Chronic Kidney Failure in Dogs Community
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Avatar universal

What diet to feed your 10 year old Yorkie when he's been diagnosed with stage 4 KD?

My yorkie was diagnosed with kidney disease the last of July 31st. His BUN was 74, Creatinine 2.3 and Phosphorus was normal. We were told to phase him in slowly on Hill's K/D. We had to wait for them to get the Hill's K/D Chicken and Veggies in because he is allergic to grains and soy. By the time we got to the halfway point of phasing in, he refused to eat it any more.
On August 17 I carried him in because he had a few inside accidents. His BUN had risen to 174, Creatinine 9.1 and Phosphorus was 20.3. They did 8 hours of IV on Friday, and 4 hours IV on Saturday. They instructed us to carry him to the 24 hour emergency clinic to continue his drip until Monday morning.
The 24 hour clinic ran more blood work before beginning treatment and his BUN had dropped to 98, Creatinine had dropped to 6. They did not test for phosphorus. They also ran a RBC/HCT/HGB which was 2.4/16.2/5.9 which was incredibly low. On 8/17 his RBC/HCT/HGB was 4.7/36/11. The vet told us that she thought that even continuing with the drip he would only have a couple of weeks at the most. They quoted us a $9,000 quote that didn't include a sonogram. We asked that they give him a subq bag for hydration and were left to see our vet Monday. We syringe fed him water and food until we were able to go to our vet Monday 8/21.
Tony, I followed one of your recipes, and another one I found online and substituted low fat Turkey for the protein. Monday his levels had improved except his BUN had risen from the Emergency Clinic visit. BUN 134, Creatinine 5.7, and Phosphorus 11.5.  Also, his RBC/HCT/HGB had risen to 4.3/31/10.3. The vet did not tell me the phosphorus but he said it had risen some also. I was very encouraged. They are giving us 350 ml of sub q to continue at home and were are administering 200 ml in the morning and 150 ml at night. I am having to syringe feed him food and water because he is still not eating. Occasionally he will eat ground turkey with some broth.
What stool he has is small but normal. He is on anti nausea medicine and Fomatidine .25 of a 10mg tab twice daily and Cerenia 16mg once daily. The vet office only has two vets and they are father and son. The father seems ok with a homemade diet but the son wants me to still phase in the K/D. He believes if I phase it in it won't affect the pancreatitis. Even tho I' terrified to do that, I began phasing it in again at 25%. He had so much more energy yesterday and even ate a tiny bit of cooked ground turkey with sticky rice and broth on his own. Today he is very listless and fights even the syringe food. I'm heartbroken that I can't make him ok. Any suggestions for diet or any other information will be greatly appreciated. Thanks so much!
4 Responses
Avatar universal
Correction: They had me come back 8/23 for the last labs which was Wednesday and not Monday. They wanted to see how the sub q fluids might be working. Thanks
Hi. First thing first, the phosphorous is so high that it will be making huge amounts of toxins, which in turn will cause nausea and inappetence. So, that's the first thing we need to sort out. I would normally advise getting Aluminium Hydroxide, but the low RBC counts denotes anemia - and that's a big issue.

Aranesp (darbepoetin alfa) is a supplement related to Epogen that is used to treat anemia related to kidney disease that has also been used for dogs. A human study found that Aranesp given every two weeks was as effective as Epogen given weekly. Aranesp is available from Thriving Pets.

You need to test erythropoietin levels to see if they're the cause of the low red blood cells, otherwise, the medication can be harmful. Anemia can also be caused by malnutrition if you are feeding too little protein.

Creating red blood cells requires iron, so iron supplementation is recommended while taking EPO or other medication designed to increase red blood cell production. Again, too much iron can be toxic, so follow your vet's dosage instructions.

And all of that depends on whether the anemia is Regenerative Anemia or not - again, something your vet needs to consider and deal with fairly urgently. As his RBC had risen to 4.3, that's not far off normal, and I'm sure it would be safe to use the Aluminium Hydroxide if your vet approves it.

Once the anemia is properly sorted out (hopefully), then you can start the phosphate binder. Aluminium Hydroxide is the most effective, but you shouldn't use it while anemia is present (far better once RBC count is within normal range) - in the meantime, you could use something like Epakitin (talk to your vet), which will do for now and at least you can make a start on controlling the rising phosphorous.

Great that they did the IVs, although that in itself may have caused some swings in blood counts. SubQs are essential as ongoing maintenance (to keep up the good work done by IVs). I can check whether 350ml a day is enough - please let me have your dog's current weight.

