Paying close attention to your dog’s water consumption is crucial, as it offers vital clues about the health of their kidneys. Ensuring a constant supply of fresh, pure water is paramount. [
Thousands of dogs are diagnosed with kidney disease annually. The conventional veterinary approach often involves a drastic switch to a low-protein “kidney diet” food, with owners warned against any high-protein treats. Many dogs find these diets unpalatable and refuse to eat, leading to a cycle of suspicion and eventual reluctant consumption. Despite these efforts, the slow deterioration of dogs with Chronic Renal Failure (CRF) often continues, leaving owners questioning their choices. However, a new perspective on feeding dogs with kidney disease offers a more promising scenario, promoting both the dog’s well-being and the owner’s peace of mind.
The Protein Debate: Challenging Conventional Wisdom
The prevailing strategy among most American veterinarians is to prescribe a low-protein diet upon diagnosing kidney disease. This recommendation stems from early research on rats, which suggested that excess protein could harm kidneys. Consequently, many pet food manufacturers offer low-protein prescription diets, and owners are advised against feeding meat and other high-protein foods.
However, this widely held belief is being challenged by newer research. Wendy Volhard, author of Holistic Guide for a Healthy Dog, states that the notion of low-protein diets for dogs with kidney disease was fundamentally questioned as early as 1975 by David Kronfeld, PhD. Kronfeld’s research proposed that the focus should be on feeding higher-quality protein rather than reducing protein intake altogether. This concept suggests that inferior-quality protein can indeed be detrimental, but the solution lies in improving ingredient quality, not simply reducing quantity.
Despite studies disproving the low-protein dogma being published in veterinary journals, this information is slow to permeate mainstream veterinary practice. Mary Straus, a dedicated dog enthusiast and researcher of health and nutrition, notes that many veterinarians, particularly those who haven’t graduated recently, remain unaware of or dismiss newer studies indicating that low-protein diets neither slow kidney disease progression nor prolong life.
Straus highlights the potential harm caused by prescription foods like Hill’s Prescription Diet k/d®. When protein levels are excessively low, the body may break down its own tissues to obtain necessary protein, paradoxically increasing waste products. Furthermore, the unpalatable nature of these diets can lead to dogs eating just enough to survive or refusing to eat altogether, exacerbating their condition.
Veterinary nutritionist Patricia Schenck, DVM, PhD, from Michigan State University, points out that older dogs actually require a higher protein intake to maintain their body reserves compared to younger adult dogs. She cautions that reducing dietary protein in senior pets can have adverse effects, as their ability to utilize nutrients declines with age. Protein restriction, she argues, is only appropriate when the disease has become severe. Canine health writers Susan Thorpe-Vargas, PhD, and John C. Cargill, MA, emphasize that healthy geriatric dogs need approximately 50 percent more protein than young adults, making up 20 to 30 percent of their total caloric intake. Protein restriction can impair wound healing, weaken immune function, and reduce enzyme activity. Dogs with impaired renal function, they note, benefit more from dietary phosphorus restriction.
A New Action Plan: Tailoring Diets for Kidney Health
Mary Straus’s experience with her Chinese Shar-Pei, Nattie, exemplifies the success of a revised dietary approach. Nattie, diagnosed with kidney disease at age 14, was transitioned to a diet that prioritized high-quality protein while specifically reducing phosphorus. Straus adjusted Nattie’s diet to approximately 37 percent protein (on a dry matter basis), and Nattie thrived. Her kidney indicators actually improved over two years, and she lived to age 16, succumbing to a cause unrelated to kidney disease. This experience underscores the importance of informed dietary choices for dogs with CRF.
Dietary Goals for Kidney Patients
When formulating a diet for dogs with kidney failure, leading experts recommend the following principles:
- Moderate to high amounts of fat: Fat provides essential calories and energy, and most dogs digest it well. Good sources include fatty meats, butter, whole-milk yogurt, egg yolks, and coconut oil. However, polyunsaturated vegetable oils and cod liver oil are generally not recommended due to their vitamin D content, which failing kidneys struggle to process. Fish oil (body oil, not liver oil) has shown promise in helping CRF dogs.
- Moderate amounts of high-quality protein: The emphasis is on quality over quantity. Eggs are considered a top-quality protein source, but their yolks are moderate in phosphorus. A strategy is to feed one or two egg whites for every whole egg.
- Low amounts of phosphorus: Limiting phosphorus is crucial, as failing kidneys have difficulty excreting it. Foods high in phosphorus include bones, fish with bones, cheese, organ meats, and egg yolks.
- Moderate amounts of low-phosphorus carbohydrates: Carbohydrates provide necessary calories and nutrients.
- Abundant fluids: Plenty of water, juices, and broth are essential to maintain hydration.
