Diets recommended for pets with
kidney Disease


We vets all pretty much agree on this subject:

As pets become old, the kidneys slowly lose their ability to work well.  Young healthy kidneys contain approximately 1 million individual kidney tubules, each able to process and excrete urea, eliminate excess electrolytes and concentrate the urine.  With age, many of these tubules are damaged, clogged up, scarred, and become non working and go into retirement.  The pet's own immune system will often attack damaged tubules and replace them with a type of scar tissue.

Protein molecules, which are too large to be excreted through a young and healthy kidney begin to pass through the less healthy kidneys of older pets. 

It becomes harder and harder for the kidneys to process and eliminate urea. This is one of the most important functions of the kidney.

Another function of the kidneys is to product a hormone (erythropoietin) that stimulates the bone marrow to produce red blood cells.  As the kidneys age, this function is also compromised. Anemia is the result.

Kidney disease tends to be a slow degenerative process that owners and veterinarians alike miss in the early stages of the disease because there are no obvious symptoms and we don't have simple, accurate, or inexpensive urine or blood tests that detect the disease in the early stages.
There are often no symptoms of illness until the kidneys are down to about 25% of normal function.

As the disease progresses the observant owner will often notice that the pet is drinking and urinating more.  This happens as a result of the kidneys attempting to flush out urea and also because that are losing their ability to concentrate the urine.  We have test kits that detect excessive amounts of protein in the urine at this stage of the disease and routine blood tests that may or may not confirm the disease at this mid stage of the disease.

As the disease gets worse, pets start acting sluggish, have poor appetites, often are nauseated, and just don't feel well.  They'll have good days and bad days.  Routine blood tests will confirm the disease.



In human medicine, kidney transplants and dialysis are commonly available, but not for pets.

For pets, the most important part of managing kidney disease is through therapeutic diets specially designed for kidney disease patients.

There are several excellent therapeutic kidney diets to choose from... simply find one that your cat or dog likes.

These diets tend to be low in sodium to prevent fluid retention and prevent renal hypertension, have reduced phosphorus to slow the progression of kidney disease.
Increased Omega-3 Fatty Acids to improve blood flow to the kidneys.
Proteins chosen to minimize urea production, buffering to prevent metabolic acidosis, and increased B vitamins and potassium to compensate for urinary losses associated with kidney disease.  Added soluble fiber designed to bind and lower serum urea nitrogen.

Studies indicate that kidney disease patients live about 30% longer and with fewer symptoms when fed prescription diets made for treating kidney disease.   Here are the prescription only diets that I know about that are often very successful in managing kidney disease:

Hill's K/D diet for cats or dogs. 
Royal Canin's Renal diets for cats and dogs
Purina NF (Nephritis Formula) for cats & dogs

As far as I can tell, they all work about equally well, and all are available for both cats and dogs.  Canned or dry.

On This Page:

An introduction to the prescription diets I use more than any other: the ones that allow senior patients with kidney disease to live a longer, higher quality life.

This page is about diets.  But on the following page we discuss Kidney & Urinary Tract Disease

On Other Pages:
a directory to our other pages on pet nutrition:

The companies that make pet foods... a little history and some comments.

Using Nutrition as therapy for diseases in pets

Diets used to Treat Urinary Tract Diseases                  
Diets used to Treat Obesity
Diets used to Treat Kidney Disease

Diets used to Treat Heart Disease           

Maximum Calorie diets for recovery from major illness, surgery, or for military and other dogs under major stress                 
Diets used to Treat Arthritis and Joint Disease

Nutrition topics on other pages:

Our introductory page about nutrition in general

Our introductory page about  Nutrition as therapy for diseases in pets

Diets used to Treat Urinary Tract Diseases                  

Diets used to Treat Weight Issues
Diets used to Treat Skin Allergies
Diets used to Treat Kidney Disease

Diets used to Treat Heart Disease                                 

Diets used to Treat Arthritis and Joint Disease

Diet as a treatment for Stomach and Bowel Disorders 

An interesting page about the companies that make pet foods... a little history and some comments.

Cat with Feline Asthma
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The most important part of managing kidney disease is through special therapeutic diets
Of all the common diseases, kidney disease is the most responsive to therapeutic diets.  Kidney disease is usually incurable but pets on therapeutic kidney diets usually live much longer and much more comfortably.
Note: it's a common misunderstanding; diseases of the bladder or lower urinary tract diseases (bladder stones, bladder infections, etc) are treated differently than Kidney problems.  Therapeutic diets are an important part of treating lower urinary tract diseases too, but they are different.
In addition to the special diets, we also recommend the following supplements:

Omega fatty acids: all of the special diets discussed on this page already have added omega fatty acids.  They help with blood flow to the kidneys and may help reduce inflammation and aid in healing.  Adding more may or may not be helpful.  I vote for more.

Phosphate binders:  Phosphorous levels rise with kidney disease which initiates a destructive cycle further reducing kidney functions.  All of the recommended renal diets have reduced phosphates to help prevent this problem.  But, by adding medications that further reduce serum phosphorus has been shown to inprove quality and quanity of life in kidney patients.  Phosphate binders come in tablets that your vet may prescribe if blood tests indicate your pet has high phosphorus levels.
Epakitin is my first choice as a phosphate binder because it has helped a lot of my patients and has the advantage of tasting good... an important plus especially for cats.  Phosphate binding tablets are very inexpensive but are very bitter and difficult to administer.

Renal Essentials: a product for cats and dogs made by the VetriScience.
I don't recommend very many herbal or neutriceutical products ... mainly because I don't know much about them and because so often when I try herbal treatments on my patients ... on the basis of reading how wonderful they are... the reality is usually disappointing.  But renal essentials does seem to help.

Active Ingredients Per 2 Tablets:
Eicosapentaenoic Acid (EPA) . . . . . . . .180 mg
Docosahexaenoic Acid (DHA) . . . . . . . . 120 mg
Astragalus Root Powder . . . . . . . . . . .60 mg
Lecithin . . . . . . . . . . . . . . . . . .50 mg
Rehmannia (Root) Extract. . . . . . . . . . 50 mg
L-Arginine . . . . . . . . . . . . . . . . .50 mg
Nettle (Urtica dioica) Seed Extract. . . . .50 mg
Cordyceps sinensis Extract . . . . . . . . .50 mg
N,N-Dimethylglycine HCl. . . . . . . . . . .25 mg
Potassium (Gluconate). . . . . . . . . . .8.25 mg
Pyridoxal 5-Phosphate (Vitamin B6) . . . . . 8 mg
Inositol . . . . . . . . . . . . . . . . . . 8 mg
Thiamine (Vitamin B1) . . . . . . . . . . . .4 mg
Riboflavin (Vitamin B2) . . . . . . . . . . .4 mg
Choline . . . . . . . . . . . . . . . . . . .4 mg
Folic Acid . . . . . . . . . . . . . . . .0.15 mg
Methylcobalamin (Vitamin B12). . . . . . 0.050 mg

This is interesting; I understand that Epakitin is made from ground up crab and shrimp shells which explains why cats love this stuff.  Epakitin's active ingredient, chitosan, is a natural polysaccharide derived from shells of shrimp and crab. Chitosan naturally binds phosphorus in the bowels which limits the absorption into the blood stream.