# What do you feed your kidney dog?



## pawsaddict (Apr 17, 2013)

My dog has had acute kidney disease since she was around one year of age. She was put on a prescription diet right away, which I have had her off of for around 2 years now. I feed her The Honest Kitchen's Keen formula (21% protein and under 1% phosphorous) with raw green beef tripe (4.3% protein and .13% phosphorous) that I add to each meal myself. Her kidneys have been concentrating well for years and she is by no means uremic, and I am very, VERY happy about it. However, I have always wondered about feeding her more high-quality protein (either in a dehydrated or raw form). My vet always warns me against it, saying that I am already pushing it protein-wise. 

With the protein issue being such a hot topic, I was wondering what everyone else with kidney dogs does in regard to feeding?


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## TTs Towel (May 22, 2012)

Why are you adding the tripe?


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## pawsaddict (Apr 17, 2013)

My dogs love it and jump for joy whenever I pull it out from the fridge. But my main reason for feeding has many health benefits, since it is loaded with digestive enzymes and probiotics. It also contains Linoleic acid and Linolenic acid, two essential fatty acids. 

As an example of some of the health benefits, Lactobacillus Acidophilus is known to help:

Treat and prevent vaginal infections
Treat diarrhea and GI infections
Aid in digestion
Treat chronic constipation
Treat symptoms of Irritable Bowel Syndrome
Enhance the immune system
Lower the risk of pollen allergies

Tripe itself is also good for:

Picky eaters
Cleaning Teeth
Rejuvenating older dogs
Aiding in a healthy skin+coat

With all of the health benefits it provides while being low in phosphorous, I think it is a very good addition to her diet.


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## Kathyy (Jun 15, 2008)

It isn't the protein that is the problem, it is extra phosphorus that can make the dog feel worse faster. And yes there have been studies that show that dogs survive longer with more protein even with kidney issues. See the dogaware link I posted further down.

Sassy didn't tolerate fat well so her diet was only about 14% fat and 28% protein or about 1.5 grams of protein per pound of dog. She did seem much better on that much protein as she was very old and losing muscle mass and strength rapidly before I upped the protein. She actually took in nearly double the calories when sick as she did when young and healthy. Her diet was super low phosphorus white glutinous rice and stewed chicken with no skin and I added the chicken skin, beef and lamb fat as tolerated. Egg white is another very low phosphorus protein that she stopped tolerating. I used canned green tripe and even was able to get raw tripe for a while but she started refusing it as it was too fatty for her.

Since the info is lost in the wall of text, stewed chicken was the lowest phosphorus protein my dog did well on and egg white is even better.

You might want to figure out how much protein is going in per pound of dog, may be more than you think. Sassy's food looked like mostly rice but there was a lot of protein in there.

I took much from dogaware's kidney disease pages, look there for more ideas on how to deal with the limited diet. Hydration and limiting phosphorus in the later stages worked well for the last 3.5 years of Sassy's life.
http://www.dogaware.com/health/kidney.html

THK is lower phosphorus than most commercial dog foods but I was shooting for about 50% of normal so it wouldn't have worked out for Sassy. With the amount of calories she took in I would have been giving her ~200% of her healthy requirement near as I can figure out from the AAFCO PDF and a quick google of calories per dry kilo. Max eats a lot less so he would be getting just about his NRC requirement! Needless to say [but I am anyway] figuring out actual intake of your dog is just as important as percentages of nutrients.


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## pawsaddict (Apr 17, 2013)

Kathyy said:


> It isn't the protein that is the problem, it is extra phosphorus that can make the dog feel worse faster. And yes there have been studies that show that dogs survive longer with more protein even with kidney issues. See the dogaware link I posted further down.
> 
> Sassy didn't tolerate fat well so her diet was only about 14% fat and 28% protein or about 1.5 grams of protein per pound of dog. She did seem much better on that much protein as she was very old and losing muscle mass and strength rapidly before I upped the protein. She actually took in nearly double the calories when sick as she did when young and healthy. Her diet was super low phosphorus white glutinous rice and stewed chicken with no skin and I added the chicken skin, beef and lamb fat as tolerated. Egg white is another very low phosphorus protein that she stopped tolerating. I used canned green tripe and even was able to get raw tripe for a while but she started refusing it as it was too fatty for her.
> 
> ...



