Chronic kidney disease (CKD) can feel overwhelming for pet parents. Between lab work, staging, diet changes, and long-term medication plans, it’s normal to feel confused or afraid of “missing something important.” But the right treatments can dramatically improve quality of life — and sometimes even extend the amount of good time you get with your cat or dog.
In Episode 4 of the Mission RENAL series, which stands for Real Education for Navigating Advanced Longevity, veterinary internal medicine specialist Dr. JD Foster provides information on the medications commonly used for chronic kidney disease, and what pet owners should expect as CKD progresses. The discussion includes:
- The medications commonly used to treat hypertension, proteinuria, hyperphosphatemia, and anemia
- How each medication supports kidney function
- How IRIS stages help guide prognosis
- What pet owners should expect as CKD advances
- How to maintain quality of life — even in late-stage disease
Myths and misconceptions about CKD management
This episode will help you understand why each medication matters, how veterinarians decide what to prescribe, and what signs might mean your pet’s disease is advancing.
A Real-Life Example: Treating the Right Problem in Chronic Kidney Disease Changes Everything
Dr. Foster recalls a cat being tested to enroll in a clinical trial for a new CKD therapy. Before starting the study, he found the cat was profoundly anemic.
After correcting the anemia with appropriate therapy, the cat’s quality of life dramatically improved — energy, appetite, even mischievous behaviors like jumping up on countertops returned.
This story highlights an important truth:
Sometimes the most impactful CKD treatments are the tried-and-true ones.
New medications are exciting, but foundational therapies like treating anemia, proteinuria, or high blood pressure can create life-changing improvements for pets.
Blood Pressure in Cats and Dogs with Chronic Kidney Disease: Why Hypertension Matters
Most pet owners are surprised to learn that we can and should measure blood pressure in cats and dogs — especially seniors and pets with kidney disease.
High blood pressure in chronic kidney disease is dangerous because:
- The kidneys regulate blood pressure through hormones.
- When kidneys are damaged, they lose this ability, leading to hypertension.
- High blood pressure then causes further kidney damage.
This speeds up CKD progression.
It’s a vicious cycle.
Normal vs. Concerning Blood Pressure in Pets
- At home: around 120 systolic, similar to humans
At the vet: readings up to 150 systolic can still be normal due to stress
For highly anxious cats, Dr. Foster sometimes recommends in-home blood pressure checks for more accurate readings. Click here to learn more about decreasing stress before your vet visit.
Common Medications for High Blood Pressure
- Amlodipine (especially in cats)
- Telmisartan
- ACE inhibitors like benazepril or enalapril
Most pets require these medications for life. If your pet is difficult to medicate, talk to your vet. Many options exist, such as pills, liquids or sometimes compounded flavored formulations. Veterinary technicians are also a great resource for helping you troubleshoot giving medications to your pet at home.
Managing Urine Protein Loss (Proteinuria) in Pets with Chronic Kidney Disease
Proteinuria means protein is leaking into the urine. This is more than a lab value — it’s a major driver of kidney damage. As protein moves through the kidneys, it causes:
- Oxidative stress
- Inflammation
- Damage to tubules and nephrons
- Faster progression of chronic kidney disease
Veterinarians diagnose proteinuria through a urine protein:creatinine ratio (UPC). Yearly urine testing is essential. Some pets are diagnosed with early CKD only because proteinuria is detected, even when bloodwork looks normal.
Proteinuria is often treated with similar medications used for high blood pressure:
- Telmisartan
- Benazepril
- Enalapril
In many cases, the same medication manages both hypertension and proteinuria, which simplifies the treatment plan. Your veterinarian can determine which treatment plan is right for your pet.
Phosphorus, Kidney Damage & The FGF-23 Breakthrough
As CKD progresses, the kidneys can’t excrete phosphorus effectively. Too much phosphorus:
- Damages kidney cells
- Speeds up CKD progression
- Decreases quality of life
Prescription kidney diets help by reducing phosphorus intake. But many pets still need additional phosphorus control. That’s where phosphate binders can be helpful. If phosphorus remains high, veterinarians add phosphate binders to meals.
FGF-23 is a hormone that helps maintain phosphorus balance. A cat may have normal phosphorus but elevated FGF-23.
This means the body is working overtime to keep phosphorus normal — and this predicts worse survival. Dr. Foster now checks FGF-23 regularly in cats with CKD.
If FGF-23 is high, a phosphate binder may be started early. This proactive approach can protect kidney function before overt elevations in phosphorus develop.
Treating Anemia in Pets with Chronic Kidney Disease: Why It Happens & What Helps
Many CKD pets become anemic as the disease advances. Contrary to popular belief, most CKD-related anemia is NOT caused by iron deficiency.