A balanced approach suggests a diet where total calories are roughly divided equally among fat, protein, and carbohydrates.
Understanding and Managing Phosphorus
Phosphorus is a key concern in managing kidney disease. As bones are very high in phosphorus, they should be eliminated or fed in very small quantities. When creating a homemade diet, it’s vital to use a calcium source that doesn’t include phosphorus, such as ground eggshells or calcium carbonate. Dairy products (especially cheese), fish with bones, organ meats, and egg yolks are also high in phosphorus and should be managed carefully. While these foods are nutrient-dense, they should be fed in reduced amounts, balanced with low-phosphorus grains and vegetables. Higher-fat meats are generally lower in phosphorus than lean cuts. Crucially, calcium should be added to all meals to act as a phosphorus binder, with approximately ½ teaspoon of ground eggshell or 1,000 mg of calcium per pound of food recommended.
Mary Straus provides a helpful color-coded system on her DogAware website to guide caregivers in managing phosphorus levels:
- Code Red (Feed in small amounts): Includes low-fat meats (ground turkey, lean beef, skinless chicken breast), organ meats (beef heart, chicken liver), canned fish (jack mackerel, pink salmon, sardines in water), high-phosphorus grains (oatmeal), and dairy products (cottage cheese, whole-milk yogurt, mozzarella, cheddar, whole eggs, egg yolks). Raw meaty bones like chicken parts and turkey necks should be fed sparingly, if at all.
- Code Blue (Feed in moderate amounts): Features higher-fat meats (dark-meat chicken, 20-percent-fat ground beef, pork, lamb, liverwurst), green tripe, winter squash (acorn, butternut), and whole grains (brown rice, millet, whole-wheat bread).
- Code Green (Okay to feed in large amounts): Encompasses egg whites, yams, sweet potatoes, white potatoes, certain cereals (Cream of Wheat, Cream of Rice, Malt-o-Meal), glutinous rice, white rice, barley, and white bread. Cooking grains and boiling vegetables (discarding the water) can help reduce phosphorus levels.
Further Dietary Tips and Supplements
Green tripe, the unprocessed stomach lining of cud-chewing animals, is gaining popularity for its easily digestible protein, beneficial bacteria, enzymes, and relatively low phosphorus content. Ensure it’s the raw, unbleached “green” variety.
If opting for a prescription commercial food, supplementing with fresh protein sources like meat, eggs, or tripe can be beneficial, especially in the early stages of the disease. For diets based on raw meaty bones, significantly reduce the bone content. If a diet plan like Wendy Volhard’s Natural Diet calls for bone meal, consider switching to fatty meats and using calcium carbonate instead to manage phosphorus.
While dogs aren’t naturally grain-eaters, many CRF diets incorporate up to 50 percent carbohydrates for calories and nutrients. Soaking grains overnight can improve digestibility and reduce toxins. White rice and glutinous rice are particularly low in phosphorus. For dogs with arthritis, be mindful of nightshade plants like white potatoes and tomatoes.
Dogs with high blood pressure, often linked to kidney disease, may require reduced sodium. Home-prepared diets are naturally low in salt, but processed foods like cottage cheese and canned fish should be monitored for sodium content. Rinsing canned fish can help reduce salt.
Combating dehydration is critical; always ensure fresh water is available. If excess drinking leads to incontinence, discuss subcutaneous fluids with your veterinarian. Filtered or low-mineral bottled water is preferable to hard water.
To manage a flagging appetite, owners can experiment with food temperatures, raw versus cooked options, and offering multiple small meals. While Nattie initially refused raw eggs, she ate them scrambled with a bit of cheese, highlighting the importance of finding palatable options, even if they aren’t perfectly aligned with ideal recommendations.
Adding green tripe or Seacure (a fish-scented protein supplement) can enhance flavor. If a dog refuses a commercial diet like k/d, finding an alternative, preferably a homemade diet, that provides high-quality protein while controlling phosphorus is key. Fresh foods, with their higher moisture content, can also help protect kidneys and improve a dog’s overall well-being.
Recommended Supplements for CRF Patients:
- Salmon oil or other fish body oil: Up to 1 gram (1,000 mg) per 10 pounds of body weight daily.
- Coenzyme Q10: Adjust dosage based on weight, approximately 15 mg per 25 pounds of body weight, three times daily.
- Vitamin E: 50 IU daily per 25 pounds of body weight.
- B-complex vitamins and moderate Vitamin C: Around 500 mg for a 50-pound dog. Avoid multivitamins containing phosphorus or vitamin D. Buffered or ascorbate forms of Vitamin C are gentler on the stomach.
- Glandular supplements: Canine Renal Support from Standard Process is often recommended by holistic veterinarians.
- Herbal supplements: Traditional kidney tonics like dandelion leaf and root, couch grass, and marshmallow can be beneficial.
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