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Tuesday, March 27, 2012

Home-Made Kidney Diet

Sarah sent the following scenario....

My aunt has a  22 lb female beagle mix that is somewhere between 12-14 years old. She seems to be in about stage 2 of chronic kidney disease. Her family vet had her switch to Hills K/d, but her dog has stopped eating it. My aunt did some basic research and found a recipe for a home made diet that is supposed to be appropriate kidney disease. Her own vet had little to say about the diet, so my aunt went ahead and fed it. I believe the diet consists of white rice, white bread, sometimes carrots or green beans, a potato starch, and either a lean mean or hard boiled egg.  I was hoping that you might be able to point me in the right direction to find a reliable recipe for a canine kidney diet. She has also been supplementing calcium in the form of Tums tablets to bind the phosphorous. I have some understanding that it is advised to supplement calcium, but I am wondering what the most efficient way of doing this is.

I'm not a nutritional specialist, but I can see some problems with this diet, depending on the amounts used.  Making a nutritionally balanced home-made diet is always difficult, but the problems are compounded when you are making it for a medical condition.  In many disorders the correct nutrition can make or break the case, and this is certainly true with kidney disease.

Here's a recipe for a fully balanced diet that will help with kidney disease.  This comes from Small Animal Clinical Nutrition, 4th Edition (a veterinary nutrition textbook).

Daily food as fed formulation for an 18kg (40lb) dog.  Change the amounts based on the size of the dog.  Food can be weighed with a regular cooking scale or other gram scale.
Cooked white rice (may substitute rice baby cereal and flavor with meat broth during cooking)--237g
Cooked regular beef (retain the fat)--78g
Large boiled egg--20g
White bread--50g
Vegetable oil--3g
Calcium carbonate--1.5g
Iodized salt--0.5g
1 human multivitamin

For a 4.5g (10lb) cat you can use the following recipe for daily amounts.
Cooked chicken liver--21g
Cooked white rice (may substitute rice baby cereal and flavor with meat broth during cooking)--98g
Cooked white chicken--21g
Vegetable oil--7g
Calcium carbonate--0.7g
Iodized salt--0.5g
Salt substitute (KCl)--0.5g
1/2 human multivitamin
1 to 1/2 taurine tablet (500mg/tablet)

Obviously, making a balanced diet at home can be difficult and a lot of work.  But it can be done.  Using these recipes you'll meet all nutritional needs for kidney disease, as well as the calcium. 

Let's say a word about phosphorus here.  In advanced kidney disease the phosphorous level will become very high.  To keep the phosphorous low, you need it in reduced amounts in the diet (which the above diets take into account) and often with additional medications to "bind" the phosphorous in the diet, preventing the patient from absorbing it.  First, your aunt needs to talk to her vet about the phosphorous level.  If it's not elevated, there is nothing other than diet that should be done to keep the levels low.  Calcium by itself does not bind phosphorous well and is not normally used.  The two most common binders recommended are aluminum hydroxide or aluminum carbonate.  Calcium acetate may also be used, but can cause the calcium levels to be too hight.  The aluminum compounds are actually commonly found in over-the-counter antacids, as well as in specialized forms that can be easily obtained from human pharmacies. 

Sarah, I hope this helps.  Above all, have her keep in close contact with her vet and follow the recommendations about further testing and monitoring.

7 comments:

  1. Thanks! I appreciate the response and I'll be sure to pass this along to her.

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  2. Chris, there was a pretty good article about homemade diets in JAVMA last month (March 1?). Most of the diets analyzed were inadequate, so your recommendation was spot on, I think, even though I'm just a horse doc. Check it out if you're suffering from insomnia, as I was. :-)

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  3. I was just wondering if Hill's k/d is good. I cannot make my dogs food.Most Vets.promote Hill's but is it really good? I read many reviews that it is garbage and the use meat by products.Isn't all meat a by product? I am new to needing this renal food for my Pomeranians kidney stones.Sincerely,Kim

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  4. Hills is a very good quality food, and was the first company to make disease-specific foods. Anyone who speaks against by-products doesn't actually understand what they are. By-products are simply organ meat excluding skin, ingesta, and so on. So this is liver, kidneys, intestines without the contents, lungs, heart, etc. By federal definition by-products CANNOT contain intestinal contents, skin, hooves, hair and similar things. It is NOT junk ingredients. In fact, there are numerous nutrients found in these organs that are important yet not found in muscle meat. Now personally I lean towards the Royal Canin diets in my own recommendations, but we also carry Hills and I think they are good foods.

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  5. If my dog has a history of elevated calcium levels and will be taking a phosphorus-binding supplement, should I leave the calcium carbonate out of the above mentioned diet?

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  6. Talk to your vet about that, Lisa. They will know more about the specifics of your case and whether or not this would be a good idea.

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  7. If my dog has a history of elevated calcium levels and will be taking a phosphorus-binding supplement, should I leave the calcium carbonate out of the above mentioned recipe? Or is it still critical? He is in advanced renal failure with a grave prognosis, ~2 months to live. He is happy but starving since the diet switch. Will not eat Royal Canin or Hill's. :(

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