Canine Kidney Disease

CKD Diet

Recently my 4-year-old dog, Oliver, was diagnosed with what the vet assumes is Chronic Kidney (Renal) Disease (CKD). K/d tends to be something an older dog develops much later in its life. For that reason, my vet thinks it could simply be a congenital issue.

A bad hand to be dealt, especially for such a young dog. So, like any dog owner and nerd, I both listened to my vet and turned to the internet to do some research on how to prolong my little guy’s possible lifespan, quality of life, etc.

I decided to write down all my findings in hope that maybe someone else turning to google can read this as a layman’s adventure through the digital world of sometimes contradicting k/d (kidney disease) dog diet information.

Disclaimer

I’m not a vet, don’t listen to me.

What My Vet Told Me

I’m going to paraphrase a bit here, but here’s the professional advice I did get from my vet about the situation after we did some bloodwork/urinalysis.

1. I got a prescription for special “kidney” dog food
2. He mentioned some folks give their dogs with k/d something called “Epakitin”
3. He briefly mentioned that conventional renal support diets included a reduction of protein, but that may not be the case anymore
4. He mentioned that some people are really into “herbal” medicines for dogs with k/d, but provided no additional detail - likely because it’s unsupported by real scientific research

Prior to diagnosis, Oliver was already eating a mix of chicken flavored Hill’s Science Diet Adult Sensitive Stomach & Skin (Small Breed) / basic Hill’s Science Diet Adult (Small Breed) food. He always seemed to do well on that, and I don’t think Hill’s is considered a “bad” or “cheap” brand as far as kibbles go.

So, naturally I took my perscription went on chewy.com and bought the chicken flavored Hill’s Prescription Diet k/d food and a bottle of Epakatin.

This seemed like safe start, but I knew there was probably more I could do for the little guy, so I went to the internet …

The Basics of Renal/Kidney Failure in Dogs

The basics of managing k/d in dogs is to change the dog’s diet. This includes some pretty specific guidelines, not terribly different from the same guidelines provided to humans with kidney issues.

1. Hydration (Water)
2. Mineral & Electrolyte Management
3. Protein
4. Anti-Inflammatories, Antioxidants, Microbiomes, & Vitamins

We’ll dive into each of these major categories.

Hydration

Since a diseased/damaged kidney is not as effective at filtering waste products from the body via urination you must consider your dog’s hydration. After-all, apparently the first “sign” of kidney issues is an increase in a dog’s thirst…I never thought Oliver was an unusually thirsty dog, but then again who pays that close attention to their dogs drinking habits?

With this in mind, you should give your dog a good supply of clean, filtered, fresh water. This was the easiest adjustment for me. Prior to diagnosis, Oliver drank out of a bowl in the kitchen which I’d fill with sink water when it was empty or low - pretty standard. Instead, he now has a 1 gallon “Replendish” gravity waterer that I bought for $12 on Amazon. The “Petmate” brand I bought also comes with a little slot for a small charcoal filter to help further filter the water. You can buy replacement packs of 12 filters for around $11. So…this was as cheap and easy adjustment to make - plus I don’t have to check the water nearly as often (the 1 gallon lasts at least 3-4 days between Oliver and my other small dog, Bailey).

Hydration is also the biggest “argument” against a prescription kibble diet. Dry kibble takes more moisture from the body to digest properly, and a lack of moisture makes the kidneys work harder to filter toxins through the renal systems. Dry kibble foods “further dehydrates a dog that is already dehydrated.” Thus, if you serve your dog a more moist food their kidneys should have less strain put on them.

Although his prescription food does seem a little more oily than his old kibble, at the end of the day, it’s still a dry food.

The food on the left is the normal small breed Hill’s compared to the slightly larger prescription kibble size. Both are fairly dry at the end of the day.

The easiest solution for this is just to add some water to your dogs kibble, and that would work great if Oliver wasn’t a picky eater to begin with. Serving him a bowl of mushy kibble tended to result in a skipped meal and me eventually being forced to toss out quite expensive prescription dog food. Not ideal, especially because a sign that the kidneys are getting worse is a loss of appetite. Watching your dog not eat for 2 days because he doesn’t want kibble soup is distressing.

Also, for the record, Hills’ does make a wet, canned k/d dog food that I have yet to try.

