Can someone talk to me about

OK this is what my friend sent to me! Hopefully you can do something about it.

Here is the kidney failure info. Diet is a (the) huge part of current protocol.

You may see some repetition, because it's three+ different sources, but please read it all, because they differ slightly. All three are (in my opinion) authoritative and reliable, and each one includes info that the others do not.
If at all possible, everything I have read about chronic kidney failure would prefer fresh real food, with all the natural fluid that's in real meat, etc.

Canned is the next choice.

(Kibble isn't appropriate because of the dryness...... more below.)
Nutrition plays a big part in the comfort of the rest of the dog's life, according to all the recent vet monographs I just read.

Nothing I read anywhere, except on the sites of the manufacturers, supports a diet of a food with corn products in a high ingredient spot (or anywhere) for ANY dog, much less a chronically ill dog.

The vets have been educated by the salespeople or by the courses, brochures, and glossy material the manufacturers provide, IMO.

A lot of info follows from authoritative sites that I have found to be reliable in the past, and I personally trust.

You might want to print it all out for your friend, or maybe all you want is the bottom line.

The bottom line so far, IMO, is this: The dog needs either homemade food or a good-quality canned food. One example of a good canned food is Wellness Super5Mix Senior Canned Dog Food, described below.

Hydration is vital, and water shouldn't be withheld even if he becomes a house dog and has to go out to pee in the night. Fluid intake should be monitored and encouraged, and his weight should be monitored too.

About a vet: I'd probably call around and ask about nutritional experience with chronic renal failure. OTOH, it's totally reasonable to read up yourself, and educate your current vet.

Here's one important paragraph from below: "[He] should be encouraged to eat an amount of food to maintain weight and provide the appropriate nutrition. To increase the appetite, it may help to feed several small meals a day, to enhance the palatability of the diet with additives such as cottage cheese, yogurt, or chopped up vegetables, or to add a medication that stimulates appetite. Warming the food may also increase the palatability. Do not feed hot food as burns may result. The appetite may come and go during the day, so try feeding at various times during the day. Food-induced nausea may happen at certain times of the day and not at other times. Medication to control nausea may increase the appetite also."

From PetEducation.com, "Owned & Operated by Practicing Veterinarians":

Treatment of chronic renal failure (CRF)

Chronic renal failure is characterized by irreversible lesions within the kidney. In most cases, improvement of the renal function should not be expected once the body has compensated as much as possible. If the renal failure is prerenal (caused by a disease other than actual kidney malfunction that decreases the blood flow to the kidney) or postrenal (caused by a build-up of pressure in the urinary system from an obstruction, for example) components, it may be partially reversible with treatment. Renal function in chronic cases tends to be relatively stable for weeks to months baring unforeseen changes. Function does progressively deteriorate over weeks to months to years. The clinical and biochemical consequences of reduced renal function can be minimized by symptomatic and supportive therapy.

Many times, the earliest signs of CRF are missed by owners. These include a mild to moderate increase in thirst and urination (polydipsia and polyuria) and a need to urinate during the night (nocturia). Other common early clinical findings include variable weight loss, poor hair coat, lethargy, and selective appetite. As the condition progresses, more signs appear.

If the cause of the CRF can be identified, it should be treated if possible. Many times, the condition is found in older pets and is due to age.

Fluid therapy: The fluid need is greater in the CRF patient because the patient is unable to concentrate the urine so more water is passed out of the body in the form of urine. In earlier stages, patients may be able to maintain fluid balance by continuing to eat and increasing the amount of water consumed. The fluid level needs to be maintained to prevent dehydration. As the disease progresses, additional fluid in the form of subcutaneous (SQ) fluid may be necessary. Owners can typically give these fluids at home after being shown how at the veterinary clinic. The addition of potassium to the fluids or to the diet may be necessary to maintain proper levels of this electrolyte in the body. Low potassium levels cause generalized muscle weakness and heart rhythm disturbances. In some cases, intravenous (IV) fluids may also need to be given.

