Hello, I am very sorry about your dog!
Your question is similar to the previous question about feline renal disease and is pertinent to your dog's condition.
Shivering is a bad sign that is linked to kidney failure, unfortunately.
Azodyl can cause digestive disturbances if introduced too quickly, in some cases.
Azodyl is supposed to help the digestive system remove toxins that can no longer be filtered by the kidneys. The theory is sound.
Substitutes for Azodyl include: Pre and Probiotics such as acidophilus, bifida factors, FOS, and others plus beet fiber. Both are available at health food stores or online. They are both available as powder. Begin with a very small amount ¼ teaspoon of each and gradually increase to 1 tablespoon on food twice daily. Even higher doses can be used as long as they do not upset your dogs digestion. Dosing is monitored by the consistency of your dog’s stool. Once the stool becomes loose go back to the dose prior to the loose stool.
Daily Sub-Cutaneous Fluid therapy is very important and can be performed at your vet's office, or can be given at home (your vet or veterinary nurse/technician can instruct you how to perform this). Give 200 to 300 milliliters daily of Lactated Ringers Solution daily, if possible.
Give the Chinese Herbal Formula for kidney disease: Rehmannia 8 (Jin Gui Shen Qi Wan) at a full human adult dose twice to three times daily. This is a common herbal formula and you may be able to find one specifically for pets online.
Have urine samples checked frequently and treat any urinary tract infection.
Give a glucosamine/chondroitin supplement, this will help bladder and kidneys as well as joints.
An Ace Inhibitor medication, such as enalapril can be a helpful adjunct, since it helps to aid in perfusion of the kidneys. This is available at your veterinarian's
B-complex vitamins, vitamin C and D. Use an over the counter vitamin formula at ½ human adult dose. Vitamin D is extremely important because when kidney function is lost vitamin D is no longer produced in adequate quantities. A blood test is available to check vitamin D levels.
A low protein diet is no longer always advocated for kidney disease.
Veterinary Acupuncture would be very beneficial. It could be used for the hip dysphasia and to benefit kidneys. It would also help reduce the dependence on Metacam, and increase your dog’s quality of life. Rehmannia 8 is available at most veterinary acupuncturists.