Prescription Diets for Dogs with Kidney Disease
See Also:
- Kidney Disease in Dogs
- Tests used to Diagnose Kidney Disease
- Diet for Dogs with Kidney Disease
- Overview of Dietary Goals for Dogs with Kidney Disease
- Is a Low Protein Diet Necessary or Desirable?
- Table of Nutritional Values of selected foods
- Sample Homemade Diet for early to moderate stage kidney disease
- Nattie's Story
- Prescription Renal Diets
- Non-Prescription Commercial Diets
- Supplements
- Medical Treatment for Dogs with Kidney Disease
Disclaimer: I am not a veterinarian, nor do I have any formal training in any medical field. The information presented here is not meant to replace your vet's advice or prescribed medications, but only to suggest additional options to explore, based on your dog's condition.
There are several prescription renal diets available that are not as low in protein as k/d, which is designed for dogs with advanced kidney disease and is not appropriate for dogs with early-stage kidney problems. There are also some senior diets that have low enough phosphorus levels to be used for dogs with early stage kidney disease (see Non-Prescription Commercial Foods).
Another option is to make your dog's food yourself. Balance IT now offers a variety of recipes for dogs with different stages of kidney disease. They require your vet's approval in order to see the actual recipes, but that should be easily obtained. Be sure to request recipes that use their new Balance IT Canine K Plus supplement, which includes no phosphorus (unlike the older Canine-K supplement).
In the table below, use the "dry matter" (DM) percentages for comparing brands, and canned vs. dry. Use the "as fed" values for computing how much you are feeding. In particular, do not use the amount per can or per cup for comparison purposes, as the size of the can/cup varies quite a bit between brands. Remember that low protein is unnecessary and even harmful unless your dog is uremic, but low phosphorus is advisable. Moderate protein reduction may be required if your dog has proteinuria (significant protein in the urine). In general, I think canned food may be preferable to dry, as the extra moisture can help your dog stay hydrated, though you can add water to dry food to accomplish the same purpose.
For comparison purposes, most regular commercial diets have around 1-2% phosphorus on a dry matter basis. A dog with early stage kidney disease should be limited to around 0.6% phosphorus on a dry matter (DM) basis. Another way to figure it is that you want to feed no more than 30 mg phosphorus per pound of your dog's body weight daily if your dog has early stage kidney disease. These numbers must be reduced further for dogs with moderate stage kidney disease: aim for around 0.45% phosphorus DM, or 20 mg/lb of body weight. Dogs with advanced, late-stage kidney disease need even lower phosphorus: around 0.3% DM, or 10 mg/lb of body weight daily.
It has occurred to me that another possible choice for feeding a commercial diet to dogs with kidney problems is to use a diet developed for cats with kidney problems. Because cats require higher protein, these diets will have more protein than the diets developed for dogs with kidney problems, while still reducing phosphorus. The biggest concern is that cat foods are quite high in fat, which could predispose your dog to pancreatitis. Also, for the most part these are still not high quality foods, though Royal Canin is probably better than Hill's and Iams (formerly Eukanuba). See Dry Cat Food and Canned Cat Food for tables listing the amount of protein, phosphorus and other values in various prescription cat diets.
Add water If you feed dry food, it's best to add water to help your dog stay hydrated. Remember that dry food will spoil once water is added, so you shouldn't leave it out all day.
Add fresh foods: Note that when feeding a prescription kidney diet to a dog with early stage kidney disease, you can improve the overall quality of the diet and increase the amount of protein without pushing the amount of phosphorus too high by adding fresh foods such as meats, egg whites (and a limited number of whole eggs), dairy, and other animal-based foods. Use lean meats because prescription diets are already high in fats. Do not add grains or vegetables, since the prescription kidney diets are already high in carbohydrates. Compare the mg of phosphorus per 100 kcals (far right column) in the prescription kidney diets below with some of the fresh foods listed in the Table of Nutritional Values and you'll see that many of these foods have similar or less phosphorus per calorie than the kidney diets do. For dogs with early stage kidney disease, look for foods to add with 150 mg of phosphorus or less per 100 kcals. Be sure to add calcium at the rate of 1/2 tsp ground eggshell (1,000 mg calcium) per pound of added food. See Sample Combination Recipes below for more information.
