The goals of dietary therapy can be defined as follows:
To achieve these goals, it is necessary to create dietary diets modified by the following ingredients: phosphorus, protein, calcium, sodium, potassium, water-soluble vitamins, as well as energy and fat concentration.
It is necessary to reduce phosphorus in the diet
A number of studies have shown that a decrease in the phosphorus content in feed slows down the development of renal failure in dogs (1, 2), although the mechanism of this phenomenon is unclear. It can be assumed that this effect is associated with one or more consequences of a decrease in the level of phosphorus (not always manifested as hyperphosphatemia), which follows from the weakening of renal function.
Hyperphosphatemia is common in animals with chronic renal failure. It occurs when the glomerular filtration rate drops to about 20% of normal, which leads to impaired renal excretion of phosphorus. Retention of phosphorus can cause kidney mineralization, secondary hyperparathyroidism, and possibly kidney damage. Renal mineralization is common in dogs and cats with chronic renal failure and may be an important factor in its development. Soft tissue mineralization occurs when plasma calcium and phosphorus concentrations exceed the solubility product of calcium phosphate.
One of the main effects of elevated serum phosphorus levels is inhibition of 1k-hydroxylase activity in the kidneys, leading to a decrease in the formation of 1,25-dihydroxycalciferol (calcitriol), the most active form of vitamin D2 (Figure 1). On the contrary, a decrease in the concentration of calcitriol (together with hypocalcemia, when it is observed) stimulates the secretion of the parathyroid hormone (parathyroid hormone), leading to secondary hyperparathyroidism (3). Parathyroid hormone can be considered as a strong uremic toxin that can play a role in the occurrence of anemia, neurotoxic effects, dyslipoproteinemia, insulin resistance, promotes soft tissue calcification, renal osteodystrophy and, most importantly, the development of kidney damage (4,5).
Chronic renal failure is the most common manifestation of renal disease in dogs and cats; which often represents their final stage. Chronic renal failure is most often diagnosed in the group of aging animals, and today there is an idea that the disease has a progressive dynamics and poor prognosis, i.e. most animals eventually die from uremic complications.
Despite the fact that chronic renal failure is not completely curable (since acute lesions of the renal tissue are irreversible), no one will undertake to dispute the importance of correcting metabolic disorders, mitigating the clinical manifestations of the disease and reducing the rate of its development.
The kidneys perform a number of vital functions, which in the broadest sense of the word can be grouped into three groups:
Chronic renal failure has a multifaceted effect on these functions. The results of clinical and laboratory studies reflect their progressive suppression over time, but since the kidneys have functional reserves, visible symptoms appear only after extensive destruction of the renal tissue. Screening, especially for older patients, allows renal failure to be detected before overt symptoms appear.
Azotemia occurs due to an increased concentration of urea, creatinine, or other non-protein nitrogenous compounds in the blood. It can be due to the influence of pre- or post-renal factors, as well as as a result of primary kidney disease. Azotemia can occur in animals without overt clinical signs of renal failure.
Uremia is a polysystemic toxic syndrome that develops against the background of pre-existing renal failure and is characterized by certain clinical signs in combination with azotemia. Such signs include:
Diet correction is an important part of the management of chronic renal failure, but it is only one possible approach in determining treatment. In the case when it is possible to identify the root cause of renal pathology or, for example, if adrenal structures are involved in the pathological process, specific therapy should be used. Possible additional measures include:
maintaining normal water balance by providing unlimited access to fresh and clean drinking water or replacing fluids with persistent vomiting;
Although it is impossible to achieve a complete cure for patients with chronic renal failure, adequate veterinary care can lead to an improvement in the quality of life for months or even years. For these reasons, early diagnosis of chronic renal failure is desirable. Detection of early stages of the disease can be facilitated by routine blood and urine tests in older animals.
Figure 2 Effect of dietary phosphorus reduction on survival in dogs with induced renal failure (data from Brown et al.) (1)
The data characterizing the effect of limiting phosphorus levels in the diet of cats is even less complete. The beneficial effect of lowering phosphorus in cats with induced chronic renal failure (although the mechanism behind the induced disease is unclear) has been reported by Ross et al. (9). In this study, the effects of reduced (0.42% dry matter) and normal phosphorus (1.6% dry matter) in the diet were compared when feeding animals over 343 days. The serum phosphorus concentration was significantly higher in the group fed a diet with its normal body mass. The serum PTH concentration was also markedly higher in this group of cats after 6 weeks of the experiment, after which it continued to increase. In the group of animals kept on a diet low in phosphorus, the serum parathyroid hormone level was only slightly higher than in the control group.
During the study, none of the diets had a significant effect on changes in kidney function. However, kidney mineralization, fibrosis, and cell infiltration were found in cats fed a high phosphorus diet, while little or no change was found in the kidneys of cats fed a low phosphorus diet. This study concluded that for cats with chronic renal failure, a decrease in dietary phosphorus was accompanied by a slowdown in the development of kidney damage, but no clear improvement in the clinical picture and the effect on the course of the disease (as determined by changes in renal function) was found.
