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ESSENTIALS JULY/AUGUST 2018 13 ESSENTIALS Nutrition is arguably the most important aspect of chronic kidney disease (CKD) management. Manipulating the composition of a patient's diet can slow the progression of CKD, minimize uremic symptoms, and improve quality of life. A seminal study in dietary management of CKD demonstrated that dogs with spontaneous CKD lived an average of 13 months longer when fed a diet designed for renal disease compared with a maintenance diet. 1 In addition, dogs eating the renal diet had a 3-fold reduction in relative risk of uremic crises compared with dogs eating the maintenance control diet. At the end of the 2-year study, only 33% of dogs receiving the renal diet died from renal-related causes, compared with 65% of dogs receiving the maintenance diet. Most therapeutic diets designed for CKD use a combination of moderately restricted protein, phosphorus, and sodium, with moderately elevated concentrations of omega-3 fatty acids and potassium ( TABLE 1 ). This article explores the evidence behind these nutrient alterations. PROTEIN The goals behind lowering dietary protein concentration for dogs with CKD are to (1) lower the amount of nitrogenous waste produced during protein metabolism while (2) minimizing the amount of protein entering the glomerular filtrate of the kidneys. Protein restriction as a dietary management strategy for CKD has become increasingly controversial. Some argue that, in an effort to retain muscle mass and increase diet palatability, dogs with kidney disease should not be placed on a low-protein diet, while others cite research suggesting that lower-protein diets, in combination with other nutrient modifications, reduce morbidity and prolong lifespan. 1-3 Azotemia and Uremia Creatinine and blood urea nitrogen are waste products of protein and muscle metabolism cleared through the kidneys. Elevated levels of these substances, along with other by-products of protein metabolism not routinely measured in blood samples, result in azotemia and clinical signs associated with uremia (e.g., nausea, inappetence, malaise). Nitrogenous wastes can also contribute to gastric ulceration, reduce red blood cell lifespan, 4 and exacerbate polyuria and polydipsia through creating excess solute load in the kidneys. Reduction of dietary protein intake may lower the concentration of these uremic toxins in dogs. Feeding Dogs with Chronic Kidney Disease: What the Evidence Can and Can't Tell Us Angela Witzel Rollins, DVM, PhD, DACVN The University of Tennessee College of Veterinary Medicine NUTRITION NUTRITION STRATEGY Manipulating a patient's diet can slow the progression of CKD, minimize uremic symptoms, and improve quality of life.

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