A Low-Protein “kidney diet” Is Not Always the Answer

Only dogs whose kidney failure is advanced need very low-protein diets.


by CJ Puotinen Every day, thousands of dogs are diagnosed with kidney disease. The first suggestion most conventional veterinarians make is to switch from whatever the dog has been eating to a low-protein “kidney diet” food. Clients are sent home with bags or cans of “prescription” food and warned not to feed high-protein foods or treats of any kind. Most dogs, even chow hounds, approach their new, low-protein food with suspicion, since these diets are generally much less palatable than foods that contain more animal protein. Many refuse to eat. Conventional veterinarians are used to this response and tell their clients to stick to the new food for their dogs’ own good. “Your old food is too high in protein and will actually speed kidney failure,” they warn. “Keep giving him the prescription food. He’ll come around when he gets hungry enough.” Eventually most CRF patients do accept their new food, though without much gusto or enthusiasm. Worse, despite their food’s low protein levels, the dogs’ slow deterioration continues. Many look back, after their dogs have died, and wonder whether they did the right thing. Now a new approach to feeding dogs with kidney disease offers a different scenario – one that’s more likely to keep CRF dogs, and their human companions, happy. A paradigm shift It’s a fact of life that not all medical discoveries and “breakthroughs” in disease treatment prove to be as promising as they seemed at first. Adopted on the basis of a few small, encouraging studies, some strate-gies are found later to cause mixed or even adverse results. This is definitely the case with the currently predominant treatment strategy of giving dogs with CRF a low-protein diet. Newer research has radically changed and fine-tuned the dietary recommendations for canine CRF patients. Those using the latest, recommendations to feed their CRF dogs a therapeutic home-prepared diet report excellent results. Best of all, most dogs love the combination of high-quality protein and freshly prepared ingredients. About CRF Chronic renal failure affects male and female dogs of all breeds and all ages. Its underlying cause may be hereditary or related to inflammation, tick disease, progressive degeneration, damage following acute renal failure, or unknown causes. Acute renal failure may be triggered by a trauma injury, exposure to poisons like antifreeze or rat poison, or damage caused by medications, bacterial infections (such as leptospirosis), fungal infections, or dehydration. Many animals born with poorly constructed or poorly functioning kidneys succumb to kidney failure at a young age. Most cases of chronic renal failure are seen in dogs age seven or older. Chronic nephritis, a common diagnosis in CRF patients, involves low-grade, long-term inflammation of kidney tissue that causes permanent damage to delicate renal tissue. Conventional veterinary medicine considers all forms of kidney disease to be irreversible, progressive, and eventually fatal. But many holistic veterinarians disagree, saying that the progress of chronic renal failure can be interrupted or slowed with improved nutrition and holistic support. “Since I turned to a natural approach to wellness,” says Florida veterinarian Russell Swift, DVM, “I have seen many dogs outlive their death sentence by years.” Like many holistic vets, Dr. Swift blames a toxic lifestyle for causing many cases of CRF. “I believe the major reasons for kidney failure are poor-quality nutrition and exposure to toxins. Processed foods are a major contributor to kidney disease because they combine poor-quality ingredients with harmful additives or residues, and that leads to chronic illness. The inadequate and improper protein sources in processed foods and the low moisture content of dry foods are two major kidney stressors. “When dogs are treated with prescription drugs for the problems that often accompany commercial diets, they are given nonsteroidal anti-inflammatories (NSAIDs), antibiotics, and other medications that are damaging to the kidneys. I also question the use of food additives and preservatives and the use of fluoride in drinking water, and don’t forget environmental toxins like lawn chemicals and other pesticides, including those that we use around ourselves and our companion animals. It’s a wonder more dogs don’t develop kidney problems.” The protein debate As soon as they diagnose kidney disease, most American veterinarians prescribe a low-protein diet. They believe that protein harms the kidneys and that reducing protein consumption slows the progress of kidney degeneration. This is because early research on rats was assumed to be true for dogs, and excess protein causes problems for rats. A number of pet food manufacturers sell low-protein prescription diets for dogs with chronic renal failure, and those who prepare their own food at home are warned against feeding meat, poultry, and other foods that are high in protein. “Those recommendations are based on a myth,” says Wendy Volhard, author of Holistic Guide for a Healthy Dog. “In fact, the whole theory of low-protein diets for dogs with kidney disease was blown apart in 1975 by David Kronfeld, PhD, who was at the time a veterinary researcher at the University of Pennsylvania. His concept was not to feed less protein but rather to feed higher-quality protein. “The low-protein myth is like an old-wive’s tale, something based on ignorance that just won’t die. Yes, inferior-quality protein can harm a dog’s kidneys, but the solution isn’t to continue with inferior-quality ingredients and feed less of them. The solution is to improve the quality of ingredients and in that way provide what the dog needs for good health.” Studies disproving the prevalent low-protein prescription have been widely published in veterinary journals and textbooks. But it is moving into the mainstream very slowly. “Most vets who did not graduate from college in the last few years (and some of those as well) are still unaware of or dismiss the newer studies that show low-protein diets neither slow the progression of kidney disease nor prolong life,” says Mary Straus, a lifetime dog lover from the San Francisco Bay area who researches health and nutrition issues. “Too many dogs are forced to eat Prescription Diet k/d® or similar low-protein prescription foods,” says Straus. “These can actually cause harm. When protein levels are very low, the body will cannibalize itself to get the protein it needs. This creates more waste products than if you feed the proper amount of high-quality protein in the first place. Also, k/d is not very palatable, and many dogs with kidney disease will eat only enough of it to survive, or stop eating entirely if that is all they are offered.” Older dogs actually require a higher level of protein to maintain their body stores of protein than do younger adult dogs, says veterinary nutritionist Patricia Schenck, DVM, PhD, of Michigan State University’s Center for Veterinary Medicine. In an article published in Veterinary Nutritionist, Dr. Schenck wrote, “Reducing dietary protein in older pets may have adverse effects. As pets age, their ability to utilize nutrients decreases. The only time dietary protein restriction is appropriate in renal failure is when the disease has become severe.” Healthy geriatric dogs require about 50 percent more protein than young adults, say canine health writers Susan Thorpe-Vargas, PhD, and John C. Cargill, MA. Depending on the quality of the protein, they say, it should make up 20 to 30 percent of total calories ingested. “Protein restriction can result in impaired wound healing, diminished immune function, and lowered enzyme activities and cellular turnover. Dogs with impaired