Preliminary data from clinical studies have shown that WHISKAS Low Phosphorus, Low Protein (low phosphorus and protein) leads to significant reductions in blood PTH levels in cats with chronic renal failure (10) (Figure 3). Some clinical studies have shown that a decrease in dietary phosphorus and protein may delay the onset of renal failure compared with a control group receiving a diet containing “normal” amounts of phosphorus and protein (11,12).
How to feed a dog with kidney failure
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Diet therapy for renal failure in dogs and cats
Peter Markwell is the Senior Clinical Nutritionist at the WALTHAM Center for Pet Nutrition, Waltham-on-the-Wolds, Melton Mowbray, Leicestershire, UK.
DIETARY FEEDING OF DOGS FOR KIDNEY AND URINARY TRACT DISEASES
Glomerulonephritis Is an acute and chronic infectious and allergic disease of dogs. The disease is characterized by damage to the glomeruli (glomeruli) of the kidneys and a different form of severity of edema, arterial hypertension and changes in the composition of urine (presence of protein. albuminuria), blood (hematuria).
Homemade Dog Food for Kidney Disease Recipe (Simple and Cheap)
In case of violation of the excretory function of the kidneys and their failure, the removal of metabolic products from the body worsens. The appointment of dietary feeding and its duration depends on the characteristics of the disease, the severity of renal dysfunctions.
With acute nephritis the basic principles of diet therapy are to sharply limit the amount of protein, extractives of meat and fish, essential oils, vegetables and table salt. In severe acute nephritis with delayed urine flow and edema for 1-2 days, a fasting diet is prescribed (treatment with “hunger and thirst”). Then, for 2-3 days, a sugar diet is prescribed (75 g of sugar per 1 glass of weak tea) for 4-5 doses per day. With nephritis of moderate severity, a sugar diet is used from the first days of the disease. You can use other carbohydrate unloading diets: potato, watermelon, compote, grape. The choice of a fasting diet is determined by the tolerance of the sick dog to certain foods. On fasting days, the sick dog is not given water. Then the sick dog is transferred to a diet according to diet No. 7. With mild acute nephritis from the first days of illness, the sick dog can be fed with diet according to diet No. 7. The food of this diet is prepared without salt, the diet is enriched with vitamins.
Since protein in the diet is limited by 15–20% compared to the norm, the amount of energy to the norm is replenished with fats and carbohydrates. In order to avoid depletion of the dog’s body with sodium and chlorine, which is manifested by loss of appetite and weakness, it is necessary to add some salt to the food after 2–3 days from the onset of the disease (15–20% lower than the norm of table salt). When edema appears or increases, table salt is again limited.
With chronic nephritis part of the kidney glomeruli ceases to function. Chronic nephritis in dogs can be asymptomatic, with varying degrees of edema, hypertension, albuminuria, as well as without impairment of nitrogen excretory function or with its impairment, i.e. with chronic renal failure. In chronic nephritis without exacerbation, without impaired renal function, in the absence of edema, hypertension and only small changes in urine, it is recommended to feed the sick dog according to a diet corresponding to diet No. 7 or even a normal diet, compiled according to the existing norms of dog’s energy and nutrient requirements with a moderate restriction of table salt (25-30% below the norm). At the same time, it is recommended to give the dog carbohydrate fasting days once, about 10 days.
With kidney failure, which occurs in dogs with chronic nephritis, bilateral pyelonephritis, amyloidosis of the kidneys, nephrosclerosis of the kidneys, as a complication of other diseases, metabolic products accumulate in the dog’s body, residual nitrogen (azotemia) increases in the blood, water-salt metabolism and acid-base balance are disturbed ( metabolic acidosis). With extreme kidney failure, self-poisoning of the body occurs (uremia).
The basic principles of diet therapy for kidney failure: restriction of protein in the diet by 15-30%, depending on the severity of kidney failure; ensuring the norm of the need for energy due to fats and carbohydrates; regulation of table salt and water in the diet, taking into account the presence of edema, hypertension and impaired renal excretory function in a sick dog.
In the initial stage of kidney failure, a sick dog is recommended to be fed according to a diet prepared in accordance with diet No. 7, in which proteins are reduced by 30%, of which 40-50% are proteins of animal origin.
In a pronounced stage of kidney failure, taking into account the condition of a sick dog, the amount of protein in the diet is reduced by 50% or more, of which proteins of animal origin should be up to 70% due to meat, fish, dairy products and eggs. The length of time a sick dog stays on a low-protein diet depends on the time the animal’s condition improves. Against the background of a low-protein diet, a small amount of table salt is periodically added to the feed, which reduces azotemia. When edema appears, salt is completely excluded and carbohydrate fasting days are used, which helps to reduce the phenomena of metabolic acidosis and azotemia. On fasting days, the diet uses rice-compote, apple-sugar, potato diets.
