Kidney Diets

[feemandvm]

I just got back from a veterinary conference and one of the topics that I attended dealt with treating kidney disease. Anyway... there is a good paper and research published showing that feeding a "kidney diet" will help slow the progression of kidney disease in patients with mild to moderate kidney disease (see below). IMHO it is not the protein restriction in teh foods that are the most beneficial (at least not in early disease unless there is protein loss in the urine) but the restricted phosphorous and the alkalinizing effect of the diet. The specialists actually recommended starting the dogs pretty early b/c we know it helps them as the disease progresses and it is easier to switch them earlier in the disease b/c they have less GI upset and are more open to diet changes. We need more research to show if the kidney diet is truly beneficial in very early stages or if it just makes the transition easier. Anyway... I've not always been a big fan of kidney diets early in kidney disease unless there is protein loss in the urine but now I'd rethink things a bit:

 

Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs

J Am Vet Med Assoc. April 2002;220(8):1163-70.

Frederic Jacob1, David J Polzin, Carl A Osborne, Timothy A Allen, Claudia A Kirk, James D Neaton, Chalermpol Lekcharoensuk, Laurie L Swanson

1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA.

 

Abstract

OBJECTIVE: To determine whether a diet used for dogs with renal failure (renal food [RF]) was superior to an adult maintenance food (MF) in minimizing uremic crises and mortality rate in dogs with spontaneous chronic renal failure. DESIGN: Double-masked, randomized, controlled clinical trial. ANIMALS: 38 dogs with spontaneous chronic renal failure.

PROCEDURE: Dogs were randomly assigned to a group fed adult MF or a group fed RF and evaluated for up to 24 months. The 2 groups were of similar clinical, biochemical, and hematologic status. The effects of diets on uremic crises and mortality rate were compared. Changes in renal function were evaluated by use of serial evaluation of serum creatinine concentrations and reciprocal of serum creatinine concentrations.

RESULTS: Compared with the MF, the RF had a beneficial effect regarding uremic crises and mortality rate in dogs with mild and moderate renal failure. Dogs fed the RF had a slower decline in renal function, compared with dogs fed the MF.

CONCLUSIONS AND CLINICAL RELEVANCE: Dietary modifications are beneficial in minimizing extrarenal manifestations of uremia and mortality rate in dogs with mild and moderate spontaneous chronic renal failure. Results are consistent with the hypothesis that delay in development of uremic crises and associated mortality rate in dogs fed RF was associated, at least in part, with reduction in rate of progression of renal failure.

 

 

 

 

[Trudy]

Anyway... I've not always been a big fan of kidney diets early in kidney disease unless there is protein loss in the urine but now I'd rethink things a bit:

So Bill, what is your take on change of diet without evidence of kidney issues, but loss of protein in the urine?

Ryan's protein level check in Oct was 9.6. Brought in a sample a week or two ago and it is still quite high, but dropped down to 6.? (was 6.something, don't remember and don't have copies of that yet).

Ryan was on Evo when he started having all his issues. I kept asking about changing his food and the vet didn't want to change anything while he was doing so badly and his opinion was protein levels in the kibble wasn't much a concern. I changed him anyway to the new wheat free Nutro for other reasons. He'll eat anything, but he seems to be doing better on the Nutro than he was on the Evo.

[GreyTzu]

Our old 'Tzu, JD, was diagnosed with high BP and early KD in May of last year by an internal specialist. He did not recommend diet change, but put him on two BP meds and Epakitin. JD is doing well.

 

JD turned 14 in Nov. and lost an eye on Arpil of last year. He is our Little One-eyed Wonder Dog.

[StridersSis]

Thanks for the read, Lizzie was put on KD in early kidney disease and I was wondering what the cost of low protein in her urine would be. Looks like its still the correct decision and shes doing great!

[Guest suzye]

I put Jazz on a prescription kidney diet immediately after onset of her symptoms. We started out on prescription food, but home-cooked is better. The prescription foods rely heavily on fat to make up for calories lost in protein reduction (in effort to reduce phosphorus), and they do NOT provide enough protein. At the very least I think people who feed Rx diet shoud supplement their dog's diet with egg whites. Anemia is common. I do not think Jazz would be with me any longer had she remained on either a regular diet (high in phosphorus) or even a Rx renal diet. She would have succumbed to high phosphorus on the regular diet, and probably succumbed to pancreatitis on the Rx diet. Now I even have to cut out hamburger (I was giving 10% fat) now due to her high lipase (ultrasound was OK). Some dogs can handle the fat and that makes it easier.

