Feeding changes in dogs with chronic kidney disease (CKD)

• …preserve the still functioning kidney tissue for as long as possible and have a positive effect on the disease.
• … optimize your dog’s quality of life.
• … relieve symptoms.
• … help your dog to live well with the disease for years to come.

The Kidney – a Miracle Organ

The kidneys perform numerous vital functions in the body. When healthy, they are very efficient and can compensate for a dysfunction for years. What is common is that 70% of the kidney tissue is already permanently damaged before noticeable symptoms appear. Once this has happened, all the toxins that the kidneys can no longer excrete accumulate in the body, which further destroys the kidney tissue.

Early diagnosis and immediate, lifelong treatment often slows the progression of the disease.

It is therefore all the more important to have regular kidney checks (blood count, urine values, ultrasound if necessary) carried out by the veterinarian from the age of 5 at the latest , even if the dog is not yet showing any symptoms*.

*In dog breeds with a hereditary predisposition to developing CKD, kidney checks should be started earlier.

What function does the kidney have in dogs?

Your dog’s largest filtering system is his two kidneys.
They have a variety of functions in the body:

• Purification of the blood from toxins and waste products, especially breakdown products of protein metabolism in the so-called nephrons (renal corpuscles). Dogs have an incredible 180,000 – 400,000 of these filters per kidney
• Regulation of blood pressure, fluid, electrolyte and acid-base balance
• urine production
• release of certain hormones
• biosynthesis of erythropoietin for the formation of red blood cells

Causes of CNE in Dogs

Congenital kidney damage

Breed predisposition: Dalmatians, German Shepherds, Cocker Spaniels, Poodles, Bernese Mountain Dogs, Beagles, Lhasa Apsos, Samoaeds, Rottweilers, Dobermans, Chow Chows or Golden Retrievers as well as all terrier breeds such as Yorkshire Terriers have a genetic predisposition to kidney problems

Medication: Long-term medication can trigger CKD

Age: The filtering capacity of the kidneys decreases with age

Feeding: Too high protein or phosphorus concentrations in the food can cause further problems in dogs that already have kidney problems

Diseases: Infections, diabetes, infectious diseases such as leptospirosis, Lyme disease, leishmaniasis, uterine infection, diseases of the urinary tract (such as bladder and ureter), kidney stones, kidney cysts, tumors

Traumatic influences: Injuries or temporary poor blood circulation to the kidneys caused by an accident

Environment: Chemicals and toxins that can cause kidney damage

symptoms of CNE

One of the easiest signs to recognize is frequent drinking and, as a result, frequent urination.

As the disease progresses, toxins accumulate in the blood (azotemia), i.e. there are increased concentrations of urea, creatinine or other nitrogen-containing substances in the blood, which in turn leads to poisoning of the entire organism and a variety of symptoms.

Only in the advanced stages of the disease do further symptoms appear

Increased drinking and urination

Lack of appetite, possibly with weight loss

lack of energy, listlessness, weakness

Urine-like bad breath, pale mucous membranes

inflammation of the mouth and throat

inflammation of the gastric mucosa

Recurrent diarrhea and/or vomiting

Dull coat

susceptibility to disease, frequent infections

high blood pressure

Diagnosis – what tests are necessary?

Your vet will first carry out a thorough general examination of your dog, including measuring his blood pressure . This will be followed by further tests to determine whether and to what extent your dog's kidneys are diseased:

• Blood analysis: Creatinine and urea levels are elevated because these waste products can no longer be adequately filtered out of the blood due to impaired kidney function. The sodium and phosphorus levels also provide information about the degree of damage. The biomarker SDMA (symmetrical dimethylarginine) helps to detect CNE at an earlier stage.
• Urine test: Blood, protein and sugar content provide information about kidney function and the severity of the disease
• X-ray or ultrasound: Changes in the structure, shape and position of the kidneys become visible

What does the therapy look like and what does it all have to do with nutrition?

For long-term successful treatment, it is crucial to have the therapy regularly monitored by your veterinarian .

• Drug therapy: Helps to relieve the kidneys, alleviates symptoms, slows the progression of the disease and reduces disturbances in fluid, electrolyte, vitamin and mineral balance as well as acid-base balance
• Special kidney diet: Decisive factors are a reduced phosphorus and protein content , with high protein quality, the palatability of the feed and the coverage of energy and nutrient requirements
• Adequate drinking: Your dog with kidney disease must always have enough water available - day and night . He can no longer concentrate his urine sufficiently and therefore loses too much fluid. If he cannot compensate for this fluid loss, he risks life-threatening dehydration.
• Preventing and treating diseases that cause CNE (see Causes)

What does the special kidney diet look like for your dog with CKD?

IMPORTANT: The kidney diet and prescribed medications must be continually adjusted to your dog's current blood values .

Above all, the change in diet should be implemented early , not only when serious clinical symptoms occur.

Reduced protein content with high protein quality

Protein is broken down into urea and excreted through the kidneys. The aim of a kidney diet is to reduce the accumulation of urea in the blood and at the same time provide your dog with enough protein . To ensure that there are enough essential amino acids for healthy cell regeneration, the proteins used should be very easily digestible (less toxin formation) and have a high protein quality .

Plant protein can also be a good alternative for CNE, provided it has been optimally digested . A suitable feeding plan should be drawn up by a veterinarian specializing in animal nutrition.

Reduced phosphorus content, possibly also sodium content

There are two ways to reduce the phosphorus content of feed:

• Use of a low-phosphate feed
• Use of a phosphate binder, whereby excess phosphate is bound in the intestine and then excreted in the feces

Your veterinarian will decide what makes more sense in your case.

Bones, bone meal, offal, yeast or whey have a high phosphorus content and are unfortunately taboo for CNE dogs.

Since sodium excretion is also impaired in CNE, the sodium content may also need to be reduced. You can achieve this by omitting salty food components, for example. Please make sure to discuss this with your vet beforehand. He will decide based on the blood results whether low-sodium food is necessary.

Reduced phosphorus content, possibly also sodium content

Due to the increased excretion of water-soluble vitamins in CKD, you should definitely ensure an adequate supply of vitamins and trace elements and intake of B vitamins, vitamin D, possibly potassium and iron .

Since the accumulation of toxins affects your dog's sense of taste and smell and often reduces his appetite , you should feed him particularly tasty food with a high energy content .

2-3 meals spread throughout the day relieve the metabolism and are advisable for CNE. Don't forget your treats and chews ! They are part of the kidney diet and may even have to be left out. With the right immediate measures, your dog can lead a good and happy life even with CNE. Lots of love, attention, tasty food and good dog friends make your dog's everyday life with such a serious illness much easier.

We have summarized the most important points with which you can help your dog here:

General tips for dogs with chronic kidney disease:

• Have your dog's condition monitored regularly by your veterinarian
• Avoid stressful situations for your dog
• Always discuss medication administration with your veterinarian to avoid causing a deterioration in renal blood flow
• Change the diet to a kidney diet early, not only when severe clinical symptoms occur
• Your dog with kidney disease must always have sufficient water available – day and night

Your VEGDOG team

A change in food should always be discussed with a veterinarian. If you have any questions about this illness, please contact our veterinarians at tierarzt@vegdog.de.