In case of final kidney failure with a sharp deterioration in their function, table salt in the diet is slightly increased, but not to the full norm, but 30-40% lower, and they give the sick dog more drinking water, protein in the diet is also reduced by 30-40% of the norm. In the final stage of kidney failure with uremia (self-poisoning), the “artificial kidney” apparatus is used for hemodialysis. the purification of blood from nitrogenous and other metabolic products. With regular hemodialysis, a diet consistent with diet should be full of energy, fat, and carbohydrates, but protein should be reduced, of which 65% should be of animal origin. The food is prepared without table salt.
In acute renal failure against the background of some acute infections, trauma, extensive burns, acute nephritis, a sick dog is fed according to a diet corresponding to diet No. 7, but with a minimum amount of protein, of which 75% is of animal origin, at the same time the amount of energy should be normal due to fats and carbohydrates.
With urolithiasis (urolithiasis), which occurs in dogs with various metabolic disorders, urinary tract infection contributes to the formation of stones, and urolithiasis itself can be complicated by a urinary tract infection.
Stones can form from salts of uric acid (urates), oxalic acid (oxalates), phosphoric acid (phosphates). In dogs, stones are found from the salts of all of the listed acids.
The basic principles of diet therapy for urolithiasis: restriction of feed substances from which sediment or stones in the urinary tract are formed; change due to feeding urine reaction (pH) to prevent excretion and better dissolution of sediment; regularly drinking water to remove sediment from the urinary tract.
Diet rations are made taking into account the characteristics of metabolism, the chemical composition of stones and the reaction of urine. Excessively prolonged feeding with a dietary ration with urolithiasis can act unfavorably, since in diets, mainly with uraturia and phosphaturia, the amount of food products of certain groups is limited or increased. When diet therapy of urolithiasis, concomitant diseases are taken into account. Dog obesity is a risk factor in the development of urolithiasis and worsens its course, therefore, joint diet therapy of urolithiasis and obesity is more effective than urolithiasis alone.
If one of the types of protein metabolism. purine metabolism. is disturbed, uric acid accumulates in the dog’s body, uraturia occurs, in which the diet must correspond to diet No. 6. In this diet, foods rich in purines are limited or excluded: meat, especially meat by-products, fish. Dairy products, cereals, eggs, vegetables are poor in purines. When boiling meat and fish, up to 50% of purines pass into broth, therefore, boiled meat and fish are used in the diet and broths are excluded.
Since urates are more often formed during an acidic reaction of urine, vegetables, dairy products are widely used to alkalize urine in the diet, and porridge is somewhat limited. Due to the frequent formation of mixed stones from uric and oxalic acids, feed products rich in oxalic acid are excluded from the diet.
In case of impaired purine metabolism, it is advisable to reduce the diet of feed products, the fats of which are rich in saturated fatty acids. When uraturia is combined with obesity in the diet of diet No. 6, the amount of energy is reduced by 20-40% due to fats and carbohydrates, depending on the degree of obesity.
If the metabolism of oxalic acid and oxaluria is disturbed, foods rich in oxalic acid are excluded from the diet: sorrel, spinach, rhubarb, etc. Moderate oxalic acid. in beets, potatoes, carrots, onions, black currants, blueberries. These foods are somewhat limited in the diet with severe oxaluria, but are not excluded from the diet. In most other vegetables and fruits, oxalic acid is low. The excretion of oxalates from the body is facilitated by decoctions from the peel of the fruit.
The occurrence of urolithiasis with oxaluria in dogs is facilitated by a lack of vitamin B6 (pyridoxine) and magnesium in the diet, therefore, the diet should include foods rich in these substances, in particular wheat bran, as well as preparations of pyridoxine and magnesium salts. At the same time, in the dietary diet, carbohydrates and gelatins (jelly), which can be source of formation of oxalic acid, salt, smoked products, extractives (broths, meat and fish without boiling) are limited. In case of oxaluria, it is recommended to feed sick dogs according to a diet prepared in accordance with diet No. 5 with a 15–20% restriction of carbohydrates with the inclusion of fasting days in the feeding regimen.
With a violation of the exchange of phosphorus and calcium in dogs, phosphaturia and calciumuria occur. Feeding animals with this disease is carried out according to a diet corresponding to diet No. 9. The diet should be dominated by foods that increase the acidity of urine (meat, fish, eggs, cereals, loaf, biscuits) and a limited amount of vegetables and dairy products. Vegetables and dairy products are periodically included in the diet so as not to cause a sharp depletion of the body in calcium. The diet according to diet number 9 is poor in vitamins C and P (bioflavoid), which must be replenished by including broths of wild rose and vegetables (pumpkin, green peas, cranberries, lingonberries) in the diet.
