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Care Suggestions
Article Links
 Dietary Protein
Much
progress has been made in clinical nutrition in the past decade
especially in the area of nutrition in the kidney failure
patient. This is still an area of controversy between
clinicians and nutritionists, but research is providing more insight
concerning the role of dietary protein in the management of the
kidney failure patient. What I hope to do here is provide a
digest of this current state of affairs and let you make your own
decisions.
- There is a link between dietary protein levels and the
clinical signs of kidney failure.
- Once dogs have developed signs of uremia such as
decreased appetite, vomiting, depression, electrolyte changes, GI
ulceration, increased BUN and creatinine and weight loss, then
decreasing the protein content of the diet is indicated these
signs. Decreasing the protein content of the diet prior to
the onset of clinical signs does not affect the progression of
kidney failure. The pathogenesis of kidney failure is not
clear and the rate of progression is variable.
- We know that increasing the protein in the diet results
in increased blood flow to the kidneys - this occurs in both
healthy dogs and those with decreased kidney
function.
- Increased levels of dietary protein do not seem to
change rate of progression of kidney
failure. Protein levels in the diet do not seem to affect
mortality, rate of progression of uremia or the development of
kidney lesions.
- Decreased protein levels in the diet may impair immune
responses, decrease hemoglobin levels, cause anemia, decrease
total protein levels and result in muscle wasting.
- Phosphorus restriction is an important factor in
management of dogs with kidney failure.
- 3/4 to 15/16 of the kidney mass must be lost before
progression of kidney failure occurs.
- When protein restriction is initiated fat and
carbohydrate levels must be increased to provide alternate energy
sources.
Much of the research in kidney failure and
diet have been done in rats, dogs who have had surgically induced
kidney failure and geriatric dogs with progressive kidney failure
due to age-related changes. Does this information pertain to
dogs with amyloidosis, immune-mediated kidney diseases or
inflammatory kidney diseases? Studies need to be done to
address these scenarios. The information available can be used
to formulate the following general guidelines:
- Feed a diet with a protein level which fits the dog's
activity level. Couch potatoes on a high protein diet become
obese leading to other problems.
- Dietary protein levels do not appear to be involved in
the progression of renal disease or play a role in the prevention
of kidney failure. However, I prefer to err on the
conservative side. I think protein levels in the 20-24 %
range are probably safe. Of course other factors enter in
such as the protein source, the bioavailability of the protein,
fat content, carbohydrate levels, etc. must be considered as
well.
- When the BUN is greater than 75mg/dl and/or signs of
uremia develop, moderate protein restriction is indicated to
decrease the BUN and the clinical signs. Phosphorus
restriction is also indicated at this time. This is most
easily done with the available commercial kidney diets on the
market.
- What this also means is that these dogs must be
monitored closely to follow changes in the BUN and creatinine
levels. My experience in Shar-Pei indicates that they show
clinical signs of kidney failure very late in the course of the
condition when their BUN and creatinine levels are extremely
elevated. Often, Shar-Pei owners miss the very subtle early
changes and present their dogs when it's too
late.
Diet does not appear to play a major role in
prevention of kidney disease in Shar-Pei at this
time. I think avoiding substances and situations which result
in kidney damage are preventative steps that can be taken.
Certain drugs such as aminoglycoside antibiotics can cause kidney
damage and should be avoided, when possible. Decreased kidney
blood flow can lead to kidney damage emphasizing the importance of
IV fluids administered during anesthetic procedures and use of
monitoring equipment. Situations, which result in low
blood flow to the kidneys such as heat stroke, bloat, and shock must
also be avoided. Infectious diseases can also result in kidney
damage. These include bacterial kidney disease, heartworm,
leptospirosis, Lymes disease, etc. Toxins such as ethylene
glycol (antifreeze) and arsenic can cause kidney damage as
well. To a large extent we can prevent some of these
things. The major emphasis has to be monitoring the dogs so
the onset of kidney failure is uncovered early in the course of the
disease when dietary manipulations may be useful.
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