Avatar universal
Tony, Thank you very much for your input. He weighs 10 lbs. He returns tomorrow for another set of labs. I've made notes as the vet did plan on giving him Aranesp. They are really pushing the Hill's K/D diet and seem to think if phased in slowly, it will be ok. I'm terrified with the PSL level being so high. He also has allergies to grains and soy. Seems like so much going against my baby. He is getting 200 ml of water a day in addition to subq fluids by syringe and also being syringe fed one of your recipes with low fat ground turkey substituted.  I cannot tell you how much your helps means and I am truly grateful.
I probably should add that I am still phasing in the Hill's K/D diet and am 1/3 Hills and 2/3 homemade low fat kidney diet. He has not shown any symptoms of pancreatitis other than the PSL being in the low 700's. Do you think I should continue phasing in the Hills K/D?
1916673 tn?1420236870
Okay. I think 350ml a day is too much for a 10lb dog. The absolute maximum advised is 200ml, and I would tend to consider 150ml more appropriate. Yes, keep phasing in the Hills kd, it will be rich in good nutrients and importantly low in phsophorous.

Update with labs
The GOOD: Continued drops in levels.  BUN 83, Creatinine 4.5, Phosphorus 8.1 His RBC/Hempglobin/Hematocrit are all now in the low normal range. What a difference since last labs 5 days ago! He did drop his fluids to 225 once daily for the next 5 days, when he will recheck serum levels and reduce further.
The BAD: He still won't eat, nor will he drink on his own as much as he should. If he doesn't and looses weight then we are to put him on primarily fresh cooked foods (your diets) and add Epakitin and Azodyl.
The GRATEFUL: Sincere thanks for the wealth of knowledge you provide online. It gave me help and hope. He is feeling so much better and last night was being his old self. We know, with his levels being as high as they were, his prognosis is still not good. But, to see him playing ball last night and being his old self...what can I say, but a sincere thank you.
With phosphorous at 8.1 I would still far prefer to see Aluminium Hydroxide being used rather than Epakitin. The former is much more effective. The sooner the phosphorous can be brought down the better,as that alone will cause further issues and nausea.

Eating is often an uphill struggle, at least until the nausea and acid reflux subsides. Mirtazapine is something your vet may want to consider prescribing, along with Cerenia if it does work on its own.

Delighted things seem to be improving, albeit a bit slowly.

Thanks Tony for your reply. .Also, his calcium levels are very high.  If he is steadfast in his decision about the Epakitin, can I use the powder form  of Aluminum Hydroxide I've found thru internet sites, that doesn't require a prescription?  The dosing I've found, is for cats at 50mg for phosphorus levels between 6-8 and 100 mg per lb for phosphorous levels between 8-10.  Does that sound correct to you? I'm sorry for the continued questions as I know you probably have a day job. I'll try to make this my last one. Thanks again.
Epakitin should definitely NOT be used if calcium levels are abnormally high. Epakitin contains 10% calcium, so it would just compound the problem.

If you are in the USA, ThrivingPets.com sell Aluminium Hydroxide Gel Powder, which is a very good product. I can advise you on the dosing of it if you let me have your dog's current weight. Aluminium Hydroxide should be given daily, with the daily dose divided equally into all food and meals given (it only works on the food ingested).

It's been ordered and his weight at vets office was 10.4lbs Monday. Again, thank you for your time and support.
Avatar universal
Hi my dog Sadie is not a big fan of the prescription KD either.  I always have to supplement with fresh cooked foods, but try to get as much of the canned KD food into her as I can.  My dog has been on the KD for almost 2 years, so I think she is just tired of it.  I supplement with things like egg whites and fresh veggies, as well as some lean mean such as chicken breast and ground turkey.  Sweet potatoes are a great option if your dog's potassium is not high.  A tip I got from Tony is to drizzle a little organic honey to entice, which she really likes, I add it to her white rice.  I also make white bread toast and crumble a small amt into bread crumbs on top of the canned KD food, which she loves and will usually eat the canned food this way.  She eats Royal Canin KD canned food only, not the dry, you could try this, if he rejects the Hills as another option (not sure about the allergy ingredients in the Royal Canin).  They have 3 varieties.   Sadie has been taking Azodyl too for 2 years and this seems to have helped held her numbers steady since her DX.  As well as the Alum Hydrox phosphate binder, seeming to make a big difference too.  Sadie has recently seen a rise in her Amylase and Lipase, which I attribute to the canned high fat KD (source of energy for KD dogs), so I had to cut back on it for awhile and pick up on some carbs in the meantime.  It is a fine balance, but you will definitely get the hang of it and it sounds like you are doing great!  Hope your Yorkie continues to show improvements!
Thank your Fawn for your support. There is so much to learn quickly. His potassium levels are normal and that's a plus, as he does love bananas and will eat sweet potato, if I eat it with him off my plate. I've tried the honey and he turns his nose up at it, which until recently he loved. I'll get the white bread today and try that, toasted with a few crumbles in his food. We definitely need to try some other kd foods. I'm emailing my vet this morning about the Aluminum Hydroxide that you and Tony suggested and hopefully he will be good with that. I hope your Sadie has continued success and her pancreatic levels will go in the other direction. I'm very thankful for a forum for support and knowledge to help with all the difficulties of this disease. Thanks again!!!
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