For any type of urolithiasis, the diet of dogs should be 10-20% higher than the norm of vitamin A, which has a beneficial effect on the mucous membranes of the urinary tract.
In dogs, when an infection penetrates the renal pelvis and bladder, their inflammation occurs. pyelocystitis, when the infection penetrates deep into the kidney. pyelonephritis. These diseases are acute and chronic and often complicate other diseases of the kidneys and urinary tract, such as urolithiasis.
With pyelocystitis, first of all, it is necessary to study the reaction of urine in order to create unfavorable conditions for the development of microbes by changing it. With an acidic reaction of urine, sick dogs are fed according to a diet prepared in accordance with diet No. 6, and with an alkaline reaction, according to diet No. 9. Against the background of these diets, it is recommended to give decoctions of rose hips, vegetables and fruits as a drink. Products containing essential oils (onions, garlic, radishes, etc.) that irritate the urinary tract are excluded from the diet.
In case of acute or exacerbation of chronic pyelonephritis with fever and symptoms of intoxication on days 1–2 of illness, they give vegetable and fruit purees and decoctions. Then they are fed according to a diet corresponding to diet No. 7, with the predominant inclusion of dairy and plant products in the diet. In chronic pyelonephritis, the sick dog is fed a complete diet in accordance with the physiological norms of the need for energy, protein, fat, carbohydrates and other nutrients with a moderate restriction of extractives and oxalic acid.
Figure 1 Development and possible consequences of secondary renal hyperparathyroidism.
The most severe toxic damage caused by parathyroid hormone can occur in the kidneys, since the concentration of parathyroid hormone receptors is high in nephrocytes. The latter can stimulate the consumption of calcium by these cells, initially causing cell death and, ultimately, the deposition of calcium in the lumen of the renal tubules. As a result, hyperparathyroidism leads to a continuous cycle of renal cell death, which causes a decrease in renal activity in phosphorus homeostasis, an increase in parathyroid hormone levels, and further damage to renal tissue (3, 6). This role of parathyroid hormone is confirmed by a number of clinical studies, during which it was shown that the development of renal failure was slowed down in dogs in which the activity of parathyroid hormone in plasma was suppressed (7). However, these data are not entirely reliable, since experimental studies could not confirm the role of reducing the level of parathyroid hormone in the blood (8).
To date, the most comprehensive study of the effect of reducing dietary phosphorus has been conducted in dogs with induced renal failure (1, 2). As a result of these studies, it was shown that the level of phosphorus in the diet has a direct effect on the survival of animals, the period of time during which the renal function remains stable and the time of the subsequent decrease in the functional activity of the renal tissue (Figure 2). The results of this experiment indicate a beneficial effect of lowering phosphorus in feed during the treatment of chronic renal failure. Interestingly, this effect was observed despite the fact that kidney mineralization was independent of diet; blood parathyroid hormone levels, although associated with diet in the early stages of the study, tended to rise in the later stages in all groups. The inconsistency of these data shows that for a complete elucidation of the mechanism of action of reducing the phosphorus content, further research is needed.
Figure 3 Effect of dietary phosphorus reduction on plasma phosphate and parathyroid hormone concentrations in cats with chronic renal failure (data from Barber et al.) (10).
Thus, limiting the phosphorus content in feed is an important part of the treatment of chronic renal failure, which may have a beneficial effect on the development of the disease, even though the mechanism of this beneficial phenomenon is not fully understood (1,2). It is necessary to transfer the animal to feed with a reduced m of phosphorus at the very beginning of the development of chronic renal failure; keep in mind that this is necessary for every dog or cat with hyperphosphatemia and / or hyperparathyroidism resulting from primary renal failure.
Diet therapy should be aimed at normalizing serum phosphorus concentration and controlling the course of secondary hyperparathyroidism. The effect of a decrease in phosphorus content should be recorded by measuring the concentration of phosphorus or parathyroid hormone in serum. When determining the concentration of phosphorus, the animal is not fed for 12 hours before sampling, since after feeding the concentration of phosphorus may increase. Thus, parathyroid hormone may be the best indicator of phosphorus metabolism throughout the body.
If a decrease in the phosphorus content in the feed does not affect the course of hyperphosphatemia or hyperparathyroidism, oral therapy with phosphorus-binding agents should be used (Table 1). The treatment is used in combination with a diet with low phosphorus, but only after the animal has adapted to the diet. These drugs should always be administered with feed.
Table 1 Some phosphorus-binding agents taken orally
Most effective in liquid form. But it is more convenient to enter it better in the form of capsules or tablets;
The most effective calcium-containing agent. Risk of hypercalcemia persists.
If the phosphorus binding agents do not normalize the blood PTH concentration, calcitriol may be used. A single daily regimen with an average dose of 2.5 ng / kg is recommended for both dogs and cats (13). After starting therapy with calcitriol, it is necessary to regularly measure the concentration of calcium and phosphorus in the blood serum.