Mineral & Electrolyte Management

One of the most important aspects of a k/d diet for dogs is a drastic reduction in dietary phosphorus. Additionally, a general reduction in sodium is important - so never use salted ingredients, give salty treats, and never add salt to anything you give your dog.

Finally, in the later stages of renal failure a potassium deficiency can occur. When a dog is low on potassium it increases their chances of heart failure, and other bad things that I’m not educated enough to talk about, but extremely high or extremely low levels of potassium is bad. If additional potassium supplements are needed, buying potassium gluconate online is very cheap - I would avoid the overpriced products like Vetoquinol Renal K+. Green beans are apparently a nice natural source of potassium. However, I wouldn’t personally supplement potassium unless directed to by a professional after some recent bloodwork.

Minerals for Phosphorus Management

One thing you can do is give your dog minerals that naturally bind with phosphorus in the gut to reduce the quantity of phosphorus reaching the kidneys. In humans, they tend to do this with Calcium Carbonate (among other things). Fortunately, calcium carbonate is found naturally in egg shells. So if you choose to give your dog some egg whites, you can grind up the shell into a powder and mix that in for “bonus” calcium carbonate in the diet.

The expensive powder my vet suggested, Epakatin, is basically an equal mixture of Calcium Carbonate and Chitosan. I don’t know much about chitosasn, but basic research seems to confirm that at the very least it can’t hurt to add it for k/d management.

Both calcium carbonate and Chitosan you can buy in bulk online very easily for much cheaper than the unique “formula” provided by the Epaktain.

For a cost comparison, the Epaktain was $27 and came in a container of 2.16oz. That’s $12.50 per oz. of powder.

Buying in bulk, you can get 2.2lbs of Calcium Carbonate for $19, and 2.2lbs of Chitosan for $69. Up front that’s obviously more money. However, spending $88 for 4.4lbs (70.4 oz) of powder gives you a cost of $1.25 per oz of your home-made “Epakatin.”

Protein

This is a contentious topic when it comes to canine k/d it seems…

There seems to be a strong argument that a lower protein diet slows the progression of CKD by decreasing kidney workload in relation to excretion of protein related waste products.

However, dogs are natural omnivorous - their biology expects protein to maintain healthy muscle mass, etc. So you cannot cut protein out entirely (especially when your dog is only 4 years old.)

With protein the Internet seems to agree that a measured approach is best - don’t go overboard with an all meat diet, but also don’t cut it out and go full vegan on your dog.

Volume aside, the general consensus on the Internet is that the quality of the protein is important. Unseasoned raw meats will absolutely contain more moisture than any dog food kibble will. This extra moisture will make the proteins easier to digest and utilize throughout the body.

However, you cannot just throw any protein at your dog and expect it to be fine because of our arch-nemesis in k/d - phosphorus.

Some meats, such as ground beef, green tripe (apparently excellent, but a bit hard to find), egg whites, or dark-meat chicken will have less phosphorus per oz than other meats like pork, egg yolks, and fish. Since one of your objectives in k/d diets is to minimize phosphorus, you have to pick your proteins carefully.

Additionally, some protein-rich vegetables like peas can be supplemented to add a non-animal based protein, thus further reducing phosphorus but still providing important proteins.

Fats & Oils (Anti-Inflammatories)

I found a lot of conflicting information on fat and oils.

Fat

Some articles claim that fat is low in phosphorus so it “will increase caloric intake” and is “a good choice for younger dogs with genetic kidney disease.” Per usual though, this does not seem to be universal advice. I found several articles that referenced “the leanest beef possible”, “lean beef”, and “defatted beef”, or straight up just turkey/chicken since it’s leaner than beef to begin with.

Oils

It seems that almost everyone agrees giving your dog some Fish Oil (Salmon) for the Omega-3’s (EPA/DHA) is a good idea. These are good for a dogs coat, are anti-inflammatory, and apparently they have some sort of special interactions with proteins in the gut that may be beneficial for the kidney. “Fish Oil” does not extend to liver oils though because they are too high in Vitamin D which is difficult to process in the kidneys (This is true for raw organ meats as well like liver or heart).

I found almost universal agreement that Omega-6 will kill your k/d dog (“hastens the decline of kidney function”). So whatever you do, avoid all other oils like vegetable, canola, corn, soy, sunflower, or flaxseed.

