International kidney society includes SDMA in guidelines

The International Renal Interest Society (IRIS), a veterinary society established to advance the understanding of kidney disease in small animals, has founded an annual meeting called the IRIS Napa Meeting. It will function as a strategic planning initiative to address emerging critical issues in veterinary nephrology and will host authorities on the subject, according to a society release. 

Based on preliminary evidence with a spectrum of novel kidney biomarkers, participants hypothesized that progression of CKD may partially be perpetuated by “active” and ongoing kidney injury that remains undetected until structural losses of nephron mass are reflected by traditional “static” diagnostic markers of kidney function, according to the release. If validated through study, the hypothesis could influence the future diagnosis and management of early kidney disease. 

The complementary role of symmetric dimethylarginine (SDMA), a forthcoming kidney biomarker for the early detection of CKD, to conventional diagnostics for kidney disease and its role in the IRIS CKD staging scheme were discussed at the Napa meeting. After further discussion at the 2015 IRIS board meeting, the following interpretive comments for the diagnostic and therapeutic utilization of SDMA were added into the 2015 IRIS CKD Staging Guidelines, according to the release: 

> Serum or plasma SDMA may be a more sensitive biomarker of renal function compared with creatinine. A persistent elevation in SDMA above 14 µg/dl would indicate reduced renal function and be a reason to categorize a dog or cat (with creatinine values < 1.4 or < 1.6 mg/dl, respectively) as IRIS CKD Stage 1.

> In IRIS CKD Stage 2 patients with low body condition scores, if SDMA is ≥ 25 µg/dl, this may indicate the extent of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 3 for this patient.

>In IRIS CKD Stage 3 patients with low body condition scores, if SDMA is ≥ 45 µg/dl, this may indicate the degree of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 4 for this patient.

While these additions to the guidelines are preliminary, based on early data from the use of SDMA in veterinary patients, the IRIS board expects them to be updated as the profession gains more experience using SDMA alongside creatinine in the diagnosis and monitoring of canine and feline CKD. 

For more information about IRIS and the revised guidelines, which are expected to be available soon, visit iris-kidney.com.