Diet recommendations for kidney disease/failure

[Sue R]

Our dogs just had their annual exam yesterday and when I explained to the vet that I have had to give Megan more food than usual to maintain her weight, taking into consideration extra calorie requirements for winter weather, she suggested a blood panel to check things out. While I don't have the figures here yet, the results indicated a kidney problem.

 

The vet's first thought, based on the numbers, was kidney disease/failure. We are taking a urine sample in the morning and having that checked to rule out the possibility of a UTI of some sort. If she does have a UTI, and I've seen no obvious symptoms, we will treat that first and go from there. But I did not feel the vet was very optimistic about this alternative.

 

So, if kidney disease/failure is the diagnosis, thinking about the vet's comment that by the time she sees this sort of result on a blood panel, that kidney failure may have progressed as much as 75%, I am thinking what do I want to feed Megan to be most helpful to maintaining her health and well-being for whatever time she has left.

 

I know there are prescription diets (the vet carries Hill's, Purina, Royal Canin, Iams, and maybe one other, for kidney support) and there can be homemade diets (she will research that for me if I'd like), and there can be use of both premade and homemade. I am wondering what those of you who have experienced this with a dog have found worked (or didn't work) well for you in terms of diet.

 

I will have to say that I am largely prejudiced against anything that says Hill's or Iams on the label but I'm willing to feed her anything that will help her, should kidney disease/failure be the diagnosis. Please feel free to share your thoughts with me because I would appreciate any input that will help me make the best possible decision.

 

PS - I do really like this vet. I feel she is compassionate, and also very respectful of my opinion.

[Gideon's girl]

My preference is homemade. For kidney disease, the quality of the protein is important and the phosphorus level is important. They usually suggest a diet that has cooked egg whites as the primary protein and a simple carb. Your vet sounds like a gem, so I would ask her to look into homemade diets for you.

 

As for premade, I would go with one of the canned foods, not dry, and keep a few on hand for when you don't have time to cook or forget to defrost.

 

I'm sorry you are even having to worry about this, and I hope it ends up just being a UTI. How are Meg's teeth? I've seen a number of dogs end up with kidney issues due to an infected tooth and that should be treatable too.

[gcv-border]

Sorry to hear about Megan. I will be following this thread in case Ritz also has kidney issues. I am awaiting blood panel results, but she has been drinking more water than normal lately.

 

I have only had one dog that had kidney issues. She was almost 16, and the vet advised that there wasn't much we could do for her at that time (about 17 years ago). She had progressed too far.

 

I have had 2 cats with kidney issues that have fared better - living 2+ years after diagnosis. I understand that cats can 'tolerate' kidney problems better. Having said that, what I did with my cats was similar to what Gideon's girl stated. I tried to use high quality protein and watched their phosphorus level. Recently, my vet told me that there are meds to reduce phosphorus levels.

[aschlemm]

I'm sorry about Megan. There are things to help/extend quality of life with kidney issues. Was she tested for tick borne diseases? They can cause renal insufficency also.

Other dog food brands offer renal diets. I don't like Hills but I think Royal Canin (Waltham) is ok. Their food is called Renal LP. Purina has one also (NF, I think.) You can also dress it up with human food that is high is carbs. Pasta, bread, doughnuts. I know there are good homemade diets out there too.

Once phosphorus levels reach a certain point animals usually feel nauseous and won't eat. You can give Alternagel (Aluminum Hydroxide) it binds the phosphorus. Unfortunately, they seem to detest the taste, hopefully your vet has something tastier. You can give fluids subcutaneously also. This is easier in cats and small dogs but I knew someone with an Irish Wolfhound who was in renal failure due to Lyme disease and she lived for a good year after diagnosis (rare for a dog with Lyme.) I have a friend with an old Lab and she does Sub-Q fluids also. Depends on how you and Megan feel about needles! Hopefully she isn't quite to that point yet and a diet change will suffice.

[alligande]

Sorry to hear about Megan. I am not sure what % of kidney use Bandit had left when he was diagnosed, but he were told he did not have long. The initial vet we saw said we needed to feed him perscription food, which we immediately went and bought (from a different vet) and Bandit hated it, after the weekend we went and saw our own vet, the owner of the practise and she told us to feed him what ever he liked as he was terminally ill and let him enjoy life... We did give him Aluminum Hydroxide which he had no problem eating when mixed with what ever intersting food he got. We also gave him Sub-q fluids most nights, some nights he just did not want us to mess with him and others he happily lay on the floor while we watched tv.

