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Prescription Diets for Dogs with Kidney Disease

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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).

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).

Comparison of Calories, Protein and Phosphorus in Prescription Kidney Diets
Food
Calories
(as fed)
Protein
(as fed)
Phos
(as fed)
Protein
(dM)
Phos
(dM)
Phos
mg/100 kcal
Early Stage -- Dry
Hill's g/d 358/cup
(3.5 oz)
18.6 g/cup 377 mg/cup 18.7% 0.41% 105
Hill's d/d (average)* 370/cup
(3.5 oz)
16.7 g/cup 509 mg/cup 18.1% 0.56% 136
Iams (formerly Eukanuba) Renal Plus 245/cup
(2.4 oz)
13.5 g/cup 280 mg/cup 20.0% 0.43% 99
Royal Canin Renal MP Modified 320/cup
(2.9 oz)
11.3 g/cup 320 mg/cup 15.5% 0.40% 100
Early Stage -- Canned
Hill's g/d 426/can
(14.75 oz)
20.5 g/can 460 mg/can 18.1% 0.41% 108
Hill's d/d Lamb Formula 492/can
(13 oz)
17.0 g/can 333 mg/can 15.8% 0.31% 68
Hill's d/d (average)* 374/can
(13 oz)
16.7 g/can 592 mg/can 18.4% 0.64% 157
Royal Canine Renal MP Modified 661/can
(13.6 oz)
30.4 g/can 397 mg/can 23.1% 0.40% 60
Early Stage -- Frozen
JustFoodForDogs Balanced Remedy** 497/pgk
(14 oz)
24 g/pkg 405 mg/pkg 21% 0.36% 81
JustFoodForDogs Renal Support Moderate Protein** 651/pkg
(14 oz)
28.6 g/pkg 566 mg/pkg 22.9% 0.48% 87
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
Late Stage -- Dry
Hill's k/d  396/cup
(3.5 oz)
13.1 g/cup 226 mg/cup 14.5% 0.25% 57
Royal Canin Renal LP 271/cup
(2.5 oz)
8.9
g/cup
217 mg/cup 13.9% 0.34% 80
Purina NF 459/cup
(4 oz)
15.05 g/cup 270 mg/cup 15.9% 0.29% 70
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
Late Stage -- Canned
Hill's k/d  496/can
(13 oz)
17.1 g/can 251 mg/can 13.8% 0.20% 45
Royal Canin Renal LP 661/can
(13.6 oz)
24.3 g/can 397 mg/can 16.7% 0.34% 60
Purina NF 533/can
(13.3 oz)
22.1 g/can 300 mg/can 20.4% 0.28% 60
Hi-Tor Neo  539/can
(14.5 oz)
19.7 g/can  411 mg/can 16.4% 0.34% 76
Late Stage -- Frozen
JustFoodForDogs Renal Support Low Protein** 630/pkg
(14 oz)
24 g/pkg 357 mg/pkg 20.1% 0.30% 60
Rayne Clinical Nutrition Low Protein Egg 337/tray (14.1 oz) 10.1 g/tray 204 mg/tray 11.2% 0.23% 61

* Hills Prescription d/d diets are designed for dogs with food allergies, but they are low in both protein and phosphorus, so they can be used for dogs with kidney disease as well.
There are four dry varieties: Rice & Egg, Potato & Venison, Potato & Salmon, and Potato & Duck. Of these, Rice & Egg  is the lowest in phosphorus, with 118 mg phosphorus per 100 kcals, compared to 142 mg phosphorus per 100 kcals for the other three varieties.
There are also four canned varieties: Lamb Formula, Duck Formula, Salmon Formula and Venison Formula. The Lamb Formula is much lower in protein and phosphorus than the other three varieties, and so is shown separately. The average values above are for the Duck, Salmon and Venison Formulas only. Of those, the Venison Formula is the lowest in phosphorus, with 119 mg phosphorus per 100 kcals, compared to 175 mg phosphorus per 100 kcals for the other two varieties.

