Renal & Urinary Disorders 

Feeding Management for Dogs With Chronic Kidney Disease and Proteinuria

Aulus Cavalieri Carciofi

BVSc, MSc, PhD

São Paulo State University

Jaboticabal, São Paulo, Brazil

Ariel de Castro

BVSc, MSc Candidate

São Paulo State University

Jaboticabal, São Paulo, Brazil

Q. Why is diet important in the management of dogs with chronic kidney disease (CKD) and proteinuria?

A. Feeding management is a key point in canine chronic kidney disease (CKD) patients’ survival and quality of life. Patients with CKD often present with episodes of hyporexia or anorexia. Active monitoring of food intake, body weight, and body and muscle condition scores is necessary for early recognition of a possible deterioration in the nutritional status.

Q. What are key nutrients for dogs with CKD and proteinuria?

A. Several nutrients play an integral role in management of CKD and proteinuria:

• Energy-dense diets allow patients to obtain their energy needs in a smaller amount of food, minimizing gastric distention, nausea, and emesis,1 preventing muscle catabolism, weight loss, and uremia. Body weight and condition must be reassessed frequently to adjust energy supply to a healthy body weight.
• Restriction of dietary phosphorus to maintain serum phosphorus concentration below 1.5 mmol/L (but not less than 0.9 mmol/L; < 4.6 mg/dL but > 2.7 mg/dL) is beneficial to patients with CKD.1 If serum phosphorus remains high even after dietary restriction, IRIS (2023) recommends the use of enteric phosphate binders to effect, mixed with each meal.
• Reduction in protein intake has long been recommended to control clinical signs of uremia, proteinuria, anemia, polyuria, and polydipsia. Significant protein restriction, however, is controversial as protein intake influences lean body mass and diet palatability, and protein malnutrition is associated with patient morbidity and mortality.2
• Reduced protein intake, while continuing to meet amino acid requirements and basic protein needs, in combination with moderate sodium, supplementation with EPA and DHA, and medical management of hypertension (if needed) composes an integrated management to control proteinuria.3

Q. What are other important feeding considerations for dogs with CKD and proteinuria?

A. Despite the potential nutritional benefits, commercial renal diets should never be offered to a patient when hospitalized or sick, and any diet changes should be gradually made over the course of 2 weeks to avoid food aversion. If the patient is receiving a large quantity of treats with high phosphorus and protein content, modification of the treats alone may sufficiently decrease the dog’s phosphorus and protein intake.

Increasing diet palatability by adding warm water or a wet renal diet to dry diets and using appetite stimulants can help increase food intake.³ Feeding tube intervention should be considered for patients who do not voluntarily eat after efforts to manage nausea and vomiting, or after the use of palatants and/or appetite stimulants.

1. Parker, V. J. (2021). Nutritional management for dogs and cats with chronic kidney disease. Veterinary Clinics of North America: Small Animal Practice, 51(3), 685-710. doi: 10.1016/j.cvsm.2021.01.007

2. Maniaki, E., & Finch, N. (2018). Chronic kidney disease in cats and dogs: Managing proteinuria. In Practice, 40(7), 266-280. doi: 10.1136/inp.k3410

3. Carciofi, A. C., & de Castro, A. (2023). Chronic kidney disease and proteinuria in dogs. In C. Lenox, R. J. Corbee, & A. Sparkes (Eds.), Purina Institute handbook of canine and feline clinical nutrition (2nd ed., pp. 268-274). Embark Consulting Group, LLC.