Anemia in Canine and Feline Chronic Kidney Disease…..When to Treat?

Chronic kidney disease in dogs and cats often results in anemia or a decrease in the red blood cells (hematocrit or PCV). When the hematocrit drops, the ability of the blood to carry oxygen to the body’s tissues decreases. The signs may be varied from mild to severe. Lack of energy, decreased activity and appetite, reduced social interaction and increase in the progression of the kidney disease may occur. Traditionally it was accepted that a hematocrit of 20% was the starting point for treatment of anemia. The cause of this anemia is not fully understood but likely occurs in part from a decrease in the production of erythropoetin (a chemical produced in the kidney that decreases with disease), functional iron deficiency (the iron may be in the body but is bound and not circulating), increased fragility of red blood cells from uremia and aluminum overload from aluminum based phosphate binders. Treating the anemia may included ESA’s (erythropoetin stimulating agents), Iron supplementation, B vitamins and a new class of drugs known as HIF-PH inhibitors (Molidustat) sold as Varenzin-CA1. Most recently, it has been shown that in patients where the anemia is addressed earlier in the course of disease (hematocrit less than or equal to 25%) survival is increases and quality of life improved. When to use ESA’s, HIF-PH inhibitors, iron and B-vitamin supplementation, phosphate binders, etc. is up to the attending veterinarian. The take home message is clear. Addressing the anemia of Feline Chronic Kidney Disease and Canine Chronic Kidney Disease earlier in the course of the illness is becoming an acceptable standard of care.