Do not feed prescription kidney diets to puppies. Prescription kidney diets are too low in calcium and phosphorus to meet the needs of a growing puppy, even one with renal disease. A recent case study found that such a diet caused rickets when fed to a Shetland Sheepdog puppy. Lethargy, decreased long bone growth, angular limb deformity, and osteopenia (decrease in bone density) occurred, but these signs resolved within 3 months with nutritional management. See Nutrition-related Skeletal Deformation in a Puppy for more info. If you have a puppy with juvenile renal disease, I would either feed a homemade diet (see Homemade Diets for Dogs and Sample Homemade Diet for dogs with kidney disease for more information) or add fresh, high-protein foods (see above) if you do feed a prescription kidney diet.
To use the table below, pay most attention to the column in red on the far right, Phosphorus mg per 100 kcals. For dogs with early stage kidney disease, try to find a food (or combination of foods) with 150 mg of phosphorus or less per 100 kcals. The same is true of fresh foods you add to the diet, from the Table of Nutritional Values.
Also pay attention to the next column to the left, Phosphorus (dry matter). For dogs with early stage kidney disease, you would want to feed a diet that is 0.60% or less phosphorus (dry matter). Again, you may be able to combine two different foods, one with higher phosphorus and one with lower, to get them to average out to the numbers you're looking for. You can also add fresh foods to help reduce the overall percentage of phosphorus in the diet (see above).
The prescription diets for late stage kidney disease have anywhere from 45 to 95 mg phosphorus per 100 kcals. Again, check the Table of Nutritional Values for fresh, animal-protein foods with similar amounts of phosphorus (color-coded green and blue) that you can add to the diet without increasing the amount of phosphorus that you are feeding.
Note that dogs with significant proteinuria may need a diet moderately reduced in protein in order to control the amount of protein in the urine, most accurately measured by urine protein:creatinine (UPC) ratio. I have not been able to determine exactly what level requires a dietary adjustment. UPC of 0.5 -0.9 is considered questionable and 1.0 is considered definitely abnormal, but glomerulonephritis is not usually diagnosed unless the UPC is 3.0 or above.
If your dog is uremic, with BUN over 80, creatinine over 4.0, and symptoms such as vomiting, nausea, inappetence and lethargy, you will have to reduce the amount of protein, but not otherwise (as long as there is not significant proteinuria), as protein only affects symptoms, it doesn't harm the kidneys (other than increasing inflammation when protein is being lost in the urine).
A number of prescription diets, including Iams (formerly Eukanuba), Royal Canin, Hill's, Purina and Waltham are available online at RxPetFood.com (prescription from your vet is required, but prices may be lower).
Food | (as fed) |
(as fed) |
(as fed) |
(dM) |
(dM) |
mg/100 kcal |
---|---|---|---|---|---|---|
Blue Buffalo Kidney Support | 427/cup (3.9 oz) 3883/kg |
15.4 g/cup | 275-605 mg/cup | 15.6% | 0.28-0.61% | 64-142 |
Diamond Care Rx Renal Formula | 378/cup |
12.1 g/cup | 187-468 mg/cup | 14.4% | 0.22- 0.56% | 50 - 123 |
Hill's g/d Chicken Flavor | 361/cup (3.5 oz) 3634/kg |
15.4 g/cup | 384 mg/cup | 18.3% | 0.43% | 106 |
Hill's g/d Turkey Flavor | 388/can (13 oz) 1049/kg |
