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Diet 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.

Overview of Dietary Goals for Dogs with Kidney Disease

Based on research done in the last ten years (see is a Low Protein Diet Necessary or Desirable?), that the only time it is necessary to feed a low protein diet is when your dog is uremic, which generally means BUN is over 80 mg/dL (equivalent to 28.6 mmol/L), creatinine is over 4.0 mg/dL (equivalent to 354 µmol/L), and the dog is showing symptoms such as vomiting, nausea,inappetence, ulcers and lethargy, which are caused by the build-up of nitrogen in the blood. Even then, feeding low protein will not extend life, but it will help the dog feel better. Subcutaneous fluids can also help at this time (and before).

If your dog has significant amounts of protein in the urine (urine protein:creatinine ratio above 1.0), then you may need to reduce protein moderately, enough to control the proteinuria, but a really low-protein diet is not considered beneficial, as it can lead to hypoalbuminemia (low albumin levels). It's best to feed at least 1 gram of protein per pound of body weight daily (the grams of protein must be calculated from a nutritional analysis, it is NOT the same as grams of meat).

If your dog is not uremic, then the consensus seems to be to feed a moderate amount of very high quality protein. Eggs have the highest quality protein (although egg yolks are high in phosphorus), followed by meat (raw or cooked). The lowest quality protein comes from grains.

The site at http://www.vetinfo4dogs.com/dogdiet.html says "High quality proteins are ones that closely match the proper mix of amino acids the body needs. Ideally, there would be exactly the right number of every amino acid and no excess of protein material, making both the liver and the kidneys happy. In general, animal source proteins, such as meat, milk and eggs are higher quality than plant source proteins. This is because the animal that produced these items already made the proper proteins and so they are already in the proper mix. That is why cottage cheese is  considered to be a higher quality protein source then soy, for instance." Note that some amino acids, such as taurine, are sensitive to heat, which is one of the reasons why raw meat is considered higher quality than cooked meat.

When developing a diet for your dog with kidney failure, the goal is to reduce phosphorus by feeding moderate to high fat, moderate amounts of high quality protein,and low phosphorus carbohydrates to provide calories.

Dogs with kidney problems often do better when fed several small meals throughout the day rather than just one or two large meals.

Following are more details about these guidelines. Also see Sample Homemade Dietfor information on getting started with a homemade diet.

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Reduce Phosphorus

Feeding a low phosphorus diet has been shown to slow progression of kidney disease. NRC guidelines are to feed no more than 22.25 mg/kg phosphorus daily (about 10 mg per pound of body weight)for a dog with advanced kidney failure. For dogs in early stages, recommended phosphorus amounts can be as high as 60 mg/kg (or 30 mg/lb). Anywhere from 15-40 mg/kg (7 - 18 mg/lb) is considered a low phosphorus diet. In general, foods highest in phosphorus include bones, dairy products, fish (with bones), organ meats, and egg yolks. That does not mean not to feed these foods at all, as they are an important component of a healthy diet, but they should be fed in moderation. Be wary also of the amount of phosphorus in grains and vegetables that you feed. The Table of Nutritional Values lists some approximate values for a variety of different foods. Examples of the amount of phosphorus you should be feeding daily, based on the range of 15-40 mg/kg, and 60 mg/kg for very early stages (the further advanced the kidney disease is, the less phosphorus you should be feeding):

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Moderate to High Fat

Fat provides low-phosphorus calories, and so can be used to increase caloric intake without increasing phosphorus. With rare exception, dogs do not suffer from high cholesterol or other human problems associated with high fat intake. However, too much fat can be problematic for some dogs, and renal disease can predispose dogs to pancreatitis (or it's possible that the combination of low protein and high fat found in prescription diets may be the underlying cause, as this combination is known to predispose a dog to pancreatitis).

If your dog is overweight or relatively inactive, and doesn't need a lot of calories, then feed moderate amounts of fat. If your dog is quite active and needs a lot of calories, then you can increase the amount of fat to provide more calories without increasing phosphorus. Too much fat may lead to diarrhea or mucousy stools, and dogs that are prone to pancreatitis cannot handle too much fat. If fat is reduced, carbohydrates will have to be increased to provide low-phosphorus calories.

It is important to increase the amount of fat you feed gradually, to avoid digestive upset and to try to avoid the possibility of pancreatitis. If you see signs of problems, such as your dog seeming uncomfortable after meals, loose stools, loss of appetite, vomiting or diarrhea, that is a sign to decrease the amount of fat in the diet right away to a level your dog can tolerate.

Dietary sources of fat include:

Again, be cautious when adding fat to the diet. Increase amounts gradually, and back off if you see any signs of your dog having problems with the higher amounts.

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Moderate Protein

How much protein to feed is still a matter of some debate, although it is not necessary to feed a low protein diet unless your dog is uremic. Protein may need to be moderately reduced for dogs with glomerulonephritis, to reduce protein loss in the urine which contributes to inflammation.

Recommendations for dogs with mild to moderate CRF (creatinine 1.6-4.5 mg/dL, or 141-398 µmol/L) are 2.0 - 2.2 g/kg body weight of high biologic value protein, or around 1 gram of protein per pound of body weight daily (see the section on How Much Protein? from the Journal of Nutrition). This is higher than the recommendations for normal, healthy dogs. Note the grams of protein refers to a nutritional analysis, not grams of meat.

