What is Chronic Kidney Disease (CKD)?
WHAT IS CKD?
Chronic Kidney Disease (CKD) is a common but serious illness in cats and dogs. If left untreated, it will make them feel horribly ill and ultimately cause their death. Learn more from the International Renal Interest Society.
1 in 3 cats will be affected in their lifetime
1 in 10 dogs will be affected in their lifetime
CKD is caused when nephrons, tiny structures in the kidney responsible for filtering waste products out of the blood, are damaged. This damage can be irreversible and progressively gets worse over time. Diagnosing CKD in the later stages of disease means that there may be too much damage to the nephrons, so treatment options are based on helping the pet feel better and trying to prevent more damage to the remaining nephrons.
WHAT ARE THE SIGNS OF CKD?
The early signs of CKD can be subtle and many pets are not diagnosed until they are clearly very ill, at which point up to 75% of their kidney function could be permanently lost. Here are some signs to look out for:
Increased urination (amount and/or frequency)
Increased vomiting or nausea
Poor/dull hair coat
How to use Kidney-Chek
HOW OFTEN SHOULD I USE KIDNEY-CHEK?
We recommend regular screening with Kidney-Chek every 4 months, for any dog or cat over the age of 7.
WHAT IS THE BEST WAY TO WET THE TEST STRIP?
Rub the test pad gently along the gums, the inside of their lips, or inside the cheek in a circular motion for best results.
Check periodically to make sure the pads are completely wet, the pad will turn colour from a bright yellow to a darker yellow when it’s wet (you can briefly remove the test from their mouth to check the colour)
Dogs will typically take between 5 and 10 seconds of exposure, while cats will typically need a longer exposure of 10 to 15 seconds.
Do not let your pet lick or bite the test pad to ensure they don’t damage the test.
Dab off excess saliva with a tissue to prevent oversaturating the pad.
HOW DO I GET MY ANIMAL TO SALIVATE MORE?
Sometimes pets can have a dry mouth. You can tell by looking, or touching a finger to their gums to feel if there is saliva or not. If your pet’s mouth looks or feels dry, try giving them water and test after waiting 5 to 10 minutes.
Try your best not to use treats or food to get your pet to salivate. A stimulated salivary response can adjust the chemistry of the mouth and lead to incorrect test results. If treats or food have been given to your pet, wait 10 minutes prior to using the test.
HOW DO I USE KIDNEY-CHEK IF MY PET DOESN'T LIKE ME TOUCHING THEIR MOUTH?
Some pets do not like having their mouth touched, so start slow and be gentle, and never put yourself at risk if you fear your pet may bite you*.
Start out by petting their head and ears, working down to their chin and cheeks to get them used to you handling their face. Start lifting their lips so you can look at their teeth. It may take a few days, but be patient and when they are comfortable with you touching their face you can open the test strip and let them smell it (just don’t let them bite the test if they think you’re offering a treat!). When you use the test it can be helpful to have another person hold the pet so you can have both hands free to wet the test pad against their gums, in the corner of their mouth, or under their lips.
When you’re done wetting the test pad and have set your timer for 2 minutes, make sure you reward your pet and tell them they did well!
(*if your pet is reacting very badly to having their mouth touched it may be a sign of pain and a veterinarian should be consulted to rule out any medical conditions or dental disease.)
IS THERE ANY HARM IF MY PET SWALLOWS PART OF THE TEST PAD?
There is no toxicity from the test if swallowed, but the test should not be left unattended in your pet’s mouth in order to reduce the chance of the pet swallowing the pad or plastic strip.
How to read Kidney-Chek
THE EDGES AREA DIFFERENT COLOUR. WHICH COLOUR DO I USE TO INTERPRET THE TEST?
Sometimes the edges of the test pads will be a different colour from the majority of the pad. Read the colour from the center of the pad, ignoring dark edges.
WHAT DO I DO IF I CAN'T TELL WHAT THE COLOUR IS?
Take a picture of the test strip 2 minutes after wetting the pad and email the picture to firstname.lastname@example.org. We can help you score the test pad, or we may recommend retesting if the colour is indeterminable.
WHAT DO I TELL MY VET IF THE KIDNEY-CHEK TEST RESULT IS HIGH?
You can tell them that you performed an at-home test that detected urea in the saliva of your pet and you are concerned about their kidney health. You can request an appointment for your pet to receive a physical exam with blood work and urinalysis. It is also important to tell your vet if you notice any changes to your pet’s health (increased thirst or urination, decreased appetite, vomiting, etc), so it may be helpful to write down your concerns before going to your pet’s appointment.
What does Kidney-Chek do?
WHAT DOES KIDNEY-CHEK DETECT?