It is beneficial to limit protein in uraemic animal feed
The reduced ability of the kidneys to excrete both nitrogenous and nitrogen-free protein breakdown products is considered one of the main causes of uremia symptoms in dogs and cats with renal failure. There have been studies that have shown that reducing dietary protein intake can benefit animals with uremia. In addition to reducing the level of protein catabolites, restricting protein intake also contributes to:
However, excessive restriction of protein content can lead to additional problems. Uremia is a catabolic condition that negatively affects some aspects of protein metabolism. Renal failure can also lead to increased urinary loss of protein or specific amino acids. Protein requirements in dogs and cats with chronic renal failure have not been established, but it appears that they may be different, likely higher than those in healthy animals. Therefore, it is important that only high quality proteins are used when developing low protein diets to minimize the risk of essential amino acid deficiencies.
Very low protein diets can be poorly absorbed and lead to protein starvation in dogs with chronic renal failure (as indicated by weight loss and decreased serum albumin levels) (14,15).
Other side effects in dogs are possible, including hypertension, elevated ionized calcium and serum cholesterol levels (16). These findings lead to a recommendation that protein intake should not be less than 1.9 g / kg bw / day (approximately 11 g protein / 400 kcal Metabolic Energy [EE] in a 10 kg dog diet) unless further required. decreased suppression of uremia symptoms (15). In cats, the risk of protein starvation is even greater due to their inability to regulate the activity of liver enzymes associated with protein catabolism, even when dietary protein intake is low (17).
The use of low protein diets has been evaluated in studies in dogs and cats with symptoms of uremia. Such a reduction in protein content in the feed in the early stages, before the onset of clinical symptoms, would be appropriate if it played a significant role in slowing the progression of renal damage. However, we do not have clear data to support these beliefs for both dogs and cats.
The suggestion that a decrease in protein content could slow the progression of renal failure arose from experimental studies in partially nephrectomized rats. After a significant reduction in renal tissue in the surviving nephrons, a number of structural and functional changes occur, including glomerular hypertension, hyperfiltration, and hypertrophy. It can be assumed that glomerular sclerosis, and therefore the development of renal damage, arise as a result of these continuous adaptive changes. High protein intake in renal injury plays a role in increased perfusion, but it has been shown that a decrease in protein content in the feed from 24 to 6% reduces hemodynamic changes and slows down the development of destruction of renal tissue (18,19).
The results of studies in dogs suggest, however, that extrapolation of data from rats to dogs is not correct, although this remains controversial. Numerous studies have not found the effect of protein content in feed (as opposed to phosphorus) on the development of renal failure (2, 20, 21). In addition, studies of the effect of dietary protein content on glomerular filtration rate in a single nephron, glomerular capillary pressure and glomerular volume have shown that there are some differences between rats and dogs in response to kidney removal (22,23).
Finally, there is little evidence to conclude that very high dietary protein intake is undesirable in dogs with chronic renal failure. Robertson et al. in a 4-year study of dogs with induced renal failure found that a diet providing over 50% MA from protein was associated with greater renal damage in dogs than a diet providing about 31 or 18% MA from protein (21).
, it is clear that moderate protein reductions are desirable in the management of chronic renal failure in dogs, as high protein diets may be associated with more acute clinical problems, laboratory abnormalities, and kidney damage. Treatment should be such as to avoid excessive protein restriction. there is a risk of protein starvation and other possible side effects. The need to reduce protein intake as much as possible is also debatable. there is no evidence of the development of renal failure with a reduced protein content. Thus, it seems logical to recommend in each case individual therapy, based on the severity of the disease and individual reactions.
The main approach here is to use different feeding strategies for dogs with different stages of renal failure (24) (Table 2). Dogs with azotemia but no uremia should be fed a diet with low phosphorus (but not protein). For this stage of the disease, a diet with low phosphorus and medium protein (PEDIGREE Low Phosphorus, Medium Protein) is suitable. This food contains a reduced amount of phosphorus and a moderate amount of protein, high concentrations of which are detrimental to dogs with chronic renal failure. A pronounced effect of this diet has been shown in a clinical study in dogs with moderate to mild renal impairment (25).
Table 2 Stepwise treatment of chronic renal failure in dogs (according to Brown, 1995) (24)
Free access to fresh water. Normal protein intake. Decrease in phosphorus content /. phosphorus binding agents. Restriction of sodium in the presence of hypertension. Potassium supplementation to maintain eukalemia. Alkalinization to maintain plasma bicarbonate levels
PEDIGREE Low Phosphorus, Medium Protein feed
Free access to fresh water. Decreased protein content. Reducing phosphorus /. phosphorus binding agents. Potassium supplementation to maintain eukalemia. Alkalinization to maintain plasma bicarbonate levels. It is possible to use erythropoietin in case of anemia. Calcitriol is useful.