That's just it. I was thinking about upping her protein intake because she seems to be very lethargic and doesn't have very much muscle at all. Perhaps I am on the wrong track with that, though. May I ask how you figure out how much protein she is eating per pound of her weight? She weighs 21 pounds, and that is all she eats now aside from the odd freeze-dried sweet potato treat here and there... I feed her 1/4 cup THK Keen and 1/6 of a tripe patty 2X per day.


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## TTs Towel (May 22, 2012)

.......................


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## pawsaddict (Apr 17, 2013)

So correct my if I am wrong here, but this is the formula I used to determine how much protein per pound of weight she is eating:



(protein percent) x (weight in grams) = grams of protein ----> (0.21) x (227) = 47.67 grams of protein

(grams of protein) / (weight of dog) = protein per pound -----> (47.67) / (21) = 2.27 grams of protein per pound of her body weight

This doesn't include the tripe that I add, which is pretty minimal. I read that 2 grams per kilogram is all that a companion dog needs, but is that true? Is she eating too much protein for her weight? To little? Oh my gosh, this is so complicated.


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## pawsaddict (Apr 17, 2013)

TTs Towel said:


> That's quite a list. I can get how it might aid some digestive problems. I don't know that true irritable bowel syndrome is actually recognized in dogs. Perhaps you were thinking inflammatory bowel disease? How exactly does it treat vaginal infections? How does it enhance the immune system? Lower risk of pollen allergies????


 Now, I won't pretend that I have done studies on tripe myself, but here's some info on Tripe, if you are interested. There are many more articles out there as well. 


http://www.dogsnaturallymagazine.com/the-stink-on-tripe/

http://www.k9natural.com/component/wordpress/the-wonders-of-green-tripe/?Itemid=12

http://www.caninebark.com/2009/01/beastly-feasting-on-green-tripe.html


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## Kathyy (Jun 15, 2008)

Your math is fine but is that wet or dry grams? Nearly 1000 calories for a 21 pound dog? Rehydrated Keen has 10 grams of protein per 100 grams.

I figure 100 grams=100% so a food that has 20% protein has 20 grams of protein per 100 grams. Then looking at the calories per kilogram [lost the number somewhere in my tabs] was about 4100 dry means the Keen has about 410 calories per 100 dry grams. 42 pound Sassy needed 1000 calories a day so would have eaten 250 dry grams of the Keen getting 50 grams of protein. 38 pound Max only needs 600 calories a day so would only get about 30 grams of protein a day. Sassy would be getting an adequate amount but I would rather feed Max quite a bit more protein than that.

It is even less than a gram per pound required. A 50 pound dog only requires 35 grams of protein a day according to NRC. I thought Max was fine and dandy on about a gram of protein a day as a young adult but he is far better off now that he gets 1.5 grams per pound on his raw diet gaining 15% muscle as a senior dog. Sassy carried good muscle mass on that same kibble as a healthy adult so a lot of this is individual dog need. Sick dogs likely need more protein than healthy dogs.

As for tripe being good for kidney dogs? I gave Sassy a probiotic that was designed to absorb phosphorus in the gut. Only takes a small stretch to hope that green tripe could have a bit of that same benefit. Kidney dogs are infamous for having poor appetites and green tripe is equally infamous for being irresistible to dogs. Smart Sassy figured out it was upsetting her tummy after a year of failing kidneys so had to drop it. I didn't happen to notice whether or not she was better on it or not but I am sure many dog owners do see positive results feeding green tripe to sick dogs. Just having a sick dog eating is often benefit enough.


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## pawsaddict (Apr 17, 2013)

I'm using the dry grams because I give her 1/2 cup dry per day. Marley is on a calorie-reduced "diet", so she eats aound 250-275 kcal a day, 235 of which come from Keen. How did you get 1000 kcal? Sorry, I'm not one for math, haha. According to THK:

"If we use Thrive as an example:

Thrive is about 26% protein ‘as received’ which calculates to 28.27% protein on a DM basis and just over 13% protein, as-served.

A dry-measured cup of Thrive, as-received, weighs about 115 grams. Of this, about 30 grams is protein. Those 30 grams of protein are still present in the food after water has been added to re-constitute it – although the cup of food rehydrated food now weighs about 230 grams (and is 2 cups by volume)."

