The Best Dog Food For Dogs with Kidney Disease

The most important nutritional considerations for dog food for dogs with kidney disease to extend and improve quality of life are protein content, moisture content, phosphorus, sodium, and omega 3 fatty acids. The goal of choosing the best diet for dogs with kidney disease is alleviate symptoms, and help our dogs live comfortably with this chronic disease.

There are many different diets on the market that may be excellent choices for your pup depending on the severity of the disease. From prescription kibbled and canned foods to premade lightly cooked diets, and even homemade diet options.

What is Kidney Disease?

Kidney disease in dogs can happen one of two ways. The first way is an “acute” onset – this usually occurs due to one sudden event. Some good examples of this is if your dog is gets Leptospirosis or ingests a toxic like Grapes. These conditions if caught quickly enough can be treated and resolve with no lasting damage. Sometimes these dogs are placed on short-term dog foods for kidney disease, but other times they are not.

Nutritional management of kidney disease is most often utilized as part of a long-term management strategy for chronic kidney disease in dogs. Which is also called CKD. Chronic Kidney disease is usually either seen as a progressive age-related condition OR as a genetic conditions. But in some cases a Acute Kidney Disease condition can progress into a Chronic Condition if it is not treated fast enough, or if the condition is severe enough (like if a dog is hit by a car and loses function of one of their kidneys).

Our goal with Kidney Disease in Dogs is to hopefully catch it EARLY through routine bloodwork and physical examinations so that we can both nutritionally and medically manage the condition to extend life and reduce clinical signs.

Clinical Signs of Kidney Disease

The most difficult part about kidney disease in comparison to other diseases and conditions like allergies is that kidney disease is often a “silent” disease. Kidney disease in dogs has been broken down into four main stages of disease depending on severity of diagnostics and steps that we can take medically and nutritionally to help manage the condition. But the first two stages of kidney disease typically show no outward signs of issues.

Usually stage one or two kidney disease in dogs is caught via routine diagnostic testing. Not because a pet was showing signs of being "unwell".

Once we get into stage three to four kidney disease in dogs we start to see signs. The most common are:

• Decreased Eating, “Pickiness” or Not Eating
• Lethargy, Depression or “An’t Doing Right”
• Bad Breath, Inflammation of the Mouth/Gums, Oral Ulcers
• Nausea and/or Vomiting
• Increased Amount of Urine, and/or Increased Frequency of Urination
• Dehydration
• Weight Loss and Poor Body Condition

Diagnosis of Canine Kidney Disease

Diagnosis of kidney disease in dogs usually comes from looking at a combination of laboratory findings. In particular a:

• Full Chemistry Profile
• Complete Blood Cell Count
• Urinalysis
• Urine Protein to Creatinine Level

Your veterinarian may do one or all of these diagnostics in order to confirm a diagnosis of kidney disease. And in some cases they may even recommend further diagnostics such as an ultrasound, x-rays, or urine culture.

But some of the key values they will look at come from the blood chemistry and urinalysis. In particular the CRE (creatine), BUN (blood urea nitrogen), SDMA, urine protein, and urine concentration. These parameters can help veterinarians not only diagnose but classify the stage of kidney disease that your dog is currently in.

Stages of Kidney Disease

There are four different stages to kidney disease in dogs. Each stage has been defined due to years of research looking at different ways to improve the quality of life of dogs with kidney disease. When we look to choose dog food for dogs with kidney disease our goal is to: 1) meet our dog’s overall nutritional needs, 2) alleviate clinical signs, 3) improve quality of life, and 4) slow the progression of the disease.

STAGE	DIAGNOSTIC VALUES	NUTRITION	OTHER
Stage 1	BUN: <125 Mmol/l CRE: <1.4 mg/dl SDMA: <18	+ omega 3 fatty acids + antioxidants + fermentable fiber +/- sodium restriction +/- reduced phosphorus +/- reduced protein	– increased monitoring schedule 1-3 months +/- discontinue meds processed by kidneys + check for other disease/conditions
Stage 2	BUN 125-250 µmol/l CRE 1.4-2.8 mg/dl SDMA 18-35 *DECREASED urine concentration	all the above plus + reduced phosphorus +/- reduced protein	all the above +/- phosphorus binders
Stage 3	BUN 251-440 µmol/l CRE 2.9-5.0 mg/dl SDMA 36-54 *DECREASED urine concentration	all the above plus + reduced protein consider moisture rich diet	all the above plus +/- control vomiting/nausea +/- help with metabolic acidosis +/- help with anemia +/- control dehydration
Stage 4	BUN >440 µmol/l CRE >5.0 mg/dl SDMA >54 *DECREASED urine concentration	all the above plus creative diet rotation/topping to keep eating	all the above plus +/- dialysis +/- kidney transplant +/- feeding tube

Nutritional Management of Dogs with Kidney Disease

Protein in Dog Food for Dogs with Kidney Disease

The amount of protein that is ideal for dogs with kidney disease is almost like a “goldilocks” situation. We want enough protein to allow for maintenance of body and muscle mass. Along with enough to encourage dogs to eat readily to maintain their strength. But we don’t want too much where we over-burden the kidneys with byproducts from protein breakdown.

