The Pulse Of Veterinary Medicine
Vet-To-Vet Conversation With IDEXX
In July 2015, IDEXX Reference Laboratories began including a new kidney function test, SDMA, on all routine chemistry panels in the U.S. at no additional cost. SDMA enables veterinarians to more reliably diagnose kidney disease in cats and dogs months or even years earlier than traditional methods. As you know, chronic kidney disease (CKD) is common, and 1 in 3 cats1 and 1 in 10 dogs2 will develop some form of kidney disease over their lifetimes.
Recent studies suggest kidney disease is even more common, and until now, it has been under-recognized.3,4 SDMA provides practitioners a tool to help identify kidney disease earlier and in more patients.
As of today, we’re thrilled to say that 6 million pets worldwide have benefited from the SDMA test to date.
The road to SDMA
IDEXX collaborated with many veterinary nephrologists during the development and validation of the IDEXX SDMA™ Test, resulting in publication of 41 peer-reviewed abstracts and articles, some of which are available in the SDMA section of our website.
What is SDMA?
SDMA is a methylated form of the amino acid arginine, which is produced in every cell and released into the body's circulation during protein degradation. SDMA is excreted by the kidneys, making it a good marker for estimating kidney function.
Why is SDMA more reliable than creatinine
Proven to be a more sensitive indicator of kidney function than creatinine, SDMA enables veterinarians to detect acute kidney injury (AKI) and chronic kidney disease (CKD) earlier than ever before.5,6,7,8 In addition, SDMA is not affected by muscle mass like creatinine, making it a more reliable indicator of kidney function in geriatric pets or other poorly muscled animals.9,10
SDMA Protocol: Investigate, Manage, Monitor (IMM)
An increased SDMA should not be ignored, and IDEXX is providing practitioners with tools to help determine next steps when SDMA is increased. SDMA has also been added to the IRIS CKD guidelines to aid with diagnosis and appropriate treatments for the stage of kidney disease.
For patients with an increased SDMA level, we have outlined a three-step IMM plan for investigating, managing, and monitoring probable kidney disease in these patients. Early diagnosis provides the opportunity to take action by doing the following:
- Investigate for an underlying cause of kidney disease, especially more treatable conditions such as infection, obstruction, or exposure to toxins or potentially nephrotoxic drugs, and to look for confounding conditions by assessing hydration status, blood pressure and thyroid status.
- Manage or treat any underlying causes or confounding conditions and implementing practices to avoid future insults to the kidneys; e.g., taking precautions with prescribed drugs and when anesthetizing the pet.
- Monitor the patient as indicated based on treatments initiated for any identified underlying diseases or confounding conditions, and follow IRIS guidelines for staging and treatment if CKD is diagnosed.
And in Q4 2017, the IDEXX SDMA™ test is expected to be available as a slide for Catalyst chemistry analyzers, enabling veterinarians to deliver more reliable kidney function assessments in real time, at the point of care.
1. Lulich JP, Osborne CA, O’Brien TD, Polzin DJ. Feline renal failure: questions, answers, questions. Compend Contin Educ Pract Vet. 1992;14(2):127–153.
2. Brown SA. Renal dysfunction in small animals. The Merck Veterinary Manual website. Updated October 2013. Accessed June 22, 2015.
3. Marino CL, Lascelles BD, Vaden SL, Gruen ME, Marks SL. The prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies. J Feline Med Surg. 2014; 16(6): 465-472.
4. Data on file at IDEXX Laboratories, Inc. Westbrook, Maine USA.
5. Nabity MB, Lees GE, Boggess M, et al. Symmetric dimethylarginine assay validation, stability, and evaluation as a marker for early detection of chronic kidney disease in dogs. J Vet Intern Med. 2015;29(4):1036–1044.
6. Hall JA, Yerramilli M, Obare E, Yerramilli M, Jewell DE. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. J Vet Intern Med. 2014;28(6):1676–1683.
7. Hall JA, Yerramilli M, Obare E, Yerramilli M, Melendez LD, Jewell DE. Relationship between lean body mass and serum renal biomarkers in healthy dogs. J Vet Intern Med. 2015;29(3):808–814.
8. Hall JA, Yerramilli M, Obare E, Yerramilli M, Almes K, Jewell DE. Serum concentrations of symmetric dimethylarginine and creatinine in dogs with naturally occurring chronic kidney disease. J Vet Intern Med. 2016;30(3):794–802.
9. Hall JA, Yerramilli M, Obare E, Yerramilli M, Yu S, Jewell DE. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in healthy geriatric cats fed reduced protein foods enriched with fish oil, L-carnitine, and medium-chain triglycerides. Vet J. 2014;202(3):588–596.
10. Hall JA, Yerramilli M, Obare E, et al. Relationship between lean body mass and serum renal biomarkers in healthy dogs. J Vet Intern Med. 2015;29(3): 808-814.