Omega-9’s on the other hand have to seem no major effect on the kidney, so olive oil is fine - but why on earth would you give that to your dog anyway? Save that for your dinner.

The final debate I saw online was around Coconut oil. My dogs both love coconut oil, which I was giving to them once and a while on treats. Coconut Oil contains roughly 2% Omega-6, which we already established are bad. It also contains roughly 5% Omega-9 which we established were neutral. However, it contains roughly 93% “MCT” oils, or Medium-Chain Triglycerides. The jury is still out on coconut oil, but from what I can tell it won’t hurt. MCT’s are essentially a digestible fat that might provide some energy to your pup, and the 2% Omega-6 probably won’t be enough to rapidly accelerate k/d.

Antioxidants, Microbiomes, Vitamins, & Other Stuff

For a dog with k/d you want to generally do the following:

• Increase antioxidants
• Promote a healthy gut biome to aid digestion
• Supplement additional B, E, and C vitamins, but avoid D vitamin.

What that really boils down to is you can give your dog probiotics and some dog vitamins if you want. Dairy based “probiotics” like greek yogurt should be avoided, though, since dairy tends to be higher in phosphorus.

Other Stuff

You’ll read about a lot of “things” that may also help.

A short list includes: CoQ10 supplements, L-carnitine, Astragalus Extract, and Rehmannia Root. From what I can tell, these things are not going to hurt in moderation (Even Hill’s Prescription lists L-carnitine as an ingredient). If you give your dog an entirely raw diet, you may consider these things.

I also read a lot about beets. They may be helpful, either as a powder or raw. Some fruits are fine too, like apples, blueberries, and raspberries. If you really want to include carbs for some reason, white rice (although there’s some debate on white vs brown vs “wild” rice…), or a small amount of sweet potato seem to be acceptable.

A small, somewhat random note, there’s something about k/d dogs and the acidity of their urine. So avoid cranberry or other “bladder” supplements traditionally designed to increase urine acidity to fight off bladder/UTI infections. The Hill’s Science prescription is labeled with something fancy called “S+OXSHIELD” which is supposed to be non-acidifying, so just be careful with what you feed your dog and it’s effect on diet acidity.

What I’m Going To Feed Oliver

Well, this was a lot of random Veterinary information for what’s supposed to be a technology blog. So what’s the tl;dr of what I’m going to feed my kidney troubled dog?

I will continue to feed him the Hill’s prescription kibble. I trust the science behind the “special” formula they’ve come up with over there. There’s also lots of great vitamins, oils, and other helpful things in the kibble. Plus, Oliver doesn’t hate it.

However, I will also supplement it with my own mix of “Epakatin”, eg. bulk Calcium Carbonate/Chitosan and give him ~2 grams per day. I will also give him a tablespoon or so of some fish/salmon oil (this makes his food taste better anyway). I am still undecided on what to do about the coconut oil.

To make him “want” his kibble more, I will probably blend/mash up some peas, green beans, and carrots into a sort of terrible baby food to mix into his kibble to make sure he’s getting extra moisture (to offset the dry kibble) but also provide a natural source of fiber and highly bioavailable vitamins.

I will treat all protein additions as optional, but frankly, Oliver enjoys them - and if his lifespan is going to be cut short by chronic kidney disease my little guy might as well enjoy his meals. Plus, the research (especially for a younger dog) around significantly reducing all proteins seems dubious.

I will probably give him some egg whites with his breakfast, since hard-boiling a few eggs a week is cheap, plus Bailey can eat the yolks since she’s kidney healthy. The egg shells can be ground up in a mortar and pedestal and sprinkled over for free calcium carbonate (or into your garden).

I will, in very small amounts, add in some 90% lean/10% fat, or 93% lean/7% fat ground beef to his food once and a while to encourage him to eat and maintain muscle mass.

I might give him the occasional dog multi-vitamin as a treat since it has probiotics, CoQ10, and some other not-so-bad things in it, especially in moderation.

That’s it. All that reading, all that research, and we have an incredibly specific diet. Whew, thanks…Internet? I hope I don’t acidentally make things worse?

Note

If your dog is diagnosed with renal failure, please read up and ask your vet about Addison’s Disease / Atypical Addison. It’s a common misdiagnosis and is more treatable if you get ahead of it.

References

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• https://wagwalking.com/treatment/natural-remedies-for-kidney-failure
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