Now I would look into a homemade diet, as I think that gives you the quality of food along with the balance needed to help the kidneys.

[Sue R]

Thank you for your kind and thoughtful replies, and your advice and opinions. It is a lot to digest, shall we say?

 

As for her teeth, she has had a broken molar for many years, which we have monitored. Some plaque build-up and some bad breath have me concerned at this point (this is very recent) and she has an appointment in about four weeks (the earliest I could get) for an extraction. While there is no external evidence of infection, and nothing on bloodwork that I understood indicated infection, that is a thought and I will enquire about it.

 

Her appetite has always been excellent but I have seen very, very subtle signs that make me wonder if either the tooth is a beginning problem or her appetite might be very slightly affected. She seems to be taking just a little more time eating her food but since I'm giving her more than I have in the past, that could explain it.

 

Her SNAP test results will be back within a few days. By sending out the bloodwork for Megan and Celt, we saved some money compared to in-house testing, and the SNAP tests for those two went out with the blood panels.

 

I'll be collecting a sample this morning (in the dark, so I hope I get the ladle where I need it) and dropping that off today, and should hear back pretty soon on whether or not a UTI is detected.

 

Again, thank you!

[GentleLake]

Sue, I'm very sorry to hear about Megan, as well.

 

I don't have any experience with kidney disease in dogs (knock on wood), but I think I'd be looking into the homemade diet. I've fed a dog who was on canned kidney foods when I was dog sitting, and the ingredient list made my jaw drop. It was barely what I'd call food and the dog sure wasn't enthusiastic about it.

 

Best wishes helping Megan with this.

[juliepoudrier]

Sue,

Do you have Laura Carson's contact info? You're probably friends on Facebook. You should talk to her. She has been maintaining both June (14) and Ginger (17), both in renal failure, for the past year with homemade diets. The diets are different for each dog, and I think she worked with a nutritionist. She gives daily subQ fluids, uses the aluminum hydroxide to bind phosphorous, etc. I think she could share some useful information and insights with you.

 

If you choose not to go the homemade route, I have heard good things about Royal Canin. I have used the Purina NF for cats in renal failure. It had good palatability, which is saying something as cats are generally much pickier than dogs, especially when they are unwell.

 

The couple of times June and Ginger have stayed with me while Laura was traveling, she has sent along Science Diet and Royal Canin canned for backup use if June chose not to eat her homemade diet (which happens).

 

J.

[Sue R]

Yes, Julie, I have sent a message to Laura via FB and just got home so I haven't yet seen if she's been able to reply.

 

I did take the urine sample in and got the results, which indicated no UTI. This was probably one of the first times someone has wished for a UTI if that was going to be the problem with the kidney values instead of something more serious...

 

Everyone seems to mention "wet" food or canned, so I'm gathering that kibble is not a good choice for a prescription diet? I wonder about bones and am thinking maybe too much phosphorus?

 

I am on a steep learning curve here.

[Gideon's girl]

They do still need some phos, but yes, edible bones would probably be too much, unless carefully balanced. Wet foods are preferred because the moisture helps keep the kidneys flushed out AND it's less processed so less damage has been done to the quality of the proteins. Adding water to dry foods helps, but the water still goes through the stomach faster than the food, so isn't necessarily getting to the kidneys at the same time that the kidneys are dealing with the waste products from protein digestion. Staying well hydrated helps with that.

 

Also, think about what toxins Meg might be exposed to, cleaning chemicals, air fresheners and scented candles, lawn chemicals, flea and heartworm meds. All are processed through either the liver or the kidneys and can take a toll, especially on already weakened organs.

[Sue R]

Thank you for those suggestions. We use edible bones for entertainment and dental health but perhaps I could find a substitute for her use.

 

As for toxins, I use few cleaning chemicals (take that however you want ) and no more often than I need to, but I will keep that in mind. Of course, I wash the dog beds on occasion, using a sensitive skin formula detergent. We don't use air fresheners and rarely scented candles (most I have are soy-based). We don't use lawn chemicals in general although I do use some weed killer once or twice a summer in mulch beds. I'll have to reconsider that. We do use heartworm meds but only treat for fleas/ticks generally once or twice a year when we visit relatives in areas where those are a problem.