Anemia occurs because healthy kidneys make erythropoietin (EPO) — a hormone that tells the bone marrow to produce red blood cells.
In CKD, the kidneys cannot produce enough EPO, leading to:
- Fatigue
- Weakness
- Loss of appetite
- Pale gums
Two main treatment options are available for anemia in pets with chronic kidney disease.
1. Oral medications like Varenzin CA-1™ (molidustat oral suspension)
- Encourage the kidneys to make more erythropoietin
- Conditionallly approved for non-regenerative anemia in cats with CKD
2. Synthetic erythropoietin injections
- Used in both dogs and cats
- Mimic natural erythropoietin
Treating anemia can dramatically improve the quality of life of a pet with chronic kidney disease and make them feel so much better!
Understanding IRIS Staging & What It Means for Prognosis of Chronic Kidney Disease in Pets
The International Renal Interest Society (IRIS) created guidelines to help veterinarians stage CKD based on:
- Creatinine
- SDMA
- Presence of proteinuria
- Blood pressure
Dr. Foster, who is a member of the IRIS board, emphasizes that IRIS stages are helpful for treatment targets, but not perfect predictors of survival for individual pets. Prognosis varies because each pet’s path depends on:
- Whether anemia is treated
- Whether hypertension is controlled
- Whether phosphorus is normalized
- Whether proteinuria is reduced
When these factors are addressed, many pets live significantly longer than published averages.
Signs Chronic Kidney Disease May be Progressing
As CKD advances, pet owners may notice:
- Decreased appetite
- Weight loss
- Increased drinking and urination
- Nausea
- Vomiting
- Lethargy
- Bad breath
- Reduced grooming (cats)
- Poor sleep
Veterinarians often adjust medications and lab monitoring as pets move into higher IRIS stages.
Comfort, Quality of Life & Debunking Myths about Chronic Kidney Disease in Dogs and Cats
Many myths circulate online about chronic kidney disease, especially within forums, social media groups, and anecdotal posts. Dr. Foster outlines the real pillars of quality of life:
- Comfort
- Appetite
- Enjoying family and previously loved activities
- Minimal pain
- Emotional connection
There is no single “right time” universal for all pets. Instead, success comes from:
- Monitoring
- Communication with your veterinarian
- Adjusting therapy as needed
- Planning ahead for end-of-life decisions
- Avoiding suffering while maximizing good days
The Emotional Side of Chronic Kidney Disease in Cats and Dogs: Tracking Good & Bad Days
Dr. Foster encourages owners to keep a daily journal
noting:
- Appetite
- Activity
- Sleep
- Enjoyment
- Comfort level
Why this helps:
- Bad days feel more memorable and emotionally intense
- Owners often forget how many good days there actually were
- Trends become clearer
- It provides objective data for difficult decisions
This tool helps families determine:
- When to change medications
- When to adjust treatments
- When quality of life has declined
Specialists for Chronic Kidney Disease in Cats and Dogs
Many family veterinarians diagnose and manage CKD. If you need extra support, a veterinary internal medicine or nephrology service can help with:
- Complicated staging or rapid changes
- High blood pressure, significant protein in urine
- Anemia related to CKD in cats
- Dialysis or advanced therapies (case-by-case)
Thank You To Our Sponsors:
Sponsor Note
This episode is supported by Royal Canin® and Elanco™️ makers of Varenzin™️-CA1 (molidustat oral suspension). The discussion mentions a conditionally approved FDA treatment to control non-regenerative anemia associated with CKD in cats. Talk with your veterinarian to see what’s appropriate for your pet.
Indication
Varenzin-CA1 is indicated for the control of nonregenerative anemia associated with chronic kidney disease (CKD) in cats.
Important Safety Information
Varenzin-CA1 is for oral use in cats only and prescribed only by licensed veterinarians. Keep this drug and used syringes out of reach of children. Wash hands immediately after use. In case of accidentally swallowing, call a doctor immediately. Women who are or may become pregnant should use the product with caution. Do not give to pregnant, nursing or breeding cats. Before using Varenzin-CA1, talk to your veterinarian if your cat is allergic to molidustat, has a history of seizures or thromboembolic disease predisposition. Use with caution in cats younger than 1 year of age. Common side effects include vomiting and high blood pressure. Red blood cell proportion should be monitored. Click here for complete safety information.
PM-US-25-2384
1 thought on “Mission RENAL 4: Medications for Pets with Chronic Kidney Disease”
This is super helpful as I have 3 male cats. One is 14 turning 15 with stage 2 CKD (and I am studying feline health & nutrition). And my car has finally remissioned on stage 2 with having porus one and rotational renal support (as he ages). But my youngest was recently dignosed with high protein leak in his urine and honestly this article is BEYOND words. I will be sharing a lot of this on my social media for more pet parents to know!
Thank you!!!