14.8 g/can | 342 mg/can | 18.6% | 0.42% | 88 |
JustFoodForDogs Balanced Remedy* | 493/pgk (14 oz) |
23.9 g/pkg | 404 mg/pkg | 19.8% | 0.33% | 82 |
JustFoodForDogs Renal Support Moderate Protein* | 624/pkg (14 oz) |
26.1 g/pkg | 440 mg/pkg | 22.9% | 0.38% | 74 |
Rayne Clinical Nutrition Moderate Protein Ocean Whitefish | 233/tray (9.3 oz) |
9.3 g/tray |
159 mg/tray |
15.9% | 0.27% | 68 |
Dr. Royal's Integrative KS Formula (raw) | 602/lb (16 oz) |
58 g/lb | 636 mg/lb | 51.0% | 0.56% | 140 |
Hill's k/d with Chicken | 402/cup (3.5 oz) 4050/kg |
13.8 g/cup | 298 mg/cup | 15.5% | 0.33% | 74 |
Hill's k/d with Lamb | 459/cup (4 oz) 4048/kg |
16.3 g/cup | 337 mg/cup
|
16.0% | 0.33% | 73 |
Hill's k/d + Mobility Chicken Flavor | 496/cup (4.3 oz) 4068/kg |
16.8 g/cup | 355 mg/cup | 15.3% | 0.29% | 64 |
Royal Canin Renal Support A ** | 352/cup (3.2 oz) 3872/kg |
10.9-14.5 g/cup |
245 mg/cup | 13.3-17.8% | 0.30% | 70 |
Royal Canin Renal Support F ** | 356/cup (3.3 oz) 3782/kg |
10.8-14.5 g/cup | 377 mg/cup | 12.8-17.2% | 0.44% | 106 |
Royal Canin Renal Support S ** | 365/cup (3.3 oz) 3882/kg |
9.9-13.6 g/cup | 367 mg/cup | 11.7-16.1% | 0.43% | 100 |
Royal Canin Multifunction Renal Support + Hydrolyzed Protein | 385/cup (3.5 oz) 3925/kg |
11.9-15.8 g/cup | 277 mg/cup | 13.3-17.8% | 0.31% | 71 |
Purina NF | 459/cup (4 oz) 3978/kg |
13.8 g/cup | 462 mg/cup | 13.6% | 0.45% | 101 |
Hi-Tor Neo | 484/cup (4.4 oz) |
17.5 g/cup | 462 mg/cup | 15.2% | 0.40% | 95 |
Balance IT NVF Grain Free Pork & Potato | 476/cup (3.9 oz) |
16.5 g/cup | 385 mg/cup | 17.0% | 0.40% | 81 |
Hill's k/d with Chicken | 422/can (13 oz) 1141/kg |
11.1 g/can | 228 mg/can | 16.0% | 0.28% | 54 |
Hill's k/d with Lamb | 421/can |
11.1 g/can | 228 mg/can | 16.2% | 0.28% | 54 |
Hill's k/d Beef & Vegetable Stew | 330/can (12.5 oz) 932/kg | 10.6 g/can | 192 mg/can | 16.0% | 0.27% | 64 |
Hill/s k/d Chicken & Vegetable Stew | 330/can (12.5 oz) 932/kg | 10.6 g/can | 226 mg/can | 16.0% | 0.29% | 68 |
Hill/s k/d + Mobility Chicken & Vegetable Stew | 351/can (12.5 oz) 992/kg | 9.9 g/can | 170 mg/can | 16.0% | 0.32% | 48 |
Royal Canin Renal Support D ** | 352/can (13.5 oz) 913/kg |
9.6 g/can | 501 mg/can | 14.3% | 0.74% | 142 |
Royal Canin Renal Support E ** | 601/can (13.5 oz) 1560/kg |
15.4 g/can | 616 mg/can | 12.5% | 0.50% | 103 |
Royal Canin Renal Support T ** | 596/can (13.5 oz) 1549/kg |
17.3 g/can | 770 mg/can | 14.1% | 0.63% | 129 |
Purina NF | 494/can (13.3 oz) 1310/kg |
9.4 g/can | 189-565 mg/can | 9.6% | 0.65 - 1.97% |
38-115 |
Hi-Tor Neo | 539/can (14.5 oz) |
19.7 g/can | 411 mg/can | 16.4% | 0.34% | 76 |
JustFoodForDogs Renal Support Low Protein** | 583/pkg (14 oz) |
23.7 g/pkg | 357 mg/pkg | 19.7% | 0.30% | 61 |
My Perfect Pet Low Phosphorus Blend | 336/8-oz bar (1360/kg) | 13.6 g per 8-oz bar | 181 mg per 8-oz bar | 21% | 0.27% | 59 |
Rayne Clinical Nutrition Restrict-CKD | 417/can (14.1 oz) 1043/kg | 18.1 g/can | 240 mg/can | 18.5% | 0.23% | 53 |
* JustFoodForDogs also offers JustDoItYourself kits for their Daily Meals (but not their Vet Support Diets), consisting of a recipe and a customized supplement blend, so you can make this food yourself at home. Customized recipes and supplement blends can also be created for a one-time fee of $195. Once created, you have the option of having the company make the food for you, or you can buy the recipe and supplement blend to make the food yourself at home. Note that the Balanced Remedy is extremely low in fat.