 

It's a lot of work (and expense), but a home-cooked diet lets you cut down drastically on the phosphorus while giving you the freedom to add more high-quality protein, so they will get as much protein bang for the phosphorus buck, so to speak! Jazz's creatinine continues to climb while her phosphorus is still at a normal level. That's probably partly due to a combination of diet management and subcutaneous fluids. As far as I know Jazz did not leak protein in urine so I cannot comment on that aspect of it.

 

If I ever have a dog in the future whose urine specific gravity starts to slip, I plan to modify their diet immediately. I think that's the earliest sign of kidney disease that you can get, and if you start lowering the phosphorus load immediately, the loner you can keep those kidneys unclogged and functioning their best.

Edited January 26, 2008 by suzye

[feemandvm]

The anemia seen in dogs with kidney disease is NOT due to excessively low protein. The underlying cause is a deficiency of erythorpoetin in most cases. You can also see na anemia of "chronic disease" but this also has nothing to do with the lower protein levels found in most kidney diets. We know that lowering protein is beneficial in moderate/severe kidney failure or when the they have excessive amounts of protein in their urine. I would NOT supplement extra protein... that is something that they have studied and when the kidneys are leaking protein giving the dog more protein simply results in a more rapid progression of the disease. With more routine kidney disease... early on I don't think the protein restriction is beneficial but it is one of the ways they lower the phosphorous b/c it is heavily protein bound. There is no evidence that switching a dog with routine kidney disease (not the urine protein leaking kind) is beneficial... although it would be easy to postulate how it could be. The reasoning for switching earlier in disease is b/c the dogs feel better and might be more apt to accept a diet change. Also, there is hope that although it hasn't been studied the same benefits noted in later disease could exist earlier in disease as well.

 

Home cooking is another option but is expensive and is hard to do well. You would want to contact a nutritionist to make sure you are balancing the diet. There is no evidence to show it is "better" but if it is balanced I can't see how it could be worse.

 

A dropping urine specific gravity could mean anything form early kidney disease to a dog having a big drink of water. Don't take a randomly low specific gravity and over interpret it. Urine that persistently won't concentrate (especially that first one in the AM) would be worrisome for kidney disease.

 

The drop in protein is made up in carbohydrates and fat. There is concern for pancreatitis in "at risk" breeds but in the last 5 years I've had 0 patients develop pancreatitis on the kidney diets. Not saying it cannot happen... just that it isn't common.

 

I would change to a kidney diet if there was excessive protein loss in teh urine documented by an elevated urine protein creatinine ratio (even if the bloodwork was normal). That inherently implies kidney disease no matter if the BUN or creatinine are elevated or not.

 

Did I get to everything?

[Guest BigPercyInMa]

Are Border Collies "at risk" breeds? My MIL's Border Collie was just put on a kidney diet a few months ago (she had a UTI also).

[Guest gretzky]

My 9 1/2 year old female has had a slightly elevated protein creatine ratio that my vet has been monitoring for about 1 year. At 9 months we switched her to Canidae Platinum that has approx. 18.5% protein and phosp. is .7% min. She conitnued monthly urines, all of which were still high but under 1%. At 14 months the test came back with the ratio at 1.2%, despite being on the lower protein/phosp. food for 4 months. My vet said it was time to treat and started her on Vasotec (Enalapril Maleate). First test at 3 weeks on meds had the ratio back down to .2%. She has only been on the meds for a month and a half so that is the only result so far.

 

She is turning her nose up at the Canidae now and I am looking to switch again. Do I still look for a lower protein food or can I look at slightly higher protein as long as the phosp. is still under 1%?

Edited January 26, 2008 by gretzky

[GreyTzu]

I would ask your Vet about adding Epakitin, which is a phosphorus binder to her food.

[feemandvm]

With protein being lost into the urine (glomerulonephritis) you definitely want a lower protein diet!

 

http://www.VeterinaryPartner.com/Content.plx?P=A&A=1352

 

 

 

[greysmom]

Hi, Everyone!

 

This is my first post on this board and I really need some help and advice!

 

One of my (four!) greyhounds has just been diagnosed with kidney failure. We've got her on a home-cooked diet, an acid reducer, and some dietary supplements on the advice of our internist. Her values are extremely high (as in the vet was astounded Libby was still alive).

 

In doing some web research we/ve run across some holistic supplements at caninekidneyhealth.com (by Five Leaf Pet Pharmacy in Canada) that seems like a miracle cure if you can believe the testimonials. We were wondering if anyone has any experience with this program specifically, and homeopathic treatments in general. We're also investigating acupuncture and other non-traditional medicine.

 

Thanks in advance! I'm looking forward to posting here and talking about my greys!

greysmom

[Guest suzye]

The anemia seen in dogs with kidney disease is NOT due to excessively low protein. The underlying cause is a deficiency of erythorpoetin in most cases. You can also see na anemia of "chronic disease" but this also has nothing to do with the lower protein levels found in most kidney diets.

