Feeding A Kidney Failure Grey

[stlgrey]

Hello Everyone,

 

I have a 13.5 year old grey, Sierra who is suffering from heart issues which we have on medications for and she has moderate stage kidney disease. She is under her vet and a specialist for her care. We have tried feeding canned K/D diet from the vet but Sierra won't eat this. I have been home cooking according to a list I found online for kidney dogs. She was started in meds for her heart last week and now her appetite has really become surpressed. I have been adding nutritional flakes to her food so that it will stimulate appetite. I don't want to add to many things to her diet since this could cause diarrhea. I feed her throughout the day as she will tolerate. I am concerned the heart meds are going to make it difficult to keep her interested in her food but we have to have her on them. Any suggestions on feeding would be appreciated.

[4My2Greys]

I've pasted information from the following website you might find helpful and consider discussing with your vet about implenting if you haven't already.

 

http://www.2ndchance.info/kidney.htm

 

What Treatment Options Do I have For My Pet?

 

In the future, we may be able to regenerate failing organs. But for now, there is no known way to mend damaged kidneys. What veterinarians can do is to try to slow the rate at which your pet's kidney tissue is lost and deal with the side effects of the loss. Kidney failure is progressive that means that with time it will get worse. The key to gaining time for your pet is to use the its remaining kidney tissue as efficiently as possible. We try to do this through diet, medications and, when necessary, fluid injections (diuresis).

 

A Special Diet

 

Commercial diets, designed for kidney failure are considerably lower in protein (1/3 - 1/2 the amount) and sodium than ordinary pet foods. They also have added omega 3 and omega 6 fatty acids and compounds like potassium citrate to counteract body "over-acidity" and they are drastically lower in phosphorus.

 

But your pet's health on protein restricted diets needs to be monitored carefully. Blood tests need to be done periodically to be sure that its blood protein levels have not dropped too low and that the pet's body weight remains stable. When you do that, and the pets BUN and Creatinine levels drop or remain stable, protein restriction is a very positive step. But there are periods in a pet's ongoing fight with renal disease when restricting protein might not be a good thing to do. (For example, when 7/8th of its kidney's filtering apparatus has been lost) (ref 1 ) (ref 2)

 

Cats do not tolerate low protein diets as well as dogs. And they do not metabolize added carbohydrates as well. (ref) It may be wiser to depend more on added fat and fiber for dilution of the cat's protein consumption rather than a large amount of added plant carbohydrates. (Higher fat diets can be beneficial to kidneys. (ref)) Ketoacids, as sold through body building outlets, can also act as a substitute for dietary protein in certain instances (ref) (But I know of no veterinarians that use them in dogs and cats).

 

Always make your pet's dietary changes gradually.

 

No matter what you decide to feed, we always want to limit your pet's consumption of phosphorus. The foods naturally highest in phosphorus are the common high-protein foods, meat, poultry, fish, dairy products, peas and beans.

 

Limiting the amount of sodium your pets ingests is also wise when its kidneys are failing -so commercial-prepared kidney diets limit the amount of sodium-rich ingredients in their foods. They also add omega-3 and omega-6 fatty acids that are found in cold-water fish and fish oils combined with flax seed.

 

In advanced kidney disease, when your pet's BUN is over 60 mg/dl, most vets believe that moderately restricting protein in your pet's diet does become important.

 

Vitamin Supplements

 

Pets with kidney problems often have poor appetites, weight loss and anemia. They may suffer digestive disturbances as well that could limit the absorption of vitamins. So B-vitamins are often given as appetite stimulant and to ward off any deficiency.

 

ACE Inhibitor Medications

 

An organ as basic as the kidney does not appear to vary much between mammals. Experiments in kidneys disease are most acceptable to animal welfare advocates these days when they are done in rats. The cells that researches zero in on in declining kidney function are the podocytes , cells in the kidney's filtering apparatus that underlies its blood-cleansing abilities. Once podocytes loss begins, like a tree, bent to a severe angle by a storm - it will continue to slowly fall even after the wind ceases even though the remaining filers "super nephrons" enlarge (hypertrophy) and work harder. There is considerable evidence that medications called ACE inhibitors can slow that loss. (ref) In fact, ACE inhibitors might actually restore or aid in renal (kidney) repair. (ref) The ones most often chosen in pets are benazepril. and enalapril

 

If your pet is placed on an ACE inhibitor, it is wise to be sure that its blood creatinine levels do not increase. In later kidney failure when the remaining kidney filters (glomeruli) are filtering way above their normal capacity, ACE inhibitors occasionally drop the kidney's internal pressure so low that the pet's uremia actually worsens. The best monitoring test in those situations is a 24 hours creatinine clearance test or another test that estimates the pet's GFR.