The pet should always have free access to fresh, clean water. Withholding water at night will not decrease the pet's need to urinate overnight and may cause an acute crisis. The amount of water and food consumed each day should be monitored so the owner knows whether the pet is eating and drinking normal amounts. If not, additional fluids (IV or SQ) will be necessary to maintain hydration.

The body weight should be checked every week to make sure enough calories are being consumed to maintain weight and that dehydration is not a problem.


Diet: The veterinarian may recommend a diet change to a lower, but high quality, protein diet, which may decrease the stress on the diseased kidneys. Often, canned food is recommended. The change may need to be done slowly to keep the pet eating. The protein restriction cannot be excessive or the pet may develop protein malnutrition due to loss of protein via the kidney or the gastrointestinal tract that is not found in healthy pets. The diet should be monitored by checking the pet's weight, checking for anemia, and checking for hypoalbuminemia. If these are present, an increase in protein content may be necessary. ..............

Pets should be encouraged to eat an amount of food to maintain weight and provide the appropriate nutrition. To increase the appetite, it may help to feed several small meals a day, to enhance the palatability of the diet with additives such as cottage cheese, yogurt, or chopped up vegetables, or to add a medication that stimulates appetite. Warming the food may also increase the palatability. Do not feed hot food as burns may result. The appetite may come and go during the day, so try feeding at various times during the day. Food-induced nausea may happen at certain times of the day and not at other times. Medication to control nausea may increase the appetite also.

Electrolytes, vitamins, and fatty acids: Electrolyte levels need to be maintained in the normal range. The phosphorus intake may need to be decreased to help serum levels remain normal. Phosphate binders may be used when diet changes and fluid therapy do not keep the phosphorus level in the normal range. Calcium supplementation may be necessary as well as vitamin D therapy. Salt intake needs to be adequate to help maintain hydration and to give the food flavor but not too high that it worsens hypertension. Decrease the salt content of the food over several weeks to allow the kidneys to compensate for the change. Potassium levels should be monitored and a supplement given if necessary.

Water soluble vitamins (B and C) should be supplemented, especially during times of poor eating. Supplementation of vitamin A and D beyond the minimum daily requirement is not recommended due to a build-up of vitamin A and the changes in their metabolism of vitamin D in renal patients.

Omega-3 fatty acid supplementation may be of benefit to animals with chronic renal failure.
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By Dr. Larry Siegler:

For many animals, a diet with HIGH QUALITY protein will be better than a low-protein diet. Typically I recommend a home-made diet for my patients with CRF/CIN that addresses their individual needs. Low-protein diets, if not carefully managed, can lead to malnutrition. IF a low-protein diet is necessary, a canned formula designed for senior animals may be an option.

(Example: Wellness Super5Mix Senior Canned Dog Food


This natural formula contains high quality digestible protein, yet the protein levels have been reduced for the nutritional needs of older dogs, including Vitamin C and the presence of chelated minerals.)

Dry food is not a good option for animals with kidney problems.....

Hydration is extremely important for animals with kidney disease. Inappropriate diet is thought to be one of the contributing factors to chronic renal failure.

Nutritional Supplements

Omega 3 fatty acids from marine fish oil have been shown to slow the progression of kidney disease in a clinical trial with dogs. The anti-inflammatory action of the Omega 3‚s may reduce kidney inflammation. Vitamin E is often recommended along with the Omega 3 oils as they act synergistically. The dosage for Omega 3 fatty acids can generally be increased up to twice that recommended on the product label, but reduce the dosage if loose stools result.

I also recommend B-complex and vitamin C to help replenish the vitamins lost due to the inability of the kidneys to recycle and retain these nutrients in the body properly. Some dogs and cats appear to have a better appetite and feel better when given B vitamins or an appropriate vitamin-mineral complex.

Additionally, potassium supplementation may be necessary for some animals.