** Royal Canin Renal Support Diets are interchangeable. The letters stand for Aromatic, Flavorful, Savory, Delectable, Enticing, and Tasty.
Sample Combination Recipes
Introduction
Pertinent nutritional information on some prescription diets (per kg):
- Hills k/d (dry): 4020 kcal, 132 grams protein, 175 grams fat (43.5 GFK), 2070 mg phosphorus.
Nutritional information on selected fresh foods:
- 1 large egg, hard-boiled:
- 77 calories, 6.3 grams protein, 5.3 grams fat, 86 mg phosphorus
- 100 grams (3.5 ounces) low-fat (1%) cottage cheese:
- 72 calories, 12.4 grams protein, 1 gram fat, 134 mg phosphorus
- 100 grams (3.5 ounces) 90% lean ground beef, pan-broiled:
- 204 calories, 25.2 grams protein, 10.7 grams fat, 216 mg phosphorus
- 100 grams (3.5 ounces) chicken breast, skinless, roasted:
- 165 calories, 31 grams protein, 3.6 grams fat, 228 mg phosphorus
You must add calcium to match the fresh foods. Added calcium should be 2 to 3 times the amount of phosphorus in the fresh foods. Give with meals that include added fresh foods. Note that if you use Centrum Multi (for adults under 50), or other multi-vitamin and mineral supplement (look for those with very little phosphorus), reduce the added calcium by the amount of calcium in the supplement.
You can use any form of plain calcium, or grind eggshells in a clean coffee grinder. 1/2 tsp eggshell powder provides about 1,000 mg calcium.
Calorie needs are only estimates and can vary a great deal between individual dogs. Watch your dog's weight and adjust the amount fed as needed to maintain a healthy body weight.
Example 1:
- Young, active dog weighing 73 pounds, moderate-stage kidney failure, no proteinuria
- Feeding 3/4 Hill's k/d with fresh foods for added protein.
Daily needs:
- 1600-1800 calories
- 73 grams protein daily (more is OK)
- Up to 70-80 grams fat (43.5 grams per 1,000 kcal)
- No more than 1,300 mg phosphorus (40 mg/kg).
340 grams (12 ounces) dry k/d would supply:
1367 calories, 45 grams protein, 60 grams fat, 704 mg phosphorus
Needs an additional:
233-433 calories, 28 grams protein, and no more than 10-20 grams fat and 600 mg phosphorus.
Dog needs lots of protein with limited amounts of fat, so use a combination of eggs, lean meats, and low-fat cottage cheese.
Examples of daily amounts to add (best to rotate between these):
- 1 large egg + 100 grams skinless chicken breast:
- 242 calories, 37.3 grams protein, 8.9 grams fat, 314 mg phosphorus
- 100 grams low-fat cottage cheese + 100 grams lean ground beef:
- 276 calories, 37.6 grams protein, 11.7 grams fat, 350 mg phosphorus
- Add 700 to 900 mg calcium daily
Additional recommended supplements:
- Add fish oil in an amount that provides up to 2,100 mg EPA and DHA combined (300 mg per 10 pounds of body weight). Use concentrated fish oil gelcaps or a liquid (if liquid, make sure it's refrigerated in dark bottles and used up within a couple of months).
- Give vitamin E (not needed if you give Centrum). See Vitamin E for my current recommendations on vitamin E supplementation.
- Give a B-50 complex supplement daily (do this even if you give Centrum).
Because protein needs are met by these added foods, if more calories are needed, feed more k/d.
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