 

The most common side effect of ACE inhibitors in pets are stomach/intestinal upsets, constipation and weakness do to too low a blood pressure. In those cases, the dose needs to be reduced. Sometimes these side effects can be lessened if you begin these medications at a low dose and gradually increase them to the desired dose.

 

Phosphorus binders

 

Certain compounds called phosphate binders can block the absorption of phosphorus from your cat's foods while it is still within its digestive system. At one time, aluminum hydroxide was suggested. Dieticians now think that more modern products that are free of aluminum are safer. Some common ones are calcium acetate (PhosLo) and sevelamer (Renagel).

 

Calcitriol

 

Since pets with advanced kidney disease may not produce adequate amounts of active vitamin D in their kidneys, the preformed compound, calcitriol, can be given to them. It is generally given when blood calcium/phosphorus levels and ratios become abnormal.

 

Potassium Supplements

 

Potassium supplements (Tumil K, etc.) help when the pets blood potassium level drops too low. This sometimes helps combat the listlessness and weakness that accompanies advanced kidney failure.

 

Erythropoetin Red Blood Cell Growth Factors

 

Sold as Epogen, Betapoietin or Eporel, these compounds encourage your pet to produce red blood cells and so combat anemia. Because these compounds were engineered for humans , dogs and cats eventually cease responding to them. But they often do raise the pets PVC for a time. There is a danger in giving this product. When the pet's immune system decides to attack human erythropoetin as a foreign protein, it not only destroys the human erythropoetin that was given -it also destroys the pets natural erythropoetin. So it can make the anemia even worse. It should only be used as a last ditch effort.

 

Fermentable Fiber

 

Fermentable or soluble fiber, when added to a pets diet, also helps remove toxins from its body. Because of this, it is often an ingredient in commercial diets sold to manage kidney failure in pets. In these diets, the source is sugar beet pulp. It is sold in quantity to stables as a horse feed additive.

 

Fluid Administration

 

There comes a time with all pets when they no longer drink enough water on their own to fully utilize their remaining kidney capacity. Early in this period, you can give your pet additional fluids orally or add additional liquid to its food.

 

When that is no longer sufficient, the fluids needs to be give periodically under the pets skin by injection. The effect is called diuresis. Its effect in flushing out lowering blood toxins from your pet can be dramatic. Many owners learn how to administer these subcutaneous fluids at home. In most cases, there is no benefit in giving them intravenously. Pets with failing kidneys do need emergency intravenous fluids when they are presented severely dehydrated to veterinarians.

[macoduck]

At 13.5 I'd let her eat whatever she will eat.

 

My mutt girl Pudge has had failing kidneys for several years. We monitor her lab results. We gave her the Rx food with a little wet food. Although she may look heavy in her pictures, she is all loose skin and bones. She was miserable. She wouldn't eat. She could not tolerate any fish/omega oils. She's now at the point where even her Enalapril makes her vomit, even with Pepcid.

 

My vet said at this point it's important for her not to lose any more muscle mass.

 

We stopped everything. She now gets regular kibble with a few spoons of canned food (Alpo or Iams). She eats! She plays! We continue to monitor her lab work. It's running steady at the same poor levels as before.

 

While we would love for her to be with us for many more years, they would be very unhappy days for Pudge. We have chosen this different quality of life for her, rather than an overly-medicinal one. Within days of the food change we could see an improvement.

 

If my dog and yours were younger, I'd do whatever my vet told me to maintain good kidney health. At the age mine is now, I just want her to be happy for the time she has left.

[FiveRoooooers]

What Ducky said. Seamus also has beginning-mod stage kidney disease. He is not a dog who enjoys many foods, he is very, very picky and always has been. At 13.7+, he can have whatever he wants, my focus is to try to keep his lumbar stenosis in check and to try to keep him upright.

 

If my dog and yours were younger, I'd do whatever my vet told me to maintain good kidney health. At the age mine is now, I just want her to be happy for the time she has left. This.

[Batmom]

What all is in your homecooked diet?