renal function do better with dietary phosphorus restrictions.” The new action plan Mary Straus’s dog Nattie was a healthy, athletic Chinese Shar-Pei who had no trouble keeping up with young dogs even at 10 and 11 years of age. She ate kibble and received annual vaccinations until 1997, when Straus learned about the health benefits of raw diets and the harm that can be caused by repeated vaccinations. Nattie was 10 years old when she was converted to a raw diet and stopped receiving vaccinations. Four years later, at age 14, Nattie was diagnosed with kidney disease. After much research, Straus put the newest diet plan into place for Nattie. “I modified her diet to reduce its phosphorus but kept her protein levels high,” says Straus. “Her diet was around 37 percent protein on a dry matter basis, and she thrived. Her kidney numbers actually improved for two years, and when she died at age 16, her illness had nothing to do with kidney disease. “People need to know this information, as well as how to formulate a homemade diet or what foods to add if they are going to feed k/d or one of the other low-protein commercial diets for kidney disease.” Dietary goals When developing a diet for dogs with kidney failure, the recommendations from leading experts are to feed • moderate to high amounts of fat, • moderate amounts of high-quality protein, • low amounts of phosphorus, • moderate amounts of low-phosphorus carbohydrates, • and plenty of water, juices, broth, and other liquids. Although guidelines vary, a sensible goal is a diet whose total calories come 1/3 from fat, 1/3 from protein, and 1/3 from carbohydrates. Fat provides calories and energy, and most dogs have an easy time digesting it. Good sources of saturated fat include fatty meats, butter, whole-milk yogurt, egg yolks, and coconut oil. Polyunsaturated vegetable oils, such as canola, corn, soy, safflower, sunflower, and flax seed oil, are not recommended for CRF patients. Neither is cod liver oil, because of its high vitamin D content, which failing kidneys have difficulty processing. But fish oil (fish body oil, not fish liver oil) has been shown to help dogs with CRF. When adding fats and oils to the home-prepared diet, start with small amounts and increase quantities gradually. Too much too soon can lead to diarrhea. Dogs prone to pancreatitis should be carefully monitored. What are the best sources of protein? Most experts consider eggs to contain the highest-quality protein, but their yolks contain moderate amounts of phosphorous. One strategy for feeding eggs to CRF dogs is to feed one or two egg whites for every whole egg. Calcium is a phosphorus binder, so add small amounts of finely ground eggshell to each meal (½ teaspoon per pound of food) to help reduce the amount of phosphorus absorbed by the body. Other foods high in phosphorous include bones, fish with bones, cheese, and organ meats. “Bones are so high in phosphorus,” says Straus. “that I would avoid them or feed them in small amounts, such as one-third the normal quantity, even with early stage CRF. Like egg yolks, organ meats such as kidney and liver contain many nutrients that are important for canine health and should be included, but in moderate amounts.” Further diet tips Recently, green tripe, a food traditionally fed in Europe, has become a staple for many American dogs, including CRF patients. Green tripe is the raw, unprocessed stomachs of cud-chewing animals like cows, goats, or sheep. Supermarket tripe is white because it has been bleached and deodorized, which destroys fragile nutrients. Green tripe contains easily digestible protein, beneficial bacteria, abundant enzymes, and relatively low phosphorus levels. Tripe smells awful to humans but sublime to dogs, including CRF patients who have otherwise lost interest in food. Thanks to increasing demand, frozen green tripe is available from mail order sources and some local distributors of raw frozen foods. If you choose to feed a prescription dry or canned food rather than a home-prepared diet, add fresh protein foods, either raw or cooked, such as meat, eggs, egg whites, and tripe, especially in the early stages of the disease. If you feed a diet based on raw meaty bones, substantially reduce the amount of bone. If the diet calls for bone meal, like the Natural Diet developed by Wendy Volhard, follow her advice to switch from lean to fatty meats and substitute calcium carbonate for the bone meal to reduce phosphorus levels. While dogs are not designed to consume grains or starchy vegetables, most CRF diets include up to 50 percent carbohydrates in order to provide calories and nutrients while keeping phosphorus levels low. Steaming or boiling vegetables reduces phosphorus levels if you discard the cooking water. Alternatively, puree or juice them to improve assimilation. Note, however, that dogs with arthritis may be sensitive to nightshade plants, which include white potatoes, peppers, eggplant, and tomatoes. Whole wheat, oatmeal, brown rice, millet, and other whole grains are moderately high in phosphorus and should not be fed often or in large amounts. White rice is low in phosphorus, and glutinous or sticky rice is the lowest-phosphorus grain. To help make grains more digestible (as described in “It’s All in How You Make It,” WDJ March 2001), soak them overnight to remove enzyme-suppressors and naturally occurring toxins. “I have had good luck with Malt-o-Meal, which is low in phosphorus,” says Straus. “You have to be careful about feeding vegetables to dogs with kidney disease. I recommend using white potatoes and yams because they provide a lot of calories without adding much phosphorus, unlike many of the low-cal veggies.” Dogs with high blood pressure, which can be related to kidney disease, may need reduced salt in their food. Home-prepared diets are naturally low in salt, but cottage cheese is high in salt, canned fish can be rinsed to remove salt, and processed foods should be checked for their sodium content. Because dehydration creates serious problems for dogs with kidney disease, it’s important to provide abundant water. “Make sure fresh water is always available,” suggests Straus, “even if excess drinking causes your dog to become incontinent. If your dog already drinks a lot of water, ask your vet about giving subcutaneous fluids to help the dog stay hydrated.” Hard water contains minerals that are best avoided, so use filtered or low-mineral bottled water. Dogs with kidney disease can lose interest in food, so look for foods and flavors that can revitalize a flagging appetite. “It’s important for these dogs to eat something,” says Straus, “even if it’s not one of the recommended foods. Try offering your dog’s food at different temperatures, experiment with raw versus cooked, and offer multiple small meals rather than just one or two large ones. My Nattie wouldn’t eat raw eggs, but she loved eggs scrambled with a bit of cheese. The cheese wasn’t the best thing for her, but it got her to eat.” Green tripe can be added to food as a flavor enhancer, as can Seacure, a very fishy-smelling powder sold as a protein supplement. “If you feed a commercial food like k/d and your dog won’t eat it, find something else, preferably a homemade diet that provides high-quality protein while controlling the amount of phosphorus,” she says. Plus, she adds, most dogs love fresh food. “The higher moisture levels in fresh foods help protect their kidneys, and they feel better and enjoy life more.” Also With This Article Click here to view “Can Meat Cause Kidney Failure” Click here to view “Chronic Kidney Disease in Dogs” -In the next issue: What If It Isn’t Chronic Renal Failure? Avoiding Misdiagnosis. CJ Puotinen is the author of The Encyclopedia of Natural Pet Care (Keats/McGraw-Hill) and Natural Remedies for Dogs and Cats (Gramercy/Random House).


