The Best Dog Food For Dogs with Kidney Disease

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 Chronic Kidney Disease in Dogs

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 1BUN: <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 2BUN 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 3BUN 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 4BUN >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
DOG FOOD for dogs with kidney disease - Nutritional Management

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.

Phosphorus and Dog Food for Dogs with Kidney Disease
Image from Small Animal Clinical Nutrition page 790

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 MinimumAverage Grocery KibbleKidney Disease Rec.
0.08% DM0.85% DM0.3% 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.

Dog Foods for Dogs with Kidney Disease - Prescription Diets

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.
Just Food For Dogs Renal Recipe:the highest in protein and lowest in phosphorus. Making it a great option for maintaining lean muscle mass while also helping extend lifespan.
Royal Canine Renal Support E: A lower protein moisture-rich option, high in omega 3 fatty acids and calorically dense.
Hill’s k/d line of canned foods are lower in protein, low in phosphorus, and very high in potassium. They also contain special appetite stimulants to keep pets eating for longer, despite the lowered protein content.
Nine and Line Early Renal Recipe, high in protein but still lower in phosphorus and sodium than the typical adult diet.

Chart of Prescription Dog Foods for Dogs with Kidney Disease

DietProtein SourceProteinFatPhosphorusSodiumPotassiumEPA+DHACalories
Hill’s k/d dryChicken, Lamb12.2%
0.4g1.86g1.168g402 kcal/cup
Hill’s k/d cannedBeef, Chicken & Lamb12.7%
0.45g2.01g1.294g422 kcal/can
Royal Canin S dryChicken11%
0.7g0.9g1.5g1.2g365 kcal/cup
Royal Canin A dryRice, Corn, Chicken Fat13%
0.5g0.9g1.6g1.2g352 kcal/cup
Royal Canin F dryChicken12%
0.8g0.9g1.5g1.1g356 kcal/cup
Royal Canin D cannedChicken & Pork15%
0.8g1.2g1.8g0.9g385 kcal/can
Royal Canin E cannedPork & Chicken12%
0.7g0.4g1.3g0.8g385 kcal/can
Royal Canin T cannedPork, Chicken & Salmon14%
0.8g0.5g1.1g0.9g385 kcal/can
Just Food For Dogs Renal, fresh frozenLamb19%
0.65g0.23g1g0.17g40 kcal/oz
Just Food For Dogs Hepatic, fresh frozenCod23%
0.55g0.5g2.01g0.54g28 kcal/oz
Purina NF dryEgg, Liver12.6%
1g0.5g2g1g478 kcal/cup
Purina NF cannedBeef, Chicken13%
0.9g0.4g2.1g0.8g483 kcal/can
Nine & Line Early Renal, fresh frozenChicken18%28%
All values on Percent Calorie Basis and g/1000 kcal for easy comparison.
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 K Plus – low phosphorus Dog Food Multivitamin for Dog’s with Kidney Disease to create balance a homemade dog food recipe.

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.

Dog Foods for Dogs with Kidney Disease - BalanceIT K Recipe

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 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.

Dog Treats for Dogs with Kidney Disease

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.


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


  • 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.

Tips for Dogs with Kidney Disease

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

The Best Dog Food For Dogs with Kidney Disease - Pin Me! 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.

About the Author: Nikki is a Registered Veterinary Technician (Veterinary Nurse) and Dog Mom with over a decade of experience with dogs and cats. Since graduation from college (BS Biology, Dip. Animal Nutrition, AS Animal Science) she has adopted two mixed breed dogs – Ranger and Ash, and has focused her time learning about pet food and nutrition.

Nikki shares information on a range of dog nutrition topics: from how to create a homemade complete and balanced dog food recipes, to how to choose a dog food. Nikki strives to give dog parents the information they need in order to make the best nutrition decisions for their pup!

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18 thoughts on “The Best Dog Food For Dogs with Kidney Disease

  1. This article is a such a valuable resource on the topic of kidney disease and nutrition in dogs. I wish I had found it with my last dog, as this was the exact issue my poor Molly was living with. This article is so complete and leaves out nothing.

  2. I’m glad to see there are so many, especially fresh, food options for dogs with kidney disease. Thankfully, this is a condition I’ve never had to deal with (knock on wood) although it’s for sure a disease that’s on my radar to keep an eye out for.