Kidney-Chek detects urea (measured in millimolar, or mM), a waste product in the body that the kidneys normally filter out. If the kidneys are not working well, urea can build up in the blood and can be detected in saliva. Elevated Blood Urea Nitrogen (BUN) is common in patients with chronic kidney disease (CKD), and when used in combination with other blood and urine tests, veterinarians can diagnose and stage the severity of the disease. Learn more from the International Renal Interest Society.
AT WHAT POINT IN THE PROGRESSION OF CKD WILL MY CAT OR DOG FLAG HIGH WITH KIDNEY-CHEK?
CKD is a complex illness that requires vets to evaluate multiple factors before they can diagnose it. Once CKD is diagnosed and the pet is stable, the vet can determine the stage of the disease from 1 to 4, where 4 is most severe (based on the IRIS guidelines). At stage 2, up to 60-75% of kidney function could be lost. Azotemia is defined as the accumulation of nitrogenous products in the blood which are normally excreted by the kidney (urea is one of those products). Mild azotemia can be found in some pets with stage 2 CKD, and it becomes worse as they progress to stage 3. If the pet is experiencing azotemia at stage 2, Kidney-Chek will be able to detect the elevated urea in the saliva.
IS KIDNEY-CHEK A REPLACEMENT FOR BLOOD WORK?
Kidney-Chek is not a replacement for blood work and urine analysis. Regular wellness exams and lab work is the gold standard of care for our pets. If Kidney-Chek shows high results we recommend a consultation with a veterinarian to discuss further diagnostic testing. High blood urea can also occur with other conditions such as dehydration, gastrointestinal bleeding, or kidney stones. Elevated results on the Kidney-Chek test does not diagnose chronic kidney disease (CKD).
HOW ACCURATE IS KIDNEY-CHEK?
Kidney-Chek™ was studied in 4 veterinary clinics with over 140 animals comparing saliva test results to the gold-standard blood tests and the results were published in a peer-reviewed scientific journal, the Journal of Veterinary Diagnostic Investigation.
Please consult a veterinarian if you suspect your pet is not feeling well, even if Kidney-Chek shows normal results. As with any laboratory test, false positives and false negatives do occur.
Kidney-Chek is an exclusion test, meaning that it is used to exclude the presence of high blood urea nitrogen, a common condition caused by chronic kidney disease. A measure known as the negative predictive value is used as one of the main assessments of accuracy. The negative predictive value states “if the result is negative, what are the chances that this patient does NOT have high blood urea nitrogen (they are truly negative)?” In dogs, a negative predictive value of 93% was found for a score of 2 or less, meaning you can be 93% certain that the animal does not have high blood urea. In cats, a negative predictive value of 95% was found for a score of 3 or less, meaning you can be 95% certain the animal does not have high blood urea.
WHAT IF MY PET ALREADY HAS CHRONIC KIDNEY DISEASE?
Our clinical study did not investigate if Kidney-Chek can be used to monitor pets with previously diagnosed CKD, but we are working with veterinarians to gather that information so we can provide accurate recommendations in the future.
MY PET HAS A HISTORY OF URINARY TRACT INFECTIONS OR CRYSTALS, CAN I STILL USE KIDNEY-CHEK?
Feline Lower Urinary Tract Disease (FLUTD) is the phrase used to describe a variety of conditions that affect the feline bladder and urinary system, and can include stones/crystals, urinary tract infections (UTI’s), and idiopathic cystitis. These conditions are not directly related to CKD, although there may be some overlap. Dogs can also suffer from urinary tract issues like bladder stones and UTI’s, so it’s important to keep them in mind too! Kidney-Chek will not detect crystals or UTI’s, but you can still use it for pets who experience these issues to ensure their kidneys are functioning well!
Bladder Stones/Crystals: Cats and dogs are both at risk of having their urethra physically obstructed/blocked if they have stones or crystals in their bladder, which means urine (and the waste products urine removes from the body) can’t be released. This can cause Acute Kidney Injury (AKI). If your pet is straining or unable to urinate, it is an emergency and they need to be seen by a vet immediately.
Urinary Tract Infections: UTIs are caused by infectious pathogens causing inflammation in the urinary tract. These pathogens can spread to the kidneys if not treated appropriately, leading to inflammation and damage to the kidneys and increasing the risk of developing CKD. Pets with CKD also tend to develop recurring UTIs because their urine is more dilute, which can make the urinary tract more hospitable to certain bacteria. Paying attention to your pet’s “bathroom habits” will let you know when something is wrong, so you can get your pet the help they need right away.
Feline Idiopathic Cystitis (FIC): FIC refers to inflammation of the bladder that is not caused by stones or bacteria. It is not well understood, but reducing the cat’s stress is one of the most important ways to prevent and manage FIC. Stress is also thought to be a risk factor to the development of CKD, and it’s generally just a good thing to decrease the amount of stress our feline friends experience so they can live happy, healthy lives!