  1. Truly a life saving article! There is so much misinformation online, and sadly from my vet as well. It’s such a relief to find sensible, practical, information so I can help my dog.
    I sent it to my vet in the hopes she might stop pushing the vet food. The prescription diet food was the worse thing I ever did for my dog. Luckily I figured that out pretty much right away. I couldn’t let my dog go hungry … she started eating what I eat, but I wasn’t clear about some things … so am really grateful to have found this article. Giving my dog too much fresh meat wasn’t always the best for her kidneys, but I know I’m on the right track now!
    Thank you and bless you.

    • Rose, be sure to see the new information added to my page here:

      Hill’s k/d is designed for dogs with late-stage kidney failure. Dogs with early-stage disease may not need any diet change, depending on what you’re feeding now and the dog’s test results. If high enough to warrant a diet change, there are better options for dogs with early-stage disease, as they may be on this food for a long time, something k/d was not designed for.

    • I really needed to read this, since my 13 year old dog was diagnosed with early stages of kidney disease. The vet prescribed KD-which she woukdnt eat. I didn’t want her to lose weight so I added what she has been eating since her adoption 9years ago. I added hamburger and sweet potato. And she ate everything. But she left half of the KD! After reading your article, I am feeding what I gave her before which is meat, chicken, yams, & white potato, egg yolks and canned white tuna in water. She doesn’t like any veggies(I tried them all). She was drinking lots of water and Waking me 4 times a night to let her out to urinate. But that has stopped.. So I’m wondering if the KD has helped. She has been eating it for 2 months. But for two months, I have been giving her meat with it. Asidaid earlier, she eats all the meat and only half of the KD!

      • Toni, you can contact me via email from my website if you want me to review your dog’s test results. Chronic kidney disease does not improve; dietary changes are used to slow progression, but cannot make the kidneys better. If your dog’s symptoms improved, it may be because there was an underlying cause, such as a urinary tract infection, that was successfully treated (was your dog treated with antibiotics or anything else?). I can’t offer anything further on diet without seeing test results (blood and urine), but you can read more in the newer sections added to my website here: http://dogaware.com/health/kidney.html

      • Louie has been on KD since june 2020. After just one can he did a 180 turn around. No more night urination in his sleep. No more increased thirst. I add dark meat chicken boiled in stock to the KD. No eating problems. He has early stage CKD. He is 15. On bloodwork recheck, his numbers were very much improved

  2. Please help! We have a little dog named Abby. She is a Schnoodle and is about 14 years old. Years ago she had one bout of pancreatitis and the vet put her on a low-fat, gastrointestinal Royal Canin food. Other than that, she has always been in good health. In the last couple years, she has a bit of arthritis, but otherwise she romps and plays like a much younger dog. You would never know she is 14. Earlier this year she started having some incontinence. We took her to the vet which ran blood work. The vet determined that she had an infection and the onset of kidney disease. He gave her antibiotics, put her on Benazepril, and told us to put her on a low-protein k/d diet. We took his advice and took her back a week later for follow-up bloodwork. Her numbers had improved. Her BUN numbers went from 81 to 38. We found that to be encouraging. But she hates all the food. We’ve tried the three different kinds of Hill’s k/d food that we could find – a pate, a stew, and kibble. She won’t eat any of them. We researched online for some homemade recipes we could make. My wife made the recipe using lean beef, sweet potato, pumpkin, apple, etc. – all good, healthy foods. But it’s very low in protein, and she won’t eat that either. She seems like she’s starving. She stands around us when we eat like she wants food. We’ve sometimes offered other things just to get her to get something in her so she can take her meds. She’ll sometimes eat a bit of white rice or plain sweet potato. She scarfs down a bit of water cracker. We wrap her pill in a tiny bite of cheese or peanut butter or cream cheese just to get it down her, and she’ll scarf that down also. We tried a bite cottage cheese today, and she gobbled that down too. She acts like she’s starving, and she probably is. But she refuses to eat any of the Hill’s k/d food or any of the homemade food. We need help! I found this page today, and it’s startlingly new information. It completely contradicts what the vet says. And yet, it makes sense to us. We live in a small town and could definitely use some advice! Thanks so much in advance for anything you can offer! We just want her to eat!

    • Jon, I’m sorry to hear that your dog is having problems. It’s best to contact me via email from my website for something like this, so I can get additional information about your dog. Be sure to read the newer information on this page as well: http://dogaware.com/health/kidney.html

      It’s important that your dog eat, even it it’s not the best diet for her. Also, k/d is quite high in fat and it’s possible your dog is refusing to eat it because it causes her discomfort, and it could even lead to pancreatitis. If your dog does need to be on a kidney diet, which is not certain based on the information you provided, it would be better to use one that is lower in fat than k/d. Your dog’s appetite might also be affected by excess acidity causing gastrointestinal ulceration (treated with antacids/proton pump inhibitors along with sucralfate, a prescription ulcer medication), or by high BUN causing uremia (in which case sub-q fluids can help).