Depending on the severity of uremia: PEDIGREE Low Phosphorus, Low Protein or: Mixture of PEDIGREE Low Phosphorus, Low Protein and PEDIGREE Low Phosphorus, Medium Protein (Table 3)
Recommendations for dogs with a more pronounced stage of uremia are to limit the content of protein and phosphorus in the feed. In these cases, a low phosphorus, low protein diet (PEDIGREE Low Phosphorus, Low Protein) is better, although a mixture of the two is better to personalize protein intake (Table 3). In any case, careful observation should be carried out in order to assess the effectiveness of diet therapy and monitor the change in the condition of the sick animal in case a modification of the treatment regimen is required.
Table 3 Protein and Energy in PEDIGREE Low Phosphorus, Low Protein and PEDIGREE Low Phosphorus, Medium Protein Blends
PLPLP. PEDIGREE Low Phosphorus, Low Protein
PLPMP. PEDIGREE Low Phosphorus, Medium Protein
For cats, the situation is even less clear. There are still discussions about the effect of a decrease in protein content in feed on the development of renal dysfunction (26, 27). One study showed that reducing protein and energy levels in food and energy limits proteinuria and glomerular damage in cats with induced renal failure. However, no effect on the glomerular filtration rate was found (26). Unfortunately, the study did not differentiate the effects of protein and energy restriction.
Given the uncertainty of these data, it is unclear whether lowering protein is effective in non-uremia cats with early renal failure. The PEDIGREE Low Phosphorus, Low Protein Diet Study has shown that protein in the diet is adequate to maintain nutritional requirements in cats with spontaneous chronic renal failure, so the risk of protein starvation is minimal with this diet (11, 12). Thus, further research is needed on the effect of a low protein diet on the development of renal failure in cats; however, it is recommended to use diets with low m protein in cats, taking into account the manifestations of azotemia and hyperphosphatemia, if, despite the normal water supply, they persist, even when signs of uremia do not appear.
potassium in the diet for most cats with chronic renal failure should be elevated and monitored regularly
Hypokalemia has been shown to be the most common abnormality in electrolyte-forming ion exchange in cats with chronic renal failure. In one study, hypokalemia was found in 30% of cases (28). It appears that increased urinary potassium may be the primary sign of renal abnormality in cats with chronic renal failure, which can lead to depletion of potassium in the body if the level of potassium in the diet is low. potassium in the diet used in the study was 0.34% of the dry matter of the feed. This result suggests that potassium in the diet may be inadequate for many cats with chronic renal failure. Diets used to treat cats with this condition should contain at least 0.6 g potassium per 400 kcal MA. This level of potassium in the diet has been shown to be adequate to maintain normal serum potassium in cats with chronic renal failure (11,12).
However, not all cats with chronic renal failure develop hypo- or normokalemia. In the studies conducted, 116 cases of this disease in cats were identified, in 30% of which hypokalemia was observed, but in 13% hyperkalemia was observed (30). In one clinical study of 35 cats with chronic renal failure (11, 12), two thirds of which suffered from more severe hyperkalemia (serum creatinine concentrations were 5.4  and 6.0 mg / dL [530 mmol / l]). Thus, potassium may reflect the severity of renal failure. These observations highlight the need to monitor potassium status in cats with chronic renal failure and may need to be supplemented or assessed on a case-by-case basis.
Calcium levels should be assessed individually for each affected animal.
The blood calcium concentration in animals with chronic renal failure can be low, normal, or high (14, 31, 32). Decreased levels of ionized calcium, if any, may play a role in increased parathyroid hormone secretion (3). Many factors may be involved in the onset of hypocalcemia, including hyperphosphatemia, poor gastrointestinal absorption associated with decreased calcitriol levels, and decreased calcium intake due to anorexia. It is recommended to feed feed with normal m calcium or add calcium to feed for animals with chronic renal failure (33).
On the contrary, if the product of the concentrations of calcium ions and phosphate in the blood exceeds the product of the solubility of calcium phosphate, calcification of soft tissues may occur, leading to the development of renal damage (determination in sick people allows us to conclude that the product of calcium x phosphorus concentrations cannot exceed 55 mg / dL) (34). Adding calcium is desirable in the presence of identified hypocalcemia, contraindicated in the presence of hypercalcemia.
sodium in feed should be moderately reduced
Sodium homeostasis is initially maintained in the kidneys. In case of a disease, when the glomerular filtration rate decreases, the surviving nephrons increase their share of sodium excretion in order to overcome the deficit by increasing the load. In general, this response is necessary to maintain sodium equilibrium as long as the condition allows it. However, the kidney’s ability to adapt to changes in sodium intake is progressively limited (35).
There is controversy regarding the prevalence of hypertension among dogs with chronic kidney disease: some studies suggest that it is 58-93%, others suggest lower rates (36-38%). Systemic hypertension has also been observed in cats due to chronic renal failure, although there is much less data on this than for other animal species.