 

A lot to think about...

[GentleLake]

When thinking about meds, you probably want to avid NSAIDS (among others). I went into renal failure myself a few years ago, most likely from a history of using NSAIDs to manage a chronic pain condition, and now can't take any of them (or COX-2 inhibitors) any more. (Fun- not.)

[simba]

I feed royal canin, not their kidney food but a different one for a different health problem, and the dog has never been better on any food I've fed. That includes the no-grain stuff, the 70% angus beef stuff etc. She's shiny, she's happy, she's active and healthy, she has good muscling for her age and her coat has never been softer.

 

Now how much of that is the weight loss she also experienced and how much is the food, I don't know. But I'd definitely recommend it.

[Gideon's girl]

Hey Sue

 

I woke up this AM realizing that my thinking had turned backward last night. Since it's excess calcium in the bones and they don't use calcium if they don't have the phos to go with it, IDK if they would limit bones much. They use egg whites because they are a low phos protein, so the diet probably would limit the amount of other types of meat. I do know that bones from commercially raised beef are supposed to be bad. You want shorter lived animals, so they don't have an abundance of the metals and things that they pick up over time and deposit in their bones.

[Sue R]

Thanks! I am so much in a learning phase here.

 

We do use bones a lot, primarily beef bones because that is what we have (we grow our own beef) and usually the bones are from adult to senior animals (cull animals) with an occasional 3 year old that goes to the freezer. The edible bones are neck primarily, and any other parts of bones that tend to be "spongy" in texture. The rib bones vary in edibility, and the leg and knuckle bones tend to be gnawing bones with little edibility.

 

As for "metals" and other materials that could accumulate over time, our cattle are almost entirely grass and hay fed, with minor protein supplementation in the winter, depending on the hay quality. The supplementation is normally soybean oil meal (SOM). When weaned, all the youngsters are fed a conditioning ration for about six weeks or so. Other than that, supplementation or grain feeding doesn't happen here (well, except for the occasional senior that Ed cares for).

 

My alternative is buying chicken backs by the box, which I used to get in town and which I assume are still available. They are the only "bulk" edible boney bits that I can get locally. There is a new custom butcher and I could check with them about the possibility of getting lamb or pork bones that would otherwise be discarded, but I don't know how feasible that would be until I talk to them.

 

In our house, raw bones are a big entertainment item with the bonus of keeping the teeth in general good condition. Regular frozen boney chicken is useful for that also and the dogs love it. I can't decide who is the greatest bone aficionado, Megan or Dan. Dan can demolish some bones in an astoundingly short time, but Megan has persistence and can work a bone for a long time!

 

Thank you for your help! Thank you, all, for your help!

[juliepoudrier]

FWIW, I think wet food probably just smells better and may be more palatable for animals who may be experiencing nausea. Also, it's generally the elderly who have renal failure, and dental issues can be a contributor. Canned/wet food might simply be easier for such dogs to eat.

 

That said, I always used the kibble for the cats....

 

J.

[Blackdawgs]

My 13.5 yr old dog probably has renal disease. Her values were 2X upper limit of normal about 10 days ago during a visit to the dog ER for an issue that was probably unrelated to her kidney's. We are hopeful that the values will come down after a course of antibiotics for a mouth infection and withdrawal of NSAIDS.

 

Per my vet, I am in the process of switching her to Royal Canin Renal MP but I am not sure if this is the correct food because there is an LP for dogs with more severe disease. But, this was the food on the vet's shelf. The dog seems to like the food (she will eat anything). It smells fishy from the fat. Yes, the ingredients are kind of scarey.

 

These diets have reduced protein and phosphorous among other modifications. I'm a little miffed at the vet (although in the vet's defense until Tuesday we thought that we were dealing with kidney disease and cancer with the cancer being more pressing but that is off the table now) because I was sold this food without explanation--it does no good to feed the food if they are getting phosphorous from other sources. I'm in the early stages of compiling lists of low phosporous foods. This dog loves to eat and has always shared my food with me.

 

The management of these dogs is pretty complicated:

http://veterinarymedicine.dvm360.com/11-guidelines-conservatively-treating-chronic-kidney-disease?id=&sk=&date=&%0A%09%09%09&pageID=6

So, I am thinking that I will ask for a referrel to a veterinary internist assumming that her values are still off when she gets her mouth checked on Monday.