      If you are giving Enalapril, your dog likely has significant protein in her urine, as measured by a UPC (urine protein:creatinine ratio). This type of kidney disease requires different treatment and a different diet than chronic kidney disease. In most cases, you do NOT want to feed a low-protein diet. Instead, you should be feeding a diet with moderate protein. Phosphorus may or may not need to be decreased, depending on your dog’s creatinine (much more significant than BUN) and blood phosphorus values. Note that proteinuria is often linked to infection or inflammation anywhere in the body, so it’s important to identify and treat any such condition if possible. Blood pressure also needs to be checked.

      Most recipes you find online for both healthy dogs and dogs with health issues are unreliable. You can get recipes for dogs with kidney disease from Balance IT, with your vet’s approval, which they make easy to get. If I had all your dog’s blood and urine test results, I could offer guidelines about which type of diet your dog needs.

      Again, please contact me via email from my website with more details and I will try to help further. Please include the information from your post here so I will have a record of it.

      • Hello. I had a few questions for you if you don’t mind. My dog’s urine test results came back with a high amount of protein. His kidney numbers for his blood test results came back good. He was also found to have high blood pressure and was put on amlodipine for that. This somewhat lowered his high blood pressure but proteinuria is still persistent. We have switched to a KD diet. He is eating half Purina Veterinary NF kidney dry food and half a homemade food recipe from balance it. I saw that you say not to give cod liver oil or corn oil. The recipe from them includes both… There is so much conflicting information I have no idea where to turn. Do you have any advice?

        • Heather, your dog should not be on a prescription kidney diet if his creatinine is normal. He especially should not be on a very low-protein diet designed for dogs with late-stage kidney disease such as k/d or NF if he has proteinuria, as this can lead to hypoalbuminemia (low albumin), which is dangerous. Instead, you should be feeding a moderate-protein diet, not too high nor to low, maybe around 21% protein on a dry matter basis. He should also be given ACE inhibitors such as Enalapril or Benazapril for proteinuria — these offer some help for high blood pressure, but your dog may need additional treatment with amlodipine if his systolic pressure remains above 180. More info: http://dogaware.com/health/kidneymedical.html#ace
          I would also recommend consulting with another vet who better understands protein-losing kidney disease.
          If you need more help, please contact me directly via my website.

  3. Hi Mary,

    Like most, I’m here after googling “kidney disease dog will not eat” and finding your page. You mentioned to a few others they should contact via email; I might be overlooking it but I can’t find your email address. Could you please provide it as I would love to share my dog’s most recent records and get a suggestion on a diet that may work for her. Thanks in advance!

  4. Hi Mary! My dog is 13 and about a year ago, the vet wanted to put him on kidney meds because he had early signs of kidney failure. He gets too stressed out from getting blood drawn, so we couldn’t put him on the meds and ended up switching to a low protein prescription wet food canned diet. He has been eating well but is losing soooo much weight. After reading this article, I understand why. Since we can’t get his blood drawn due to his extreme reaction to that process, we don’t know the state of his kidney function. Can you make a recommendation about the ratio of his diet (or even a sample diet for him)? He’s a Pomeranian who was 7 pounds in his prime, and has shrunk down to the low 4 pounds over the last year or so. I know that sounds unbelievable but I swear he eats normally and acts happy(just really tired). By the way, I also read your more recent information on this topic, but it left me confused about your suggested ratio of carbs, fat, and protein. Thank you so much!

    • Hi Jamie — I’m sorry to hear that your dog is having problems, but I have no way to help you without knowing more about what is going on. Both cancer and heart disease can cause cachexia, where they lose weight despite consuming adequate calories. Have you calculated your dog’s caloric input to determine whether he’s getting the same number of calories he did before you changed his diet? Have you tried offering more food at meals, or more meals per day? It may be worth sedating your dog in order to do the tests necessary to determine what might be going on. Without any test results, it’s anyone’s guess (you don’t provide any reasons why your dog was diagnosed with kidney disease, so even that could be wrong). I don’t recommend ever feeding a low-protein diet unless it’s needed to control uremia or hepatic encephalopathy caused by advanced kidney or liver disease, so I would change your dog’s diet, but I cannot offer any input regarding what type of diet to feed since I have no idea what is really going on.

    • No, Christina, sorry, I don’t. The recipe would have to vary depending on what stage kidney disease your dog has, and whether there are other factors, such as protein in the urine, as well as variations due to ingredient tolerance and cost, and other factors. In general, I have found it very difficult to create low-phosphorus recipes that are not also low in many other areas. They usually require the use of multiple supplements in appropriate amounts in order to meet nutritional guidelines.
      Instead, I suggest that you use the recipes from Balance IT along with the Canine-K Plus supplement if your dog needs a reduced-phosphorus diet. I do not recommend recipes that use their original Canine-K supplement, which includes phosphorus. These veterinary recipes require your vet’s approval, but they make that easy to get.

  5. Mary our dog was poisoned most likely rat. She has been through the wringer. Five days in hospital and five weeks on a feeding tube. As most here say she won’t eat the kidney diet. She was eating her regular dry food and some chicken so we were able to have her feeding tube removed this week. Her creatinine level was 4 which had increased from 3.7 in about two weeks but her bun went from 80 to 216. Doc says it’s probably the higher proteins she’s getting. We were feeding her royal canin renal throughly the tube. We tried mixing the kid with her regular food and now she doesn’t seem to want to eat anything. We have tried the canned tripe and she ate it once and then snubbed her nose at it. We are so worried and don’t know where to go from here. She is only two. Any suggestions would be greatly appreciated.