[4My2Greys]

What Ducky said. Seamus also has beginning-mod stage kidney disease. He is not a dog who enjoys many foods, he is very, very picky and always has been. At 13.7+, he can have whatever he wants, my focus is to try to keep his lumbar stenosis in check and to try to keep him upright.

 

If my dog and yours were younger, I'd do whatever my vet told me to maintain good kidney health. At the age mine is now, I just want her to be happy for the time she has left. This.

I agree with this, however I think a person should first address the cause of inappetance, which is often due to a build up of toxins due to the kidneys failing to filter properly, and what can be done to minimize it such as adding fiber to the diet or starting fluid therapy, which one can learn to do and administer at home. By doing this you are helping the dog to eat, not just because the food is tempting, but because he/she feels better.

[macoduck]

Good point, 4My2Greys. I've had several long talks with my vet and she mentioned toxin build up as well. Since the lab results have been stable, she's given us to OK to continue as we are now.

[Guest goofydog]

I'm sorry your girl is having difficulty.

 

Get Em was just diagnosed with early stage kidney failure last week so I will be following this thread. His vet recommended a lower protein diet so I will be pursuing that to start with. I have also ordered the supplement Azodyl on the recommendation of his vet and several friends. Get Em will be 12 in April.

 

Hugs to your Sierra.

[4My2Greys]

Good point, 4My2Greys. I've had several long talks with my vet and she mentioned toxin build up as well. Since the lab results have been stable, she's given us to OK to continue as we are now.

Ducky, I hope it didn't sound as if I was being judgemental. I really need to take Nadir in for a more current urinalysis and bloodwork. His drinking and urination have increased significantly and I suspect he is in the beginning stages of kidney failure. I hadn't realized the role fiber could play in eliminating toxins when I started adding it to Nadir's food, but I have seen a significant change for the good since I have.

[Guest grey_dreams]

My beloved Zuki had CHF. When we had to start giving him vetmedin and lasix, it really killed his already very low appetite. It was a constant struggle to get him to eat. Some things that would usually tempt him were sardines (canned in spring water, no salt added) and green tripe (fresh is best, otherwise canned). The nutritional yeast flakes helped a bit, but Zuki couldn't tolerate it in regular doses.

 

What medicines is Sierra taking, and what stage heart disease does she have? If her heart is enlarging, that can put pressure on the trachea and lungs and make them not want to eat.

 

Also agree with 4My2Greys about toxin buildup. Zuki couldn't tolerate milk thistle. We didn't try slippery elm. He did tolerate a green superfood powder (Garden of Life Raw Organic), and that helped a lot with antioxidants, keeping the metabolism alkaline (which was very crucial for Zuki), and keeping the toxin levels lower. He also got supplements of Coenzyme Q10, hawthorn, carnitine, taurine.

[stlgrey]

She has serious heart issues, which have gotten worse. She has several leaking values. This week at the vet she was in a serious situation. We got her on meds to maintain. I am aware as the vet has told me that the meds are going to make her kidney disease progress. I have been following the diet for kidney dogs I found on dogaware.com. She has been eating well until we started the heart meds this week. I am going to feed her what she will eat and try to keep the phosphoreus levels low.

 

[galgrey]

I'm so sorry to hear you're facing this. I've lost a dog to CHF and one to Renal Failure. You've gotten good advice from the others. I just want to send good thoughts to both of you during this difficult time.

[GreyPoopon]

I've been through this with 5 elderly dogs in the last year. Each time, we've ditched the low-protein options in favour of "whatever she'll eat." There are a few medical options that can help: sub-q fluids, Mirtazapine (a human anti-depressant that can stimulate appetite in dogs; I haven't had much luck with it but continue with it anyway), and anabolic steroids (stimulate appetite and improve strength). The steroids kept Jessie going for a long time, but we caught her kidney disease early and when she was a bit younger than some of the others.

Edited February 3, 2014 by GreyPoopon

[stlgrey]

Yes, today has been "what ever I can get her to eat". She sees her specialist the week after next. I am going to see what he can give her to stimulate appetite. Tonight it hamburger and rice. I have to watch her for diarrhea.

[Blaidd49]

Low phosphorous may be more important than low protein (which tends to be unpalatable) - check out this web site. http://dogaware.com/health/kidney.html

[GreyPoopon]

I have to watch her for diarrhea.