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Renal Failure and Diet

Q: Dear Doctor, We have a three year old female golden retriever who was diagnosed 1 week ago with probable JRD. She was critically ill at the time. We were given a list of instructions for care including maintaining a low-protein diet. Because she had no appetite we have been preparing her meals. We have learned quite a bit about the benefits of a low-protein diet high in amino acids. Our problem is we have not been able to find out what the daily allowance of protein in grams should be. We are feeding her small meals 4 times a day, this appears to be working well and she has not had a vomiting episode in 4 days. She weighed 36 pounds at the of her diagnosis, she weighs 40 today. Before her illness she weighed 54. Could you please give us some guidelines for daily protein allowance? Everything we've researched points towards this type of diet being very helpful. We know that if we can get her through this crisis we can use a prescription diet but for the immediate future we feel she needs home prepared food. We know Bretts prognosis in not good but we are going to try to do everything we can for her. Thank you for any information you can provide.

A: I think that the current thinking on low protein diets is that the protein level is not as important as the phosphorous level. In trying to evaluate these diets several researchers have come to the conclusion that they work primarily because low protein diets tend to be coincidentally low in phosphorous. There is no clear connection between the low protein levels in food and progression of renal disease in recent studies. This really doesn't matter from a practical standpoint, since the best way to keep the phosphorous in the diet low is to keep the protein level low. Phosphorous levels should be kept as low as possible, about 0.3% of the diet (basically, this is as low as is practical - it is very very hard to get the phosphorous level lower than this).

http://www.vetinfo.com/drenal.html#Renal Failure and

It is desirable to try to keep the protein level at 14 to 19% of the diet (this is an average based on the recommendations I could find for renal failure diets). For a dog that weighs 44 lbs, approximately 1350 calories are necessary for maintenance per day. This is usually supplied by about 4 cups of dry dog food, which should weigh between 350 and 400 grams. I can not find a recommendation for protein in grams/day/lb. but using the above recommendations, it would appear that 400 grams of dry dog food at 15% protein would provide 60 grams of protein. I am assuming that would be the approximate amount necessary.

In general, renal failure in dogs does have a poor prognosis. We have seen several cases of early onset renal failure in recent years in which the dogs did do quite well on controlled diets and aggressive fluid therapy. I don't know if we have just been lucky but I do think giving this a really good try is worthwhile. I wish you the best of luck.

Mike Richards, DVM

and

Question: Dear. Dr. Richards,

Why is it that dogs with renal failure become very picky about what they
eat? Princess will eat most foods only once or twice and then not even
touch it again despite the fact she tells you she is hungry and wants/needs
to eat. It's very exasperating when she tells you she is hungry, but when
you offer her all kinds of foods she will just walk away. I feel that I am
running out of options and that she will slowly starve herself to death.

Tony

Answer: Tony-

I have asked a couple of people who have kidney problems requiring dialysis
what it feels like to have kidney failure. Both of them told me that they
feel really good the day after dialysis, then gradually start to feel tired
and/or sort of like they have a mild case of the flu over the next few
days. My guess is that dogs with kidney failure have a similar experience
with just not feeling completely well. Their appetites are probably
decreased due to this and therefore food has to be a lot more attractive to
be inviting, often making it very hard to find a diet they will
consistently eat. I think there may be some association made between eating
a food and feeling bad that day, too. I think this is one of the reasons
that changing foods seems to help sometimes. Doing everything you can do
reduce the effects of the kidney disease, such as fluid therapy,
phosphorous restriction in the diet, calcitriol use (if possible), perhaps
blood pressure or angiotensin-converting enzyme (ACE) inhibitor
medications, gastrointestinal protectants like famotidine (Pepcid AC tm)
and nursing care all can help to keep a dog feeling well and more
interested in life and eating when they have kidney failure. It is a
frustrating illness to be faced with. All you can do is provide the best
chance for your dog to feel good by working with your vet and with your dog
to compensate for the kidney failure.

Mike Richards, DVM

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