    • Paula, I’m so sorry to hear what happened to your dog. Unfortunately, with such high creatinine and BUN, she is suffering from uremia. Fluids can help by diluting the waste products in her blood that are causing her to feel bad (including nausea and excess acidity that can cause gastric ulceration). Talk to your vet about giving her daily sub-q fluids at home, along with medications for nausea, appetite stimulation and ulcers, but if her creatinine and BUN remain so high, it means that her kidneys have likely suffered permanent damage. She will also need a low-protein diet as long as her BUN is 80 or above, in order to help reduce the symptoms of uremia.

  6. My dog was diagnosed with being in kidney failure. Before the vet got her blood work back, he had given my dog a 2 wk antibiotic shot. Well, she has been ok since. She eats a lot and even runs around like a puppy. I’m not sure what I’m supposed to do because I was told that if the blood work came back the way it did, that we need to discuss putting my dog to sleep. I do NOT want her to suffer but she seems fine to me.

    • Jessica, I’m sorry to hear that your dog is having problems. I can’t offer any input without more information, including test results, symptom history, and your dog’s age, breed, weight, etc. Best to contact me via email from my website.

      If you think your dog has improved, you may want to recheck her blood work, maybe with a different vet.

  7. This info is SO helpful!! I have a 9 lb yorkie that is about 11/12 ( we inherited her after a grandmother died 8 yrs ago so she is extremely special). She was diagnosed July 1 with a kidney problem ( not sure if acute or Chronic). The prior Dec her blood work was fine with a BUN of 20 and Creatinine of 0.7, but July 1 she was vomiting and not eating ( she is usually VERY food motivated- at first we chalked it up to a kibble change but realized it was more than that) so we took her in to be checked- BUN was 114 and CREA was 4.5. She spent 3 days inpatient with IV fluids – where her levels went down -CREA 3.2. We brought her home with Royal canin can food and sub q fluids- on recheck 10 days later (7/14) – her BUN was 70 but her CREA had shot up to 4.5. We continued doing sub q fluids every 3 days and had her rechecked 2 weeks later ( 7/28) her BUN 37 and CREA 3.0 , We then dropped sub q down to every 4 days. most recently we went 5 days between. Recent recheck on 8/25 BUN 33 and CREA 2.9. Her weight was 9.7 in Dec 2019, dropped down to 8.2 but has since rebounded up to 9 lbs. She was very energetic and doing well- bright eyed and attentive until 3 days ago- she started acting lethargic and withdrawn and getting “shaky” periods where she would tremor and she has now started and aversion to her canned renal diet. I plan to increase the sub q and trying to feed her home made food. Any tips to get her feeling spunky again? She is an EXTREMELY picky eater- this weekend she was not interested in her recent snacks of apple, watermelon and carrot. Today I did get her to eat some egg whites and sweet potato and a few lightly steamed veggies. We are not due for another blood draw for another 2 months- not sure if I should get one sooner?

    • Angela, your dog had acute kidney failure in July. Your vets should have been looking for the cause so that it could be treated. Acute kidney disease is more dangerous in the short term, but kidney function can improve substantially if the underlying cause can be found and treated. Some dogs return to normal over a few days or weeks, while others may be left with some long-term damage to the kidneys.

      Possible causes of acute kidney disease include leptospirosis, toxins (rat poison, antifreeze, dehydrated treats from China, very high doses of vitamin D, large amounts of grapes or raisins), certain medications (aminoglycoside antibiotics, tetracyclines, NSAIDs such as Rimadyl), and kidney infection (pyelonephritis), among other things. Addison’s disease can also affect the kidneys. Addison’s disease usually causes gastrointestinal upset that comes and goes over a long period of time. More info:

      If this were my dog, I would see a different vet, possibly a veterinary internal medicine specialist, to try to determine what happened and whether or not there is a treatable cause. Your dog should have been given two weeks of Amoxicillin (or comparable antibiotic) in case the cause was leptospirosis. An ultrasound would tell you if there is a kidney infection and might provide other clues. You don’t mention a urinalysis, urine culture (to check for urinary tract infection) or urine protein:creatinine ratio (UPC) if protein was found in the urine — if there is protein in the urine in the absence of a urinary tract infection, that requires different treatment.

      It sounds like your vets have done nothing to try to diagnose the cause and have merely been treating the symptoms. I would see a new vet right away.

  8. Marlene, I’m glad to hear that Louie is doing better. May I ask what you were feeding before the switch to k/d, and what his before and after numbers were that were much improved (particularly creatinine)?
    Unfortunately, CKD is not reversible and does not improve. Your dog might have had something else happen that improved on its own, though that seems unlikely unless he also received other treatment such as antibiotics. Another possibility might have been his previous diet causing excess drinking, which I’ve heard associated with diets that are very high in protein. In that case, I would not expect his creatinine to improve (other values such as BUN are not as kidney-specific and can change more based on how long it had been since his last meal and his hydration status).
    Regardless, I hope Louie’s improvement continues, I’m just always interested in understanding what is really going on, especially since diet changes can only slow progression of CKD, not correct it.

  9. Hi,

    Really in need of some help and assistance. I recently bought a puppy from a breeder in Romania- never again!!!,
    what constant worry, stress, heart ache, money and numerous visits to the vets back and forth.

    My puppy arrived 25th oct – i noticed some discharge coming from her vaginal area, was advised to give some Amoxicillin which I did and the discharge changed colour within a week and then the discharge stopped, however it had appeared once again a couple of weeks after the course of treatment but I haven’t noticed anymore now.

    From the day of her arrival she was eating royal canin kibble mixed with ava kibble, she seemed to enjoy the rc kibble and left the ava, however after 2 days of arrival she started to display symptoms of sickness and diarrhoea. I thought this was due to the change and the transportation ,
    the sick was clumps of the kibble food
    , within 3/4 days she went off the kibble and I was feeding her chicken and rice, fruits and yoghurt, which she enjoyed
    The sickness and diarrhoea continued for roughly 3 weeks- her poos were inconsistent sometimes runny, sometimes just right, or at times there was mucous inside it, she was being sick less, however she was losing her appetite, after 3 weeks of reporting the symptoms and my concerns to the vets they decide to do bloods- they come back negative and they said there’s concerns about her renal values and its more than likely a congential probelm, BUN-61.6, Crea-255,K-3.5, PHOS- 3.95 so a few days after her bloods she went into the vets again as she had been sick even more and they wanted to do an xray and put her on iv fluids.