I guess it really is individual. I don't see any muscle tone on Marley. She has always been slightly overweight, so I'm sure that has a lot to do with it. Trying to get her weight down is a constant struggle. I'm very sorry to hear that you have had to go through KD with your Sassy. It's just awful but it sounds like she was extremely lucky to have you in her life, and vice versa, I'm sure.


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## pawsaddict (Apr 17, 2013)

Okay, so I re-did the formula...using the as-received and wet (the results are the same) because that is all I could find the grams for.

As-received & wet: (20%) x (115/2) = 11.5, (11.5) / (21) = 0.547

So low if this is correct!!!


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## Sibe (Nov 21, 2010)

Mythology of Protein Restriction for Dogs with Reduced Renal Function [by Champion pet foods (Purina)] so I'm not sure about bias]
http://files.championpetfoods.com/Myths_of_High_Protein.pdf



> A number of false assumptions about the need for reduced protein intake in regard to renal disease have been perpetuated in the literature for many years, including:
> -Increased urea load causes increased workload for the kidneys.
> -High dietary protein intake injures kidneys.
> -High dietary protein intake causes hyperkalemia.
> ...


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## Kathyy (Jun 15, 2008)

That looks right to me. And she is fine with that teensy amount of protein. No real pressure here!

What are your goals for her diet? Low calorie, wet and what else? Protein? I was restricting Sassy's phosphorus intake before her creatinine was over 2.4. While I didn't need to she clearly was more comfortable with less phosphorus. The very first indication of trouble was refusing to eat a year after diagnosis and that was solved with a simple antacid. Phosphorus acidifies the body. Heartburn that won't stop. Ouch.

To keep calories down, restrict phosphorus and add protein you could use rehydrated THK and stewed chicken without skin. Rehydrated THK Keen has 400mg phosphorus and 10 grams of protein per 100 grams and stewed chicken has 150mg of phosphorus and 27 grams of protein per 100 grams. THK has 200 calories per 100 rehydrated grams and stewed chicken has 170 calories.
http://cdn.thehonestkitchen.com/media/catalog/product/downloads/aafco_KEEN.pdf
http://nutritiondata.self.com/facts/poultry-products/653/2

For my dog I could feed half THK and half chicken and he would have plenty of calcium, zinc, copper and the rest of the nutrients I happen to have memorized and instead of 30 grams of protein and 1200mg of phosphorus in the 300 grams of THK he would take in 15+50=65 grams of protein and 600+300=900 mg of phosphorus in 150 grams of THK and 150 grams of stewed chicken. I cannot tell whether that is appropriate for your dog or not but I would definitely look into slowly changing from just THK to a mix with some stewed chicken!

Back to the tripe. Going to ND which isn't green of course I get 100 grams contains 12 grams of protein, 64mg of phosphorus in only 85 calories. Stewed chicken with no skin has 177 calories, 150mg of phosphorus and 27 grams of protein. Better than THK by far in phosphorus and calories but protein, not so much.

Back to the chicken. Do go slowly on this as you can see that even a little chicken would help a lot. You have to throw away the broth as the reason stewed is lower in phosphorus is because it leaches into the cooking water! Give it to your other dog or save for your meals.


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## pawsaddict (Apr 17, 2013)

Well, after seeing that very low amount of protein that she is getting from THK (I had no idea is was that low!), I've decided to switch her to raw. I don't have time to make any homemade meals for her, though, so I did some research and I think I found a good complete raw product for her. I calculated the protein and phosphorous for her body weight according to what it should be on dogaware.com, and I think it's right on par. I plan to add the raw tripe to every meal as well so that the phosphorous is lower for her. I started to transition her maybe two days ago, and I can already see a difference in her. She has more energy and just seems happier. I hope that, by switching her to raw, her kidney and overall health will improve.


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## Kathyy (Jun 15, 2008)

Wow, that is awesome. She is a lucky dog. Happy counts too!

Take it easy and watch her though. She will be taking in a lot less phosphorus than on the previous diet but the increased fat could upset her. I tried to keep Sassy's fat intake as high as she allowed and kept hitting a wall at a fairly low 14%. Very old dog with dicey pancreatic and liver enzymes though. Take skin off and remove the easy fat at first.

I know, 21% protein sounds perfectly reasonable but it depends on your dog whether it is a reasonable amount of protein or not. Sassy needing 25 calories per pound meant it was fairly easy to get a reasonable 1.5 grams of protein per pound into her but Max only needs 15 calories per pound and I really have to watch the fat so he gets it.


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