New iCatCare guidelines update feline chronic kidney disease care

Chronic kidney disease (CKD) is among the most common diseases in older cats, with a reported prevalence of 28% to 81% in cats older than 12 years.¹ International Cat Care (iCatCare) has released 2026 consensus guidelines on diagnosing and managing CKD in cats, updating the 2016 International Society of Feline Medicine guidelines. Published in the Journal of Feline Medicine and Surgery, the guidelines were developed by a 10-member international panel of researchers chaired by Samantha Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, FRCVS, iCatCare veterinary specialist consultant.¹

"We're delighted to support the global veterinary profession with this much-needed update. In the ten years since the last guidelines were published, knowledge has increased rapidly in feline nephrology, and our new guidelines bring together the latest expert information on diagnosis, preventing progression of the condition, and practical management of complications such as nausea, hypercalcemia, hypertension and proteinuria,” Taylor stated.

“They also emphasize the importance of supporting those caring for cats with CKD, with practical advice on helping caregivers manage medication, diet changes and veterinary clinic appointments. There are also new sections in the guidelines on understanding and optimizing mental wellbeing as an important part of caring for senior cats, including those with CKD," she continued.

Screening and diagnosis

The researchers recommends screening cats 7 years and older, with annual examinations for cats aged 7 to 10 years and twice-yearly examinations for cats older than 10 years. Screening should include body weight, blood work (creatinine, symmetric dimethylarginine [SDMA], phosphate, calcium, and hematocrit), urinalysis with urine specific gravity (USG) and urine protein-to-creatinine ratio (UPC), and blood pressure measurement.¹

Reduced urine-concentrating ability (USG <1.035) is one of the earliest signs of declining kidney function. The guidelines note a proposed higher SDMA threshold of 18 µg/dL or greater for older cats, compared with the standard cutoff of more than 14 µg/dL. Cats are staged and substaged using the International Renal Interest Society (IRIS) system.¹

Slowing progression

According to the researchers, strong evidence shows a veterinary therapeutic renal diet can prolong survival and reduce the risk of uremic crises. Even a diet that is at least 50% renal diet may benefit survival. If dietary restriction alone does not bring serum phosphate to the IRIS target within 4 to 6 weeks, phosphate binders mixed into every meal are recommended.¹

Serial monitoring of creatinine, phosphate, and body weight during the first 3 months after diagnosis can help distinguish progressive from stable disease. That distinction matters: more than 60% of cats with progressive CKD die within 365 days of diagnosis.¹

Managing complications

For nausea and inappetence, the guidelines advise first addressing contributing factors such as dehydration, constipation, hypokalemia, acidosis, and anemia. Options include maropitant, mirtazapine, and capromorelin, though capromorelin is not recommended for hemodynamically compromised patients.¹

Hypercalcemia affects approximately 20% of azotemic cats at diagnosis, and phosphate-restricted diets can induce ionized hypercalcemia in some cats. The researchers recommends measuring ionized calcium rather than total calcium and considering a diet with 200 mg calcium/100 kcal or less and a calcium-to-phosphorus ratio below 1.4:1.¹

The UPC is an independent predictor of progression in the first 12 months after diagnosis. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are indicated for proteinuric cats (UPC >0.4) and should be considered for borderline proteinuric cats. Hypertensive cats with evidence of target organ damage warrant immediate treatment.¹

Supporting caregivers and wellbeing

The guidelines recognize caregiver burden, noting that multiple medications are common in cats with CKD. The researchers encourages involving caregivers in home monitoring, such as tracking body weight, keeping a diary, and taking a team-based approach that includes veterinary technicians. New sections address optimizing the home and clinic environment and supporting mental wellbeing in senior cats.¹

The open-access guidelines are accompanied by free companion guides for veterinary technicians and caregivers.

Reference

1. Taylor S, Finch N, Caney S, et al. 2026 iCatCare consensus guidelines on the diagnosis and management of chronic kidney disease in cats. J Feline Med Surg. 2026;28(9). doi:10.1177/1098612X261466553
2. iCatCare launch brand-new chronic kidney disease veterinary guidelines. News release. International Cat Care; September 4, 2026. Accessed September 11, 2026. https://icatcare.org/news/icatcare-launch-brand-new-chronic-kidney-disease-veterinary-guidelines