    They done the xray and again they said there’s abnormalities to her kidneys and its more than likely due to a congential probelem. They repeated bloods and the current values are BUN-47.1, Crea- 211, K- 3.6, PHOS 3.39, while she was in there she started to display signs of aspiration pneumonia(which has also been possibly diagnosed by the vets) she was having serious discharge from the nose, she was given kesium and the discharge stopped however her breathing seems to be blocked and she tries to sneeze. Within herself shes doing so much better since coming out from being on the fluids- shes alot more happier, playing about more, eating loads although she is eating royal canin renal food and I have concerns about this as she doesn’t seem to be digesting it properly her poos are very loose and she doesn’t seem to be filling up from it

    • Jason, it’s better to contact me via email from my website when you have a complicated question. You don’t say how old your dog is, but if she is still growing, she should not be on a kidney diet, which is too low in phosphorus to support bone growth. From my website at http://www.dogaware.com/health/kidneyprescription.html:
      Do not feed prescription kidney diets to puppies. Prescription kidney diets are too low in calcium and phosphorus to meet the needs of a growing puppy, even one with renal disease. A recent case study found that such a diet caused rickets when fed to a Shetland Sheepdog puppy. Lethargy, decreased long bone growth, angular limb deformity, and osteopenia (decrease in bone density) occurred, but these signs resolved within 3 months with nutritional management. See Nutrition-related Skeletal Deformation in a Puppy for more info. If you have a puppy with juvenile renal disease, I would either feed a homemade diet (see Homemade Diets for Dogs and Sample Homemade Diet for dogs with kidney disease for more information) or add fresh, high-protein foods (see above) if you do feed a prescription kidney diet.

      I don’t know what you mean by “doesn’t seem to be filling up from it,” but you may not be feeding enough, especially if you’re following feeding instructions for adult dogs rather than a puppy.

  10. Hi Mary, I read your site frequently. My dog has both IBS and early kidney disease. She’s 14+ years old.
    It’s a balance of the GI issue and the kidneys. Since her kidney number aren’t high, I cook 1/3 meats ( first turkey but found 20% ground pork which I use more with rotation), 1/3 sweet potatoes ( first orange yam, now yellow sweet potatoes) and 1/3 rice ( first brown, now wild rice ). ( all foods cooked in water and supplements)
    In reading the above I wonder if I need to do 50% carbs. ( last creatinine level 2.2/ test again in a week).
    Thanks for your help, Terry

  11. Terry, I can’t really offer specific input without knowing a lot more about your dog, including symptom history and test results. In general, you should be reducing the amount of phosphorus that your dog gets since her creatinine is above 2.0. That would be even more important if her blood phosphorus level is above 4.5. But it’s impossible to know how much phosphorus your dog is getting now, and the diet you describe is certainly short on other nutrients, and may be quite high in fat, since most ground pork is extremely high in fat (meat that has 20% fat as fed is likely more than 50% fat on a dry matter basis).
    IBS is more a description of symptoms than anything else, so I can’t really comment on that other than to say that high-fat diets often cause problems for dogs with digestive issues.
    Ideally, you would get recipes using Balance IT’s Canine K Plus (not their original Canine K) for dogs with early kidney disease so that you know your dog is getting what she needs, including not too much phosphorus.

  12. My Miniature Schnauzer Pepper was diagnosed with kidney disease at New Year, she has since been diagnosed with protein in her urine and high blood pressure, she’s taking Fortekor 2.5mg. The vet gave us royal canin renal dog food tinned, which at first she loved, we’ve added biscuits as she likes biscuits. She now isn’t that keen and I’m struggling to get her to eat her meals. At breakfast she’ll eat a few biscuits but won’t eat the meat. Even when she does eat she’s hungry by lunch time and again at around 4pm. I give her carrots and courgette as treats / lunch. Any advice would be appreciated xx

    • Diane, it’s always hard to offer input without enough information. Kidney disease can cause excess acidity that leads to ulceration, so sometimes treatment with acid reducers and sucralfate (prescription anti-ulcer medication) can help with loss of appetite in that case. Note this should only occur if creatinine is elevated. Very high BUN can cause uremia that makes a dog not want to eat. It’s also possible she just doesn’t like the new food, or it doesn’t agree with her, especially since most kidney diets are high in fat and Miniature Schnauzers are prone to fat intolerance. It’s important that your dog eat well enough to avoid weight loss, even if it’s not the best food. If your dog’s creatinine is not elevated, there is no need to feed a prescription diet at all, so you might be able to return to what she was eating in the past, as long as it has moderate levels of protein (not too high or too low). The medication may be affecting your dog’s appetite as well, though this usually happens the most when it is first started, but if you increased the dose, it might be a factor. I have more info in these articles on my website:
      http://dogaware.com/health/kidney.html (check the new sections)

      • What is your email address? I am desperate for a homemade dog food for kidney disease. My dog is 17 years old, his BUN is 40 and the Vet said I had to put him on prescription k/d diet. Corky is losing weight and bvery lethargic and hardly eats. I need help fast!!!!!

  13. Hello I have a 10 year old Rottie with kidney disease. He’ll be 11 in April. The vet has me giving him phosbind in his renal food. The only renal food I haven’t tried is the k/d. He is very lethargic and refuses to eat the renal food. I have been giving him boiled Hamburger and white rice and he will eat that. If I mix it with royal canine Rottweiler food he eats around that..he eats around the NF by purina and the renal support d. I give him fluids as well.so my question..can I continue to feed him hamburger and rice and if so how much? He’s still 110lbs down from 130 and I feel I’m not feeding him enough. I’m grateful he’s eating but I need to find a diet that will encourage him to continue to eat. Can you give more specifics on the home made diet? Please help! I know 10 yrs is great for a Rottie however I feel he can go longer!