Dry d/d varieties

Rice & Egg: 3885 kcal/kg (383 kcal/cup)

Protein 13.0% min, 17.0% as fed, 18.5% DM, 4.4 g/100 kcal
Phosphorus 0.20% min, 0.46% as fed, 0.50% DM, 118 mg/100 kcal

Potato & Venison: 3711 kcal/kg (366 kcal/per cup)

Protein 14.0% min, 16.6% as fed, 18.0% DM, 4.5 g/100 kcal
Phosphorus 0.35% min, 0.52% as fed, 0.57% DM, 140 mg/100 kcal

Potato & Salmon: 3710 kcal/kg (366 kcal/per cup)

Protein 14.0% min, 16.6% as fed, 18.0% DM, 4.5 g/100 kcal
Phosphorus 0.35% min, 0.53% as fed, 0.58% DM, 143 mg/100 kcal

Potato & Duck: 3719 kcal/kg (366 kcal/per cup)

Protein 14.0% min, 16.6% as fed, 18.0% DM, 4.5 g/100 kcal
Phosphorus 0.35% min, 0.53% as fed, 0.58% DM, 143 mg/100 kcal

Average Dry: 3756 kcal/kg (370 kcal/cup)

Protein: 13.75% min, 16.7% as fed, 18.125% DM, 4.475 g/100 kcal
Phosphorus: 8.26% min, 0.5125% as fed, 0.5575% DM, 136 mg/100 kcal

Canned d/d varieties

Lamb Formula: 1330 kcal/kg (492 kcal/ 370 g can)

Protein 3.5% min, 4.6% as fed, 15.8% DM, 3.5 g/100 kcal
Phosphorus 0.08% min, 0.09% as fed, 0.31% DM, 68 mg/100 kcal

Duck Formula: 961 kcal/kg (356 kcal/ 370 g can)

Protein 3.0% min, 4.3% as fed, 17.4% DM, 4.5 g/100kcal
Phosphorus 0.10% min, 0.17% as fed, 0.69% DM, 177 mg/100 kcal

Salmon Formula: 979 kcal/kg (362 kcal/ 370 g can)

Protein 3.5% min, 4.6% as fed, 18.9% DM, 4.7 g/100kcal
Phosphorus 0.10% min, 0.17% as fed, 0.70% DM, 174 mg/100 kcal

Venison Formula: 1091 kcal/kg (404 kcal/ 370 g can)

Protein 3.5% min, 4.6% as fed, 18.9% DM, 4.2 g/100 kcal
Phosphorus 0.10% min, 0.13% as fed, 0.53% DM, 119 mg/100kcal

Average canned: 1010 kcal/kg (374 kcal/360 g can)

Protein: 3.3% min, 4.5% as fed, 18.4% DM, 4.5 g/100 kcal
Phosphorus: 0.10% min, 0.16% as fed, 0.64% DM, 157 mg/100 kcal

** 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.

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Sample Combination Recipes

Introduction

Pertinent nutritional information on some prescription diets (per kg):

Nutritional information on selected fresh foods:

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:

Daily needs:

340 grams (12 ounces) 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):

Additional recommended supplements:

Because protein needs are met by these added foods, if more calories are needed, feed more k/d.

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You can contact me if you have any comments, but I regret to say that I can no longer respond to questions about individual dogs. See my Contact page for more information. My name is Mary Straus and you can email me at either or

   


Rocky is a Yorkie-Poodle mix who had suffered from digestive problems his whole life. Click on his image to read about the diet his owner finally found to help him.
Pashoshe Fisher, a Chihuahua, was a wonderful, joyful companion to his owner for 19 & a half years. He was on a high quality raw diet for over half his life.
This is Ella, my Norwich Terrier.
Uremia refers to very high BUN and creatinine causing symptoms such as nausea, vomiting, lack of appetite and lethargy.