Generally speaking specialists agree that protein should be adequate but not excessive. Likely in the lower range of normal for the earlier stages of kidney disease (IRIS stage 1) 65-80g / 1000kcal. Then gradually reduced depending on concurrent factors – such as protein in the urine, elevated CRE/BUN/SDMA.

We have limited research which suggests that lowering protein after stage 2 may extend lifespan by up to a year in comparison to keeping dogs on a regular adult maintenance diet. But more research associated with lowing both protein and phosphorus.

Phosphorus in Dog Food for Dogs with Kidney Disease

While early research concerning dogs with kidney disease focused heavily on reducing protein intake… Later research actually found that more significant benefits to survival time can be found by reducing phosphorus within the dog food for dogs with kidney disease.

A series of research studies published in 1992 (1,2) found that no significant influence of survival time in relation to protein content of foods (16% vs 32% Dry Matter). This research instead found that phosphorus reduction was more important than protein reduction within diets (0.4% vs. 1.4% phosphorus), and had a more significant effect on survival time.

Fat in Dog Food for Dogs with Kidney Disease

According to research omega 3 fatty acids – in particular EFA and DHA have powerful anti-inflammatory properties. These properties help to reduce oxidative stress and slow down the progression of kidney disease. Research suggests a dose of 40mg/kg EPA and 25mg/kg DHA, and highly recommends NOT using ALA since the conversion rates are poor. It is also suggested that the ideal omega 6 to omega 3 ratio is around 5:1 for kidney disease.

Sodium & Potassium in Dog Food for Dogs with Kidney Disease

Sodium and Potassium are two additional factors that should be considered when choosing a dog food for dogs with kidney disease.

Sodium content for dogs with kidney disease is ideally not too low or high. Higher amounts of sodium is typically recommended to avoid in order to help control blood pressure, and to help reduce edema (fluid retention) due to impaired kidney function. We don’t want too low of sodium either – according to the authors of Small Animal Clinical Nutrition “excessive dietary sodium intake may increase the absorptive workload on surviving nephrons”. In other words – too little sodium can damage the kidneys.

Overall the role of sodium in diets for dogs with kidney disease is still being investigated – and current recommendations fall below the “average” sodium content of grocery store brands, but still well above NRC minimums.

NRC Sodium Minimum	Average Grocery Kibble	Kidney Disease Rec.
0.08% DM	0.85% DM	0.3% DM

Another minerals we need to consider is Potassium. Though more common in cats – hypokalemia or low potassium can occur in pets with kidney disease. In order to offset this issue many diets for dogs with kidney disease will contain higher amounts of potassium to offset this potential issue.

Carbohydrates in Dog Food for Dogs with Kidney Disease

A new solution found to help with kidney disease in recent years has been the addition of fermentable fiber! Fermentable fiber basically allows the the gut (instead of the kidneys) to break down nitrogen waste products (protein!). This can greatly reduce the “work” that the kidneys need to do, and can extend dog’s lives that have kidney disease.

Hydration and Moisture in Dog Food for Dogs with Kidney Disease

Often times with kidney disease dogs will loose fluids faster than the typical dog. This means that they are prone to dehydration – in order to combat this switching to a higher moisture diet can be advisable if possible. This usually means switching from a kibbled diet to a canned or fresh food diet – but it can also be as simple as adding in water to the kibbled diet that the pet is already eating.

Prescription Dog Food for Dogs with Kidney Disease

When we consider diet choice for dogs with kidney disease we look at several key nutritional factors: protein content, phosphorus, sodium, potassium, and omega 3s. Diets for dogs kidney disease tend to be lower in protein, lower in phosphorus, lower in sodium, and higher in potassium than the typical adult maintainence diet.

• Depending on the stage of kidney disease, and concurrent factors like protein lost in the urine, low potassium, high blood pressure, etc your veterinarian may advise one prescription diet over another.
• For beginning stages of kidney disease, choosing a higher protein (prescription) diet with high moisture and lower phosphorus may be advised in order to keep your pup eating, and maintain muscle mass.
• As clinical signs progress your veterinarian may opt for lower protein diets to help with eliminating a buildup of waste products associated with breaking down protein. Lowered sodium, along with increased potassium may also be advised in order to help with electrolyte imbalances and blood pressure. Additional omega 3s may also be advised to help with inflammation.
• Dogs with kidney disease may become picky due to nausea associated with the disease. Rotation of various “flavors” and textures may be advised in order to keep your pup eating consistently. Appetite stimulants may also be added to help your pup eat more consistently.