    • Kimberly, I can’t offer any diet advice without seeing your dog’s test results. You can contact me via my website with more info if needed. In general, the best way to feed a homemade diet with reduced phosphorus is to use veterinary recipes from Balance IT that use their heatable Canine-K Plus supplement (not the original Canine-K, which includes phosphorus). These recipes require your vet’s approval, but they make that easy to get. The recipes are free; you just pay for the supplement.

      If your dog is losing weight and willing to eat more food, you should feed more food. Any guidelines on how much to feed are just a starting point; you have to adjust for your individual dog based on whether he maintains, gains, or loses weight.

  14. Hi
    My dog 9 years old 9 pound was diagnosis with kidney failure stage 4. His creatine is in 7.5 and urea nitrogen 172 and phosphorus 12.1. He doesn’t want eat too much. He only eat beef, turkey, egg and ham and not too much and I tried to boil in water. he doesn’t want eat any vegetable I tried a lot and he doesn’t like. I tried the hills kidney and he doesn’t want too. I know that he is really bad. But I want try that he stay with me a little more time. What I can do that he eat a little better or that he has a quality life.

    • Maria, I’m sorry to hear that your dog is so sick. If this came on suddenly, it’s possible he might be suffering from acute kidney failure rather than chronic kidney disease, in which case the goal is to try to determine that cause and treat it if possible. If your dog had mild kidney dysfunction that suddenly became much worse, the same could be true. If either of these apply to your dog and your vet has not suggested testing to try to determine the underlying cause, I would suggest trying a new vet.
      If your dog has chronic kidney disease that has steadily progressed to this point, then there is little you can do, since this condition is not reversible. With such high values, your dog is likely suffering from uremia that leads to nausea, and may also have gastrointestinal ulceration caused by the kidney disease. There are medications for ulceration (acid suppressors plus sucralfate, a prescription anti-ulcer medication). See my article on inappetence for info on meds to help increase appetite:

      In general, I would say to feed the dog whatever he wants, but in this case, the high-protein diet is likely contributing to his uremia and inappetence, so if you could find any lower protein foods that he would eat, that might help. Something like white rice, overcooked with extra water, might help him feel better. You could try blending it with some meat to see if that might encourage him to eat it. He doesn’t need vegetables right now, but low-phosphorus grains, particularly white rice, would provide calories that would not make him feel nauseous.

  15. This is a very informative, helpful article, and I intend to investigate this thoroughly! I am a little disappointed by two factors, however. The first being that there are no references! I would love to see references to the studies cited showing the new information regarding low-protein causing older dogs/dogs with renal failure harm. This would be massively helpful. I’m also disappointed to see, considering how current this info appears to be, that coconut oil is still being recommended as a good source of fat for dogs. New information has come to light that coconut oil disrupts the microbiome and causes inflammation. It should no be recommended for internal use. External use still has wonderful benefits. Please look into this! And provide us, if you please, with reference links for the low-protein studies. Thank yo again!

  16. Hi Mary, recently I found out my 14 year old shih-tzu has stage 3 kidney disease. It’s been tough and of course, my vet recommended the k/d diet. To my surprise, my pup liked it for a day or so. She is a picky one. Now, she’ll barely eat and I’ll have to constantly push her bowl towards her to get some food in her. She eats enough just to survive, but it hurts me knowing she isn’t eating enough. She normally has a great appetite too. She has a high BUN, so her vet recommended to stay away from protein. Any tips on feeding my picky eater?

    • Lyn, it’s impossible for me to offer advice without seeing actual test results (Stage 3 is way too general to be useful). You can contact me via my website if you need more input. Generally, you can read about possible contributing factors to inappetence here (note that gastrointestinal bleeding can contribute to high BUN, especially if BUN is relatively higher than creatinine):

      You can also get recipes from Balance IT (veterinary recipes require your vet’s approval, but they make that easy to get). I can’t offer any advice about which type of diet is needed without more info, but you should choose recipes that use their heatable Canine K Plus (not their original Canine K) for dogs with kidney disease

  17. I’m just reading ur article and others furparents issues and I’m feeling helpless.
    My puppy just turn 8 months and she breaks my heart everytime I look at her. She is a German Shepherd and was the runt of her 10 puppy litter (not sure if that matters)
    I purchased her from a first time breeder and feel in love at first sight . When Zola turned 7 months she weighed 72lbs now at 8 months she is 60.5lbs . She was diagnosed with kidney failure. After multiple blood tests, IV flush fluids antibiotics and over night stays, the animal hospital suggested the hills low protein food . I feel like deteriorating infront of me and I can’t help her. Plz can u help me help her!

  18. God bless you my friend – I feel your pain. Raw green tripe (the stinky none can green tripe) got my boy eating normal again, after all the above. Keep the dish raw even if you’re adding veggies. Use safe antacid it really helps . I’m using a liquid aluminum hydroxide antacid binder. Plus he’s eating all his proteins again, egg, cottage cheese, greek yogurt, chicken thighs- cooked.

  19. My dog is 14.5 years old and she is at stage 2 or possibly 3 now of her kidney disease. Her creatine, BUN and phosphorus values are high and have been for quite a few months now. Last month she started to refuse to eat even though she was following us around imploring us to feed her, but would turn her nose up at everything including strips of fresh chicken breast/fish/her favourite treats. We were desperate and checked her into an emergency hospital where they were able to give her 48 hours of continuous IV fluid in hopes of flushing out her system and restoring her appetite level. When she returned home, she slowly became disinterested in eating again at which point my primary vet suggested I consider a feeding tube. Given her age, the level of care required and potential discomfort for my dog – I opted not to have one installed (she’s the type of dog who would freeze in place if a harness or any type of foreign object is placed on her so a feeding tube would mean a prison sentence for her in terms of movement). Finally, out of desperation, we decided to put all her food into a food processor and created a smooth gravy like consistency of liquid (similar to what one would do for putting into a feeding tube) except we used a thin syringe to feed her orally. She was extremely receptive to this type of feeding and would patiently wait for me to finish slowly syringe feeding her before swallowing. This isn’t for every dog and I am so grateful she did not fight me on this. Now her energy level is way way higher than before. It is by no means a cure for her kidney disease but it at least gives her the caloric intake she needs to sustain her current weight and bypasses the struggle of making her want to eat on her own. We were given a calculation by our vet of the amount of calories she needs in a day and prepared her food to reflect that, but we made it into a smooth gravy instead. She has since gained weight and is no longer skin and bones. We feed her three meals a day to ensure she is getting the energy she needs throughout the day and it also helps ensure she gets more liquid as well. This is what works for us, as I know firsthand how frustrating and heartbreaking it is to watch her waste away.