  3. This is a great in depth resource for dog moms and dads looking to provide the best foods for their fur kids with renal disease. I was shocked to see the similarities in symptoms of kidney disease stages compared to humans. I never owned a dog however my cat (deceased now) did suffer kidney failure towards the end of her life and I remember Royal Canin was one of the food options my vet provided. My cat preferred the fresher food and did better with that option. Thanks for sharing this information. I’m sure it’ll provide a great help to others.

    1. Having a hard time finding a kidney disease food that my dog will eat. She does not care for most of the commercial products trying to find something that is more of a fresh food more like an oatmeal consistency. She does not like the dry dog food or most of the can any suggestions

      1. You could try the Just Food For Dogs Tetra-packed Renal recipe? Or you may want to consider the BalanceIT K Plus with their Homemade recipe. Then you could adjust the consistency a bit more.

      2. Dr. Harvey’s makes Canine Health. I use it with canned KD. My dog with kidney disease loves this combination.

      3. I’m glad your pup is doing well and is controlled with the combination. But I typically don’t recommend the Dr. Harvey’s Canine Health for kidney disease. The main reason for this is, though you can reduce the protein, all the grains and vegetables listed on the ingredients list are high in phosphorus. When we create homemade recipes for kidney disease we actually purposefully do not choose foods like sweet potato, oats or brown rice of this reason. Typically diets for kidney disease are created using white rice because it allows us to use more actual protein in the recipe without going over recommended values on phosphorus. Since we know animal proteins are more digestible than plant proteins and protein is so limited in kidney disease, we really want the protein that is offered to be of highest quality.

        I hope that helps explain my reasoning a bit!

  4. What an excellent and extremely informative post. Thank you! There are a lot of “one health” studies of illness and disease in dogs and humans. Epilepsy (my one Husky was an Epi-dog) and cancer and kidney disease are all issues of study. One day maybe they will find cures for all for humans and our beloved pets. I am sharing on my FiveSibes Facebook page and Pinning this to share. Thank you!

  5. WOW!!! Such great detail information. My cat had kidney disease. She was on an IV every other day. If I remember correctly, she was on Royal Canin as well. It was fun for her. It was horrible to watch.

    With my dog, Henry, I remember my vet talking to my about different issues that are common with small dogs and with his mix of what we think is poodle and cocker spaniel. In the vet’s list of things he rattled off on Henry’s initial visit, I recall him saying the he’d watch him for kidney disease each year. Of course, that made my heart drop. But he gave me the warning signs, which were just as you indicated. So far, so good with my little rescue.

    Excellent information, as always!

  6. I home cook for Layla and mix her food with Dr Harveys Paradigm which gives her a healthy balanced diet for a 14 year old, she has no real health issues at the moment but we will be doing a wellness check up next month to make sure all is good. I monitor her all the time as I do not want any health issues. Great post and eye opener.

  7. I appreciate the comprehensive nature of this post. If a pet has kidney disease then you want to know as much as possible about giving them the best life and, if necessary giving them food that is the most beneficial for them. Many people do not realise that kidney disease does not have different stages.

  8. This is a goldmine of information for people who have dogs with kidney disease! I appreciate all your expertise, especially the last bit about caregivers needing support.

  9. I’m just arriving home from the vet after unexpectedly finding out my buppy baby man is in renal failure. Your blog is divine and I just wanted to applaud your incredibly thorough and clearly credible content, as well as thank you for going as far as to even conclude with your encouragement and email. Thank you, because this is one shitty MFN day and you provided me a tiny silvery glimmer of possibility on a day in which I feel as dark as obsidian.

    1. I’m so happy that you found this blog to be useful. I know how devastating a diagnosis like kidney disease can be, and I’m glad this blog post providing some help and guidance for you during this time. <3

  10. It is also critical to ensure that your dog does not accidentally consume foods that may cause kidney disease. Other pets’ food may need to be fed separately to keep it out of reach.

    1. Yes – I typically see this more with pets that are free-fed. But generally speaking it’s best to not have pets share foods. Foods should be offered, then removed after feeding time.

  11. I appreciate that you provided a comprehensive overview of the importance of controlling phosphorus intake in the nutritional management of dogs with kidney disease. This aspect can either make or break their treatment.

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