As long as the amount of phosphorus is kept within desirable limits, and your dog is not uremic and does not have excessive proteinuria, you really don't have to worry much about feeding too much protein (you may need to be careful not to feed too little). It is important to feed high quality protein. Eggs have the highest quality protein, but egg yolks are very high in phosphorus. Egg whites can be added to low-protein diets to provide additional protein with very little phosphorus, although the protein in egg whites is not complete. Egg whites should be cooked, as raw egg whites bind biotin (a B vitamin) and the protein is less bioavailable. Raw or lightly cooked meat is another high quality source of protein. Green Tripe may be an excellent food for dogs with kidney disease, see below for more info.

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Carbohydrates

Dogs have no nutritional need for carbohydrates, but in order to reduce phosphorus, you will probably need to feed around 50% carbohydrates (more if the diet is also lower in fat). In general, the goal is to add calories without adding much phosphorus. For this reason, grains like Farina, pasta, and vegetables like sweet potatoes and winter squashes are good choices. Phosphorus amounts given below in parentheses are taken from the USDA Nutrient Database and are shown in mg per 100 grams. If a range of numbers is given, the lower number is for cooked, the higher number is for raw. If only one number is given, it is for raw.

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Sodium

Dogs with kidney disease often also have hypertension (high blood pressure), and the standard recommendation is to feed a reduced-sodium diet. However, it is questionable whether this is necessary, and a low-sodium diet may even be harmful:

If you do reduce sodium, it's important to do so gradually, as reducing sodium too quickly in dogs with kidney disease can cause dehydration and bring on a renal crisis.

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Other Restrictions

Most other dietary restrictions depend on your individual dog. If your dog has high potassium, you will need to limit the amount of potassium you feed, for example (bananas, pumpkin, potatoes, sweet potatoes, pears, sardines, kiwi, beets, yogurt, winter squash, banana, carrots, celery, broccoli. are high in potassium) -- keep in mind that high potassium is unusual in dogs with kidney disease and may indicate Addison's Disease instead. Conversely, if your dog's potassium levels are too low, you will need to give potassium salts (both can occur with kidney disease, but it is my understanding that low potassium is more common, and high potassium is only likely to occur when kidney disease is very advanced).

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Green Tripe

Green tripe may be an excellent food for dogs with kidney disease, as it is fairly low in phosphorus and is highly palatable to dogs. You need to find green tripe, as the bleached tripe that is sold for human consumption does not have the same nutritional value. Most dogs love green tripe, so it might tempt a dog to eat that was anorexic. I've never heard of a dog having digestive upset from green tripe (though sometimes the owners do, it has a fairly strong smell, and some prefer to feed it outside). Unbleached green tripe is hard to find, see the following (note many will ship, although the cost can be high to ship frozen products):

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Raw Meaty Bones

For those who feed a diet based on raw meaty bones, you may be able to continue to feed that diet, but you will need to reduce the amount of bone fed, and eliminate bone altogether as the disease progresses (BUN and Creatinine increase), or if your dog has problems with elevated mineral values, such as magnesium, in their blood work. Bones are high in phosphorus and other minerals that can be hard on kidney patients. The Table of Nutritional Values lists some approximate values for a variety of raw meaty bones. When you reduce or eliminate the amount of bone in the diet, you should add 1/2 teaspoon ground eggshell (or 1,000 mg plain calcium from other sources) per pound of meat fed to balance out the calcium/phosphorus ratio. If your dog's calcium values are too high, you may need to use aluminum based phosphorus binders instead (see below).

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Treats

I don't worry much about treats, since they're such a small part of the diet. There are no foods that you have to avoid for dogs with kidney disease -- the goal is to reduce phosphorus levels, but again, if treats are a small part of the diet, the amount of phosphorus in them would not be significant. You might want to avoid things like dried liver for that reason, though very small amounts would be fine. I would also avoid chicken jerky treats and all other dehydrated treats (duck, sweet potato) imported from China, due to fears of potential contamination -- see my Pet Food Recall web page for more information on this topic. Biscuits by Lambchop offers low-phosphorus, gluten-free treats, but again, they're not really necessary.

Remember to keep treats small. Dogs care more about the number of treats they receive than the size of the treats. For dogs who need severely restricted phosphorus, try rice cakes and miniature marshmallows (about 2 calories each). Other good options include vegetables (baby carrots, green beans, zucchini slices, etc.), fruits (berries, apple, banana, melon -- no grapes or raisins!), air-popped popcorn (no salt or butter), and vanilla animal crackers (11 calories each).

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Water

Dogs with kidney disease should always have access to water, even if it causes accidents in the house. Distilled water may be best to use, or maybe purified water, such as with a faucet filter. Well water may be very high in minerals and is best avoided, use bottled water instead, or find a filter that will remove excess minerals. If you use a water softener at your house, your water will be high in sodium, which is not a good idea if your dog has high blood pressure. Again, switch to bottled water (filters do not remove sodium from water). It is important that your dog stay hydrated, as dehydration is very harmful to the kidneys. Adding water to the food, particularly if you feed dry food, may help with this. If your dog is drinking a LOT of water, I would definitely consider giving sub-q fluids to help him stay hydrated.

See Prescription Kidney Diets for information on ways to combine fresh foods with commercial foods to create a diet appropriate for dogs with kidney disease.

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Supplements

The most important supplement to give to dogs with kidney disease is fish oil, such as salmon oil or EPA oil (not cod liver oil). The omega-3 fatty acids in fish oil have been found to slow progression of kidney disease. Give an amount that provides as much as 300 mg EPA and DHA combined per 10 pounds of body weight daily, preferably split into two doses. For large dogs, it's easiest to use liquid fish oil, as long as it's stored in dark bottles in the refrigerator. You can also use concentrated gelcaps that have 500-600 mg EPA and DHA, rather than the more common 300 mg each.

See Supplements for more information on a variety of supplements to give to dogs with kidney disease.

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I regret that I no longer have much time to respond to questions. 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.