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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).

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 (prescription from your vet is required, but prices may be lower).

Comparison of Calories, Protein and Phosphorus in Prescription Kidney Diets
(as fed)
(as fed)
(as fed)
mg/100 kcal
Early Stage -- Dry
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

(3.3 oz) 4038/kg

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
Early Stage -- Canned
Hill's g/d Turkey Flavor 388/can
(13 oz) 1049/kg
14.8 g/can 342 mg/can 18.6% 0.42% 88
Early Stage -- Frozen
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)
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 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
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)
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
Late Stage -- Canned
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

(13 oz) 1138/kg

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 -
Hi-Tor Neo  539/can
(14.5 oz)
19.7 g/can  411 mg/can 16.4% 0.34% 76
Late Stage -- Frozen Cooked
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.

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Sample Combination Recipes


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) 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):

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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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.