Obviously cost will also need to be considered, and though moisture rich diets may help with maintaining hydration status, they can be more expensive. Thus adding moisture to dry foods or sub-Q fluids may be advised.

Chart of Prescription Dog Foods for Dogs with Kidney Disease

Diet	Protein Source	Protein	Fat	Phosphorus	Sodium	Potassium	EPA+DHA	Calories
Hill’s k/d dry	Chicken, Lamb	12.2% 35g	43.9% 51g	0.32% 0.73g	0.4g	1.86g	1.168g	402 kcal/cup
Hill’s k/d canned	Beef, Chicken & Lamb	12.7% 36g	50% 58g	0.28% 0.62g	0.45g	2.01g	1.294g	422 kcal/can
Royal Canin S dry	Chicken	11% 31g	40% 44.6g	0.7g	0.9g	1.5g	1.2g	365 kcal/cup
Royal Canin A dry	Rice, Corn, Chicken Fat	13% 34.9g	39% 44.9g	0.5g	0.9g	1.6g	1.2g	352 kcal/cup
Royal Canin F dry	Chicken	12% 34.2g	36% 40.5g	0.8g	0.9g	1.5g	1.1g	356 kcal/cup
Royal Canin D canned	Chicken & Pork	15% 41.5g	56% 62.2g	0.8g	1.2g	1.8g	0.9g	385 kcal/can
Royal Canin E canned	Pork & Chicken	12% 32.8g	14% 53.7g	0.7g	0.4g	1.3g	0.8g	385 kcal/can
Royal Canin T canned	Pork, Chicken & Salmon	14% 36.2g	49% 54.2g	0.8g	0.5g	1.1g	0.9g	385 kcal/can
Just Food For Dogs Renal, fresh frozen	Lamb	19% 43g	37% 37g	0.65g	0.23g	1g	0.17g	40 kcal/oz
Just Food For Dogs Hepatic, fresh frozen	Cod	23% 49g	11% 10g	0.55g	0.5g	2.01g	0.54g	28 kcal/oz
Purina NF dry	Egg, Liver	12.6% 34g	32% 34g	1g	0.5g	2g	1g	478 kcal/cup
Purina NF canned	Beef, Chicken	13% 41.6g	45% 50.7g	0.9g	0.4g	2.1g	0.8g	483 kcal/can
Nine & Line Early Renal, fresh frozen	Chicken	18%	28%	–	–	–	–	–

Concurrent medical factors such as allergies or other conditions like urinary disease, pancreatitis, or even cancer may guide veterinarians to choosing alternative diets such as hydrolyzed protein, or even customized homemade diets.

Homemade Dog Food for Dog with Kidney Disease

For dogs with kidney disease using a homemade recipe can be helpful for dogs who have become increasingly picky due to the disease process. Homemade, warmed foods tend to be more palatable than dried diets, and can be customized in flavor preferences according to what your dog currently prefers.

Often dogs with kidney disease will associate the nausea of their condition with particular foods and tastes, and then avoid them in the future This can make feeding times extremely challenging. And as most proteins we typically use to “top” foods to stimulate our dogs to eat are not “ideal” for dogs with kidney disease. Keeping a pet eating the prescribed kidney diet – low in phosphorus – can be difficult.

A home-prepared diet that allows for flexible rotation of proteins and ingredients can be a great option in order to keep our pups eating and maintaining their body condition and health for longer.

Where to Find a Dog Food Recipe for Dog with Kidney Disease

There are several places that you can go to get a dog food recipe for dogs with kidney disease. The first is by speaking with a board-certified veterinary nutritionist directly, the second is by working with your veterinarian to get approval for a pre-made dog food recipe using the BalanceIT K supplement. Another way to get a homemade dog food recipe for kidney disease is by a board-certified veterinary nutritionist.

BalanceIT Premade Renal Disease Dog Food Recipes

BalanceIT was a formulation software and supplement created by a board-certified veterinary nutritionist to allow to ease of access to homemade dog food recipes. Though the main formulation software allows anyone to create recipes for healthy dogs, they also have prescription recipes for different diseases and conditions. Including kidney disease!

To access these recipes head over to BalanceIT and under “Homemade Food” click on the “EZ Recipe Generator for Vet Patients”. From there you will be prompted to choose from many different diseases and conditions. You will want to select “Kidney Disease” – and I would suggest clicking on both “Lowest Phosphorus Recipes On Site For Kidney Disease Using Heatable Canine K Plus” OR “Early Kidney – Lower Phosphorus Using Heatable Canine K Plus”.

This will populate several recipe for you. I would suggest clicking on the green button that says “see full list” as this will allow you to see all the main ingredients in the recipes.

