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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.