  20. I have been feeding my dog raw diet (primal) since I got her at the age of 3. She was diagnosed with stage 2 kidney failure and my holistic vet said to switch to My Perfect pet Low Phosphorus diet. Should I do that or should I continue with what I was feeding him?

  21. I am so happy I came across your article. I have a 14 year old monitored poodle that is my everything and she was not eating and not feeling her peppy self so took her to the vet and they took blood and like other comments her kidney levels were elevated. She previously was diagnosed with pancreatitis and I was told to give her the low fat gastrointestinal food and she really didn’t like at all. So back to her kidney issues. Well like all the other comments they prescribed, yes you’ve guessed it hills science diet Kidney care well I started with the Canned which I thought she might like the stew one and she ate a tad bit and then stuck he nose up. I literally had to hand feed her and she did not eat much at all. So I then tried the dry variety and it smelled awful and she only ate a small portion and they were like Little Rock’s not appetizing to her at all so sad she would not eat I tried to hand feed her and no go.

    She had fluid treatments twice a week and she looks so sad but once she had the treatment she seems peppier. So I said f this I ordered a rice cooker and cooked organic white rice and boiled chicken green wise chicken strips and oh boy the first time I gave her this she gobbled all up. I give her three meals of their a day and apple 🍎 slices and baby carrots and she is so much better and gained a lb whereas she lost one at the beginning of the week so now she is up to 15 lbs.

    I don’t know why the vet pushes the prescription diet foods maybe they get commission hate to say that but it’s just to easy to say put her on this prescription diet.

    My only thing is my little fur baby trembles and. Not sure what that is all about and it’s only periodically. She is a fighter for sure. Also she had not had any diarrhea and her pee came back with no issues and nothing wrong with her poo test.

    I am not sure what other minerals she needs apart from the organic white rice and the boiled chicken and apple and baby carrots.

    Thanks again and I’m glad that I found this forum.

  22. This is a very good article! I’d like to also share my experience. My dog was poisoned a year and a half ago. When I finally realized he didn’t have food poisoning, he was seen by a vet who diagnosed him with acute KF. The vet kept him overnight and recommended I put him down. I resisted and put him on kidney and liver cleansing herbs for a number of days. He hated the treatment which included hot pepper! I refused the KD (the cans are lined with BPA!) and the food is garbage. I read about the green tripe and mixed it with water to skip the subcutaneous water which was torture for both of us. I did some research and fed him ground beef, green tripe, purple cabbage, baby carrots, and apple. Also very small amounts of beef heart, kidney, and liver. All raw! I weigh all meats in grams. He got 10g beef heart, 5 g liver and 5 g kidney. 140 g ground beef and 140 g raw green tripe. Meals are divided into 2 portions which is easier on the kidneys. I chose those amounts in accordance with the stage he appeared to be in. My dog also got/gets barley grass and alfalfa powders, ashwaganda, astragalus, burdock, kelp, taurine, dandelion, nettle, spirulina,kale, and chitosan and eggshellent calcium. The Chitosan and ground eggshell reportedly bind phosphorus. No synthetic vitamins except zinc and natural vitamin E. Oh also 4 mg astaxanthin with the wild salmon oil. For nausea the first few weeks CBD oil. Well, my dog was doing really well about 4 months later and off the CBD for nausea until he started having mouth tremors and high blood pressure (half closing one eye). Excellent energy though and good appetite. I was worried about the tremors and blood pressure and prayed for wisdom. Within a couple of days I received an article in my email about Modified Citrus Pectin called Pectasol C created by Dr Isaac Eliaz. In my research I found the MCP binds to Galectin-3 which is an inflammatory protein that is implicated in KD as well as many other serious conditions. The doctor mentioned in an interview that the MCP at its lower molecular weight and esterification gets in the cells and hinders fibrosis. Unheard of and I had nothing to lose! I put Popo on an adult therapeutic dose of 6 capsules 3x/day and within 3 days I saw improvement! No more mouth tremors, eye not closing.Affect even more energetic! Super appetite! So after 3 months on the MCP I marched Popo to the vet who wanted to euthanize him. He ran all the blood and urine labs, and everything came back mid range normal!! My vet said he had never seen this before!! So yes, home diets do work. The MCP was and is the game changer along with real food. Try the MCP but don’t be lured by anything other than the Pectasol C. Other brands are cheaper but don’t have a low enough molecular weight. Nothing short of miraculous here. Popo is still my kidney patient. I had lowered his capsules to twice daily ( did I mention I give it with syringed water -about 1 cup or so each time he gets the 6 capsules. He started going downhill again when our forest fires made our air absolutely toxic last summer, soI then increased the dose again to 3x a day until the air cleared to a healthy level. He perked right up again. Anyway, I still have my Popo who’s doing well 1.5 years later. So blessed to still have him! I understand the distress and heartache but don’t give up! There is hope! Good luck and blessings!

  23. A couple things I forgot to mention which are important. I add water to each meal. I also add Slippery Elm to aid in the digestion of the Chitosan which otherwise can plug up your pet. I give water at least 2x daily with a little tripe mixed in it to encourage drinking. At that time I also give the Chinese herb blend called Rehmannia 8 by Health Concerns. He gets 1 capsule each time he gets the water mixed with a bit of raw green tripe. Digestive enzymes are good if you can do them, also a probiotic for dogs. I was giving one raw cod liver oil per day for vitamin D at 42 IU since I wasn’t doing eggs or fish but I now want to research again whether the amount is safe just to be sure.