Then click on the recipe, and “edit” the recipe for your dog’s ideal weight. Then click “rerun”. This will recalculate the recipe for your dog’s weight. Finally when you click “view” you will be prompted to create an account and submit a prescription request for your vet.

Your vet will then receive a prescription request for approval.

Board-Certified Veterinary Nutritionist (ACVN Diplomat)

If you have a dog who has a very complicated medical history with multiple concurrent medical conditions like IBD, allergies, pancreatitis, or urinary stones it may be a good idea to contact a board-certified veterinary nutritionist to create a custom recipe for your dog. You can find a board-certified veterinary nutritionist at the ACVN.org directory. Currently there are only 20 boarded nutrition veterinary specialists that offer remote client consults.

Just Food For Dogs Custom Diet

For those who need a custom fresh food diet but would prefer not to cook the Just Food For Dogs Custom Diet Service may be an excellent option. Just Food For Dogs has over 11 veterinarians on staff including a board-certified veterinary nutritionist. They can not only create a custom diet for your pup – but cook that diet and ship it directly to your door. This may be a great option for dogs who have multiple concurrent conditions, or those who would like to feed a fresh food diet – but don’t have the time to cook.

Safe Treats for Dogs with Kidney Disease

The most important thing to remember when you are giving treats to your pup with kidney disease is – you want to enhance, but not hinder your pup. If in doubt – always touch base with your vet prior to adding in a new treat to your pup’s diet. And if you notice your pup is “going off” food, speak to your vet first before adding toppers.

It is not uncommon for dogs with kidney disease to become “picky” . Typically how this happens is dogs will become dehydrated due to excessive urination. This dehydration then makes the pet nauseous. In some situations the nausea will then be associated with the food and the dog will no longer be interested in eating the original diet.

If you notice your pup is going off their regular diet, always speak to your vet so they can check hydration status and/or run additional bloodwork to check for low potassium along with kidney values. Often these tests can be run in-house, and your vet can adjust your pup's medical plan depending on results.

Fresh Dog Food for Dogs with Kidney Disease

Typically when we choose treats for dogs with kidney disease we want to avoid foods high in protein, phosphorus and salt. These are typically foods like meats, milk/cheese, eggs, beans/legumes, salted lunchmeat, and nuts/seeds. Most fruits and vegetables are great options as treats for dogs with kidney disease. And using fats such as coconut oil or sweeteners such as honey to coat medications or foods to stimulate eating may be excellent options.

1. Keep All Treats to 10% of daily caloric needs
2. Avoid meats, proteins, rawhide, nuts/seeds and other animal products
3. Avoid treats with added salt such salted lunchmeat, chips, or salted dried veggies.

Vegetables:

• Cucumber
• Celery
• Cauliflower
• Bell Pepper
• Zucchini
• Mushrooms (button, portobello, turkey tail, or lions mane)
• Baby Carrots
• Broccoli

Fruits:

• Blueberries
• Strawberries
• Cherries
• Cranberries
• Raspberries
• Blackberries
• Apples (with skin)
• Watermelon
• Cantalope
• Honeydew

Simple Frozen Treat Recipe

• 1 cup watermelon or honeydew
• 1 cup cucumber
• 1/2 cup parsley
• 1/2 cup water
• 1/2 tsp honey

Blend together and freeze into pupsicles or ice-cubes for at least 4 hours prior to serving. This recipe is a total of 72 calories.

Monitoring and Transitioning to a New Routine

The biggest tip I can give those pet parents who have a dog that was recently diagnosed with kidney disease is to: be proactive, learn how to do at home monitoring, slowly transition to the new diet, and final a support network.

Be Proactive.

Many people get overwhelmed with a diagnosis of kidney disease and get information overload. Thus causes them to freeze instead of act. Nutritional management is one of the largest parts of the management plan for chronic kidney disease in dogs.

Get comfortable with at home monitoring.

I’d highly recommend speaking with your vet about how to do a muscle conditioning score, body condition score, and check hydration status at home. Along with monitoring the “ins and outs” – aka eating/drinking and urination/defecation – these are very helpful, and can help us with more proactive management strategies.

Go slow when you transition to your kidney diet

As these diets are often significantly different composition to your dog’s previous diet their body will need to adjust. Too quick of a transition can sometimes lead to side effects – from refusing to eat to fluid buildup. Once on a kidney diet transitions between “flavors” should be relatively easy as all the prescriptive recipes have similar compositions.

Find yourself a support network.

Being a caretaker is HARD. If you need help reach out to friends, family, and other pet parents. Find an online support group, and if your are able – reach out for additional professional help. Registered Veterinary Technicians can do at home nursing care under the direction of a veterinarian. House Call Veterinarians can ease vet visits, and come to you rather than having to make the trek to the vet office. Telemedicine has expanded so that you can speak to a vet almost anytime.

Overall I hope this information helps you and your pup on their journey through life. <3

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