I've heard of regenerative and non-regenerative anemia, but I don't actually know the definitions. Is non-regenerative anemia the one you mention, having to do with erythorpoetin?

The drop in protein is made up in carbohydrates and fat. There is concern for pancreatitis in "at risk" breeds but in the last 5 years I've had 0 patients develop pancreatitis on the kidney diets. Not saying it cannot happen... just that it isn't common.

Jazz's lipase was through the roof the last time we checked -- 3000 (normal range is 200-1800). It was 2400 one week before. Ultrasound a couple days after the 2400 reading ruled out pancreatitis, but I don't want to just sit around and wait for something bad to happen, so I cut out all possible fat from her diet -- the prescription food (used for snacks), fish oil supplements, and all beef. I hope the value will come down in a few weeks. If it doesn't I'm not sure what the significance is, since it obviously wasn't causing pancreatitis at the time. Could she have been headed in that direction? I never checked her lipase before (isn't part of any standard panels we've ever gotten, even the million dollar vet that I quit seeing).

Are Border Collies "at risk" breeds? My MIL's Border Collie was just put on a kidney diet a few months ago (she had a UTI also).

I heard on the kidney forum that schnauzers are an at-risk breed. I don't know about border collies.

"Dogs that are more predisposed to this condition are the following: miniature Schnauzers, Yorkshire and Silky Terriers, miniature poodles and cocker spaniels."

http://www.judithstock.com/Speaking_of_Ani...is_in_dogs.html

Edited January 31, 2008 by suzye

[feemandvm]

Just read the following in a peer reviewed vet journal recently:

 

"Storng evidence suports feeding a diet formulated to address the specific nutritional needs of animals with chronic kidney disease to dogs and cats with serum creatinine concentrations in excess of 2 mg/dl. Dietary therapy in dogs and cats slows porgression of chronic kidney disease and prevents or delays the onset of uremia and premature death due to complications of the disease. Renal diets have been shown to maintain or improve nutrition compared with maintenance diets. Patient and owner acceptance of diets used in these studies was excellent, perhaps in large part because of gradual diet introduction over several weeks. A common misconception is that renal diets are simply low-protein diets. Renal diets encompass a variety of modifications, including limited quantities of phosphorous and salt, enhanced levels of omega-3 polyunsaturated fatty acids, fiber and vitamin D, and a neutral pH effect. Indeed, the principal beneficial effects of these diets may not accrue from their low-protein content. Thus, simply replacing a renal diet with a standard manufactured diet that is lower in protein content is insufficient. Since inapporpriate diets can exacerbate clinical signs of uremia and promote progression of chronic kidney disease, cats and dogs with chronic kidney disease should be fed a renal diet."

 

Obviously the "levels >2.0 should be taken in context when referring to Greyhounds as some Greys can have those levels and have normal kidney function! : )

 

 

[Guest ss556]

Well I hope that Alan's home cooked meals 99% of the time, are still safe for his 2.3 level:)

[GeorgeofNE]

Thank you Dr. Feeman.

 

My old dog has some sort of kidney issue--and because of his age I did not want to spend tons of money getting an exact diagnosis. I switched him to Hill's K/D, and he did MUCH better and was around for two more years (and stopped tinkling in the house!). I'm a believer!

[greyhndz]

Palatability has been a problem with the K/D, for my 11 yo iggy Lexi. Her problem is a bit more complex, though: she was dx'd with immune mediated polyarthritis, the proteinuria was an incidental finding. She had to go onto prednisone for the polyarthritis. Her UPC was up around 9, but serum protein/albumin and phosphorous were normal.

 

After reading the ingredients in the various renal diets, I decided to home-cook, using a recipe provided by one the Angell Memorial nutritionists, as well as diets in Dr. Strombeck's book. Egg or cottage cheese are the best and most digestable proteins, and I tried several variations, with rice or tapioca, honey, etc. She lost interest quickly. Transitioned her slowly over to k/d which she initially ate, but now rejects.

 

Have you found any of the other prepared renal diets to be more palatable? I see Eukanuba, Royal Canin and Purina also make renal diets, and there's another one available without Rx on several websites.

[feemandvm]

Asking which diet is most palatable is sort of like asking which cola tastes best... it really is an individual thing. The nice thing about the Rx diets is that they are risk free... if your dog doesn't eat it you can take it back for a full refund. I'd try any of the diets your vet can order to find one she might like.

 

Home cooking is a very reasonable option and a healthy one... just time consuming. Be sure to work with a nutritionist to form a diet similar in make-up to the prescription foods.