Having hypertension can be important for two reasons:
The goal of treatment is, therefore, to lower blood pressure in patients with confirmed hypertension (40). It has been shown that an increase in extracellular fluid volume, hypertension and edema can be observed in dogs with uremia, receiving normal or high amounts of sodium in the diet (41). These data suggest that traditional dietary sodium recommendations are in many cases unacceptable for chronic renal failure.
In contrast, severe sodium depletion should also be avoided. It may contribute to a decrease in extracellular fluid volume in some dogs with chronic renal failure that are unable to adapt to varying sodium intake. It can also lead to a decrease in the ability to reabsorb bicarbonate, and thus to participate in the development of metabolic acidosis. However, the latter effect was not observed when animals were fed a diet containing 0.25% dry matter (DM) sodium (35.42).
Based on these considerations, much of the nutritional recommendation is for “normal” or “moderately reduced” sodium intake in dogs with chronic renal failure. The recommended limits are 0.25-0.8% DM (35), and 0.1-0.3% DM (40, 41). Diets focused on the treatment of chronic renal failure should also have a lower sodium concentration than the regular feed that the animal has previously received. This difference is the most important reason for the recommended gradual use of diet therapy (over 1-2 weeks), since the ability to quickly adapt sodium excretion in response to changes in its absorption is impaired with the development of renal failure (41).
Specific pharmacotherapy can be retained in cases where hypertension is established.
Purina Veterinary Diets NF
This food is often praised by owners of cats with kidney disease, and its effectiveness has been confirmed by veterinarians. Even those cats that do not like dry food too much and, due to illness, in principle, have lost their appetite, at least a little, but still eat Purina Veterinary Diets NF.
The owners of the animals emit a significant lack of food. a strong and pungent odor. The granules include corn, rice and wheat flour, corn gluten flour, animal fat, egg powder, pea fiber, fish oil, minerals, yeast. protein within normal limits for kidney disease. 26%.
- 350 g. 350 rubles (175 UAH);
- 1.5 kg. 1215 rubles (607 UAH).
Hill’s Prescription Diet K / D Feline Renal Health
Switching to this feed will reduce the amount of protein and urea, which indicate impaired kidney function. The minimum protein component of the granules is a guarantee of the absence of toxic metabolic products. Thanks to the presence of Omega-3 and Omega-6 (polyunsaturated fatty acids), the animal remains active, it improves the condition of the skin and coat. Granules are made from milled rice, corn gluten flour, animal fat, chicken and turkey flour, and other ingredients.
Purr owners note that the food helps emaciated and weakened animals gain weight. After switching to Hill’s Prescription Diet K / D Feline Renal Health improves appetite in cats, and veterinarians see positive changes in test results after a few weeks.
The disadvantages of feed can be attributed only one thing: over time, such food becomes boring to the animal.
What will you learn from the article
In case of kidney disease, improper diet can significantly shorten the life span of cats. Natural food can even be harmful, so medicated feed is literally salvation. In this article, you will learn what kind of food to feed a cat with kidney disease.
Representatives of artificially bred breeds suffer from kidney problems. Veterinarians often group most kidney diseases (usually only urolithiasis is usually diagnosed separately) as renal failure to simplify classification.
The presence of such a disease in a cat suggests that the animal’s body cannot (completely or partially) get rid of metabolic products that are usually excreted in the urine. Too many toxins enter the bloodstream, which can lead to the early death of the animal. Daily food plays a huge role in the treatment and prevention of kidney failure and other kidney disease in cats. therefore it is critical to know the best species.
Best cat food for kidney disease
There is an opinion that in case of kidney diseases, it is impossible to feed cats with dry food, because this way the animals are forced to drink a lot, and the kidneys will not cope with the load. In fact, a properly selected high-quality holistic or premium dry food can significantly improve the condition of the animal.
- Eukanuba renal
- Royal Canin Renal RF23
- Hill’s Prescription Diet K / D Feline Renal Health
- Farmina Vet Life Renal
- Monge Grain Free Vetsolution Renal Feline
- Purina Veterinary Diets NF
My Pet’s been Diagnosed with Kidney failure. Now what?
Complete food designed to support kidney function in diagnosed renal failure. Contraindications are the pregnancy of the cat, the period of feeding the cubs. These contraindications, by the way, are common to all medicinal feeds listed in this article.
The granules are based on corn grits and soy protein isolate. In kidney disease, animal proteins are a real poison for animals. Animal fat gives nutritional value to the feed, and corn gluten flour, sugar beet pulp, fish oil, chicken extract and other components provide the body with vitamins, micro- and macroelements. Among the disadvantages of the composition, it should be noted the presence of salt in the feed, indicated on the package as sodium chloride.
