Hannah Zulueta Canine Nutrition / Kidney Disease
The IRIS Stages
Your vet said stage two, or stage three, and the words landed like a sentence. They are not one. Tap your dog’s stage.
Creatinine in mg/dL, read together with SDMA, confirmed on at least two occasions in a stable, hydrated dog. *Stage one needs other kidney evidence.
Stage one
Creatinine still sits under 1.4, but something else points at the kidney: dilute urine, protein in the urine, changes on an ultrasound, or a persistently raised SDMA. The disease found before the classic numbers move, which is the best time to find it.
What the stage asks for: find and address any underlying cause, protect hydration, start watching the trend. Fresh, moisture-rich food does quiet good work here. No dramatic moves, just the beginning of the record you will keep.
Stage two
Creatinine 1.4 to 2.8. Often few or no outward signs, and this stage was widened in the 2023 update, so many dogs live here a long while. Do not read the number as a countdown. Read it as the working stage.
What the stage asks for: phosphorus comes under management now, held to roughly 2.7 to 4.6 mg/dL, through food first and a binder if food cannot hold it. The urine protein and blood pressure substages get checked, because each has its own treatment if it is off. Rechecks find their rhythm.
Stage three
Creatinine 2.9 to 5.0. The disease usually becomes visible from the couch now: more thirst and urination, appetite dips, weight drifting. This is the stage where owners feel it, and where the daily work earns the most.
What the stage asks for: the phosphorus target tightens to under 5.0. Appetite and nausea support enter, because a dog who eats holds every other line. Anemia gets watched. Fluids often enter the conversation. Keeping weight and muscle on becomes a goal in itself.
Stage four
Creatinine above 5.0. The late stage, where the plan reorders itself around comfort, appetite, and the good hours. Plenty of stage four dogs still have real quality of life with close management.
What the stage asks for: phosphorus held under 6.0, nausea managed ahead of time rather than after, fluids as the vet directs, and the bowl built around whatever your dog will happily eat within the boundaries. The compass question changes from slowing the disease to honoring the day.
The one thing
The stage is a treatment map, not a countdown.
The substages owners rarely hear about
Every stage also gets read on two more dials, and two dogs in the same stage with different substages are on different plans.
The honorable mention: potassium
Three questions for every visit
A stage can move the good direction. Hydration, phosphorus control, and a bowl your dog will actually eat can bring a dog staged on a bad week back down a stage on a better one. And the stage tells the vet what to do. It does not tell your dog how to feel today. Plenty of stage three dogs are eating, playing, and warming the same spot in the sun.
Every stage has a bowl that fits it.
Building that bowl for your actual dog, at the stage your dog is actually in, is what I do.
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Hannah Zulueta obtained her Certificate in Canine Nutrition from CASI Institute. She is also studying for her Doctorate in Acupuncture, Traditional Chinese Medicine, and Herbalism from the esteemed Pacific College of Health and Medicine. If you’re as keenly interested in health for yourself, visit her website for human health: Satori Acupuncture and Herbs.
She resides in San Diego with her three dogs, Maggie, Orbit, and Mr. Higgins.
She is available for one on one consultations. She develops evidence-based recipes that meet both NRC and AAFCO nutritional standards while integrating the therapeutic food principles of Traditional Chinese Veterinary Medicine into her formulations.
Additionally, you can find her sharing free content on Instagram.