 

Dehydration is a concern in these dogs, so wet foods are better due to the moisture content. Since this started, I've been pulverizing my dog's kibble with a mallet and adding water to runny oatmeal consistancy-- and I'm feeding a third meal to get even more water into her. The intact kibbles of her origional diet don't seem to absorb water very well, even after soaking for an hour at room temperature. Pretty scarey actually.

[GentleLake]

FWIW, I know many raw feeders continue to feed raw to their dogs in kidney failure. They look for lower phosphorus meats, like dark chicken as opposed to white, which is higher in phosphorus than dark.

 

If you should be interested in pursuing something like this, the Yahoo Raw Chat group might be a good source of information. https://groups.yahoo.com/neo/groups/RawChat/info

[Gideon's girl]

Sue

 

Unless your cattle are grazing along a busy road, they are far "cleaner" than any commercial beef.

[BCjetta]

Blackdawgs - FYI you cannot use Renal LP on a dog weighing more than 30lbs. The protein levels are too low for a medium or large dog.

My last 2 dogs had renal failure. The oldest one was 26 lbs and we switched her to the renal LP when she started getting more picky with food.

My border collie had renal failure but also had heart disease and arthritis. I discussed her issues with some internal medicine specialists and we decided not to go with the renal MP food, but to keep with the mobility support food I was feeding her. I used the mobility food so I wouldn't have to use NSAIDS for her arthritis because many of them are processed in the kidneys which can strain them further. She was also on several drugs for her heart, including furosemide which is contra-indicated with renal failure.

However, neither of my dogs passed away from the renal failure. The first dog ended up getting mast cell tumors through her intestines, and my border collie ended up dying because of the heart. Both dogs lived over 2 years after we discovered the renal failure.

[GentleLake]

NSAIDS for her arthritis because many of them are processed in the kidneys which can strain them further.

 

AFAIK, all NSAIDs are cleared through the kidneys and shouldn't be used by anyone with kidney problems.

 

Not only NSAIDs, but many drugs are cleared through the kidneys, so it's always important to ask about any medications that someone (and by "someone" I mean dogs as well) who has kidney disease. I always double check with my pharmacist as well as my doctors with things I take or that I give my dogs. Pharmacists often catch things or have additional information to add to what the docs have said. Case in point, it was a pharmacist who told me that thyroid medication (at least for hypothyroid) should be taken on an empty stomach. My own doctors (2 of them!) never mentioned that to me, and a friend's vet never told her this for her dogs. But my pharmacist did and the doc verified it when I asked.

[GentleLake]

What about adding some herbal support as well?

 

Stinging nettle and dandelion are used for kidney support.

 

My holistic vet (and friend) recommended a product (for me) she uses a lot in her practice. It's Kidney Support Compound, a tincture from Herbalist Alchemist.

[Root Beer]

When Speedy's kidney values went above normal, his chiropractor recommended that I add just a pinch of baking soda to his food. I did that and I saw a noticeable change in him, and when he was checked again, the levels had gone back to normal.

 

All of the info I found on using baking soda for kidney problems was anecdotal, but I did find some British sources of information.

 

Might be something to consider, regardless of what you ultimately decide diet-wise.

[Sue R]

Hmm, I can't locate it now but I read one source that did not recommend baking soda (calcium bicarbonate).

 

I think my head is about to explode...

[Maxi]

There has been this study on humans with chronic (long standing) kidney failure. http://jasn.asnjournals.org/content/20/9/2075.full . It concluded that dietary addition of sodium bicarbonate slowed the rate of progression towards end stage renal failure.

 

However thie Cochrane review http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0046738/ Indicates that the same is not true for acute ( rapid onset) renal failure.

 

So I guess that it may depend on the type of renal failure as to whether baking soda (sodium bicarbonate) is potentially useful or not.

 

(ETA the Cochrane reviews combine and analyse all the relevant published studies on a topic so end up with a larger dataset plus hopefully remove any unintentional bias that could occur in any one single trial..but from a quick search I can't find whether they have reviewed the studies that assess any potential benefit of sodium bicarbonate in patients with chronic renal failure ..So maybe there have not been enough independent human trials published for them to consider doing this

 

...and of course whatever the findings, you still need to decide whether you can extrapolate the results obtained from studies using human patients to dogs...).

 

I wish Megan and you all the best