My kidney dogs have all been prone to diarrhea (except, oddly enough, the IBD dog). We use Tylocine (Tylan). They've also been on Renal Advanced (digestive aid/vitamin for kidney dogs) when I could get them to eat whatever it was on or mixed into.

[Batmom]

If there's protein, there's phosphorus. Not really any such thing as a low-phosphorus protein altho some have a bit more, some a bit less, than others.

 

Whether protein/phos restriction is beneficial depends on the degree of kidney disease. In more advanced disease, it is helpful. Some kidney diets use a little extra fat to help add calories; the fat can lead to some mooshy poop.

[kikibean]

Kerry, I'd get hold of Teresa or Suzanne at Treats Unleashed and see if she can recommend a food for Sierra. Teresa recommended one for Maddy that was easy for her to digest and that she actually liked to eat. Some of the other staff may be able to help you as well, but I know Teresa and Suzanne are great at helping choose foods. Leann may even have some ideas.

[EllenEveBaz]

Dear Scout got the Azodyl supplement his last few months. Independent literature says there's no verified effect on toxins, but either his BUN or creatinine (I forget which) significantly lowered. Although he kept losing weight, he kept on eating well and seemed to be feeling good.

 

I hope Sierra's journey is as gentle as Scout's was, and that you have many amazing moments with her.

[duncan41]

Please don't be distracted by dietary issues. I am sure that Sierra would much rather have you spend quality time with her rather than researching and fretting over diets. Just feed her whatever she will eat - anything - raw, cooked, from mac and cheese to filet mignon. It just doesn't matter at this point. You will cherish the memories of her enjoyment of new foods much more than the time spend agonizing of what to feed her.

 

I did it all. Did it make a difference? I will never know, but I was lucky because mine ate every day. When I knew we were losing the battle, I loosened the reigns and added things to her homemade diet that I knew she loved. It was so worth it.

[Jiffer]

At 13.5, I'd be concentrating on just getting her to eat.

Our angel Atlas developed hypothyroid, kidney disease and eventually congestive heart failure in his last year with us. We realized afterwards that the latter two are actually symptoms of the CHF, but we kept missing it until the condition was more advanced (he also had a grade 3/4 heart murmur all of his life). He continued eating Salmon and Sweet Potato adult food, but I supplemented with Omega Oils, Glucosamine HCL, and a bit of raw food or dehydrated liver broken up to keep him interested. He also had Fortekor daily to address his kidneys and slippery elm (1/4tsp powder mixed in 1/4 cup hot water; given orally before meals). We had an acupuncturist visit him once or twice a month depending on how he was feeling.

 

He did lose some weight, but it was likely due to the organ condition rather than his lack of eating because once we found the magic combination, nothing would keep him from his food. On really bad days, he'd choose eat nothing but dog cookies. I didn't care as long as he was eating and was happy.

[brandimom]

I would highly recommend joining a yahoo group. I think it is K9kidneys yahoo group. You can google them When I thought our dog had kidney disease I found this group. I think they have about 4,000 members and they were a wealth of information. It certainly can not hurt to search them out. I found the moderators very professional and they knew a lot about kidney disease (more than my vet).

[macoduck]

Ducky, I hope it didn't sound as if I was being judgemental. I really need to take Nadir in for a more current urinalysis and bloodwork. His drinking and urination have increased significantly and I suspect he is in the beginning stages of kidney failure. I hadn't realized the role fiber could play in eliminating toxins when I started adding it to Nadir's food, but I have seen a significant change for the good since I have.

No offense taken. This is what I like about GT. Shared experiences can lead to more choices an owner can discuss with their vet.

[stlgrey]

Sierra has two issues going on advanced CHF and kidney disease. My focus is keeping her eating. Each day its something different she may or may not want. I returned the K/D diet to the vet, she won't touch that stuff. She seems to like ProPlan canned Beef and Peas selection. I have also gotten her eat hamburger patties fried up and rice with a bit of Fresh Pet hidden in it. So as most people have replied its about what she will eat and how much I can get her to eat each day. She pounced in the snow today and looked at me and wagged her tail! Those are the things that make me smile.

[Batmom]

Once they get to a certain point of kidney disease (and I don't know where your girl is), it can help them feel better to eat lower protein/phosphorus food. IF they'll eat it. If they won't, better that they eat something than not eat anything.

 

Hope your girl can hold her own and be happy for a long while yet.