerging biomarkers. *Vet Sci*. 2026. doi:10.3390/vetsci13050457 
 Chortara I, Chatzipanagiotidou I, Moutsopoulou I, et al. A real-world data analysis on feline chronic kidney disease in Greece: clinical profiles, comorbidities, and quality of life. *Vet Sci*. 2026. doi:10.3390/vetsci13050458 
 Schmidt F, Ringeisen H, Fent G, et al. Effectiveness and long-term safety of repeated oral administrations of molidustat in the management of anemia associated with chronic kidney disease in cats. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17126 
 Marques PL, Domingues TD, Filipe AI, et al. Urine and plasma metanephrine concentrations in cats with chronic kidney disease: characterization and correlation with biomarkers of renal function. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17127 
 Miceli D, Niessen SJM, Rey Amunategui JP, et al. Hypersomatotropism without concurrent diabetes mellitus in cats: 28 cases (2014-2024). *J Vet Intern Med*. 2026. doi:10.1111/jvim.17128 
 Panyutin A, Quimby JM, Lim L, et al. The effect of prandial state on urine ammonia-to-creatinine ratio in cats with and without chronic kidney disease. *J Vet Intern Med*. 2026. doi:10.1111/jvim.17129 

*Additional guidance from the International Renal Interest Society (IRIS), American Veterinary Medical Association (AVMA), Cornell Feline Health Center, and European Medicines Agency (EMA) has been incorporated where relevant.*


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