Chronic kidney disease (CKD) is common in dogs and cats and can occur at any age, especially in geriatric animals. The variable presentations of the disease and their different hemodynamic and metabolic alterations are issues of profound research. Currently clinicians progress in the comprehensive management of chronic kidney disease to decrease the progression and clinical symptoms of the disease and now there are numerous novel methods that also were proposed to slow the progression of the disease, with the possibility of use in non-referral center. The objective of this critical approach is to provide an overview of the comprehensive treatment of chronic kidney disease, expose new treatments that could improve the intervention of dogs and cats with chronic kidney disease and reassess the usefulness of some existing drugs.Key words: chronic kidney disease; cardiorenal syndrome; glomerulonephritis; dog; cat KRITIČEN PRISTOP K ALTERNATIVNI OBRAVNAVI KRONIČNE ODPOVEDI LEDVIC PSOV IN MAČK Kronična odpoved ledvic (CKD – iz angl. chronic kidney disease) se pogosto pojavlja pri psih in mačkah katerekoli starosti, pogostejša je pri starih pacientih. Z različnimi oblikami bolezni in njihovimi raznolikimi hemodinamskimi in presnovnimi različicami se ukvarja veliko raziskav. Trenutno izboljšanje celostnega zdravljenja kronične odpovedi ledvic se osredotoča na upočasnitev napredovanja kliničnih simptomov bolezni, obstaja pa vedno več novih metod za ta način zdravljenja v nereferenčnih centrih. Cilj predlaganega kritičnega pristopa je zagotoviti celovito obravnavo kronične odpovedi ledvic ter izpostaviti nove načine zdravljenja, ki bi lahko izboljšali poseganje v zdravje psov in mačk s kronično odpovedjo ledvic in ponovno oceno uporabnosti nekaterih obstoječih zdravil.Klljučne besede: kronična odpoved ledvic; kardiorenalni sindrom; glomerulonefritis; pes; mačka