Farmina Vet Life Renal
Crude protein in this feed is only 26%, which fully meets the requirements for medicated feeds designed for cats with kidney disease. Farmina Vet Life Renal has a fairly high level of polyunsaturated fatty acids and carbohydrates that are easy to digest.
Pet owners note that their pets usually like this food. Cats and seals in 3-4 weeks notice an improvement in their well-being, become more affectionate, purr more often.
How to feed a cat with kidney failure
Monge Grain Free Vetsolution Renal Feline
Unlike the other feeds analyzed in the article, Monge Grain Free Vetsolution Renal Feline is grain-free, which means that it is perfect for animals who are allergic to corn, rice, etc. The main component of the pellets is freeze-dried chicken, but no more than 24% of crude protein in the feed.
Indications for switching to this food are not only various kidney diseases, but also anorexia, metabolic acidosis, and depletion of the body. In most cases, this food can only be obtained from veterinary clinics. Animal owners do not distinguish other disadvantages of feed.
How to feed a dog with kidney failure: choosing the right diet
Kidney failure is one of the most difficult and frightening diagnoses that a dog can be diagnosed with. But the breeder should not give up on hearing him: today there are quite effective methods of treatment that can seriously lengthen the life of a dog suffering from this pathology. A huge role in the treatment of the disease belongs to a properly selected diet. Veterinarians believe that good food is a 70% guarantee of improving the quality of life of a sick dog, and in some cases good feeding can contribute to the onset of remission. So what to feed your dog with kidney failure? Let’s find out!
In general, “renal failure” is not called any specific disease, but a syndrome caused by a wide variety of pathologies: from benign kidney tumors to infectious diseases and poisoning with heavy metal salts. So the approach to choosing the optimal nutrition should take these nuances into account without fail. It should also be remembered that with this disease there are two main negative points: azotemia and uremia. If not to complicate, then both of these conditions are characterized by a sharp increase in the content of nitrogenous bases in the blood, which causes severe intoxication of the body. However, about everything in order.
What are the goals of nutritional therapy for renal failure??
It should be noted that in case of renal failure, it is extremely important to maintain a normal water-salt balance of the body, since the animal urinates a lot and often, and also to monitor the level of protein. In addition, feeding dogs with renal failure should have the following goals:
- Sodium bicarbonate is added to food, which allows you to relieve acidosis.
- It is necessary to give food containing a reduced amount of phosphorus. Research by Peter J. Markwell BSc, BVetMed, MRCVS from Great Britain proved that in this case it is possible to significantly slow down the development of the pathological process.
- It is extremely important to observe the correct level of protein: if there is a lot of it, the condition of the animal will only worsen due to the rapid development of azotemia, if not enough, a state of protein starvation will come, which is fraught with cachexual edema.
So, what kind of dog food with kidney failure should you use??
Types of food used
First, you should turn your attention to specialized medicated foods, which are produced by almost all major dog food manufacturers around the world. For this, it would be best to consult with an experienced veterinarian. Of course, not all dog owners have the opportunity to spend money on the purchase of such food, and therefore we give a list of those products that can and cannot be included in the diet of a sick dog:
- Shown in small quantities: rabbit, chicken, beef. It is quite possible to give waste of meat production, but only in the case of their sane quality. This is especially important if the dog has lost weight. By-products are allowed (good liver, heart and kidneys). It is important to remember that in the early stages of the disease, the amount of protein may be almost normal, but it should come from quality foods. For old dogs, it is advisable to cut the amount of meat and offal to a minimum.
- Cereals. to limit as much as possible, since they contain a lethal dose of carbohydrates, and they are extremely contraindicated in chronic renal failure.
- Bones. only in the early stages. In all other cases, they are completely excluded from the diet.!
- But the dog should get a lot of fat. You can give directly pressed vegetable oil, chicken or rabbit fat. Vegetable oils are especially important as they are high in vitamin E, which is a powerful antioxidant.
- Vegetables will be useful to the dog. In order for him to eat them, the food is passed through a blender and chicken or rabbit broth is added. It is important to remember that the diet for dogs with kidney failure should eliminate stress, so it is not worth forcibly stuffing raw carrots into the dog.
- Do not forget to add complexes of water-soluble and fat-soluble vitamins to food. But! Vitamin A is strictly contraindicated! The veterinarian treating your animal should tell you more about this.
Important! Never give your dog fish oil if you have kidney failure! Yes, it contains many vitamins and minerals, but fish oil contains a lot of vitamin A, and we have already said that it is contraindicated for sick kidneys (especially in such doses).
Oddly enough, garlic is very useful (no more than a clove per kilogram of feed), which contains a lot of folic acid. Since bones are contraindicated in the diet of a sick dog, it is useful to add ground sesame seeds, which are very rich in calcium, to food. Remember that vegetables are poorly digestible food for canines, and therefore veterinarians prescribe digestive enzymes that must be given at every feed! Here’s what to feed a sick pet.