| SUMMARY:
ROYAL
CANIN Veterinary DietTM/MC canine RENAL
LPTM/MC (low protein canned), RENAL
LP 11TM/MC (low protein dry), RENAL
MPTM/MC (medium protein canned), and
RENAL MP 14TM/MC (medium protein dry),
are formulated with restricted phosphorus levels and reduced protein contents
to aid in the dietary management of chronic renal failure in dogs.
Two levels of protein, medium and low, are offered in order to permit
a staged approach to the management of renal failure. In addition, by
combining diets, it is possible to vary the protein delivery to meet the
individual requirements of dogs of different body weights. Therapy may
be individualized based on the severity of clinical signs and changes
in laboratory parameters.
INDICATIONS: |
CONTRAINDICATIONS:
|
| -- |
For
the management of chronic renal failure in adult dogs |
-- |
Growing
puppies |
| |
|
-- |
Pregnant
or lactating bitches |
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RATIONALE:
Dietary management of dogs with chronic renal failure (CRF) is
aimed at improving clinical symptoms, minimizing vitamin, mineral, electrolytes
and acid-base imbalances, and slowing disease progression. In order to
achieve these goals, levels of phosphorus, protein, calcium, sodium, B-complex
vitamins, and fat have been modified.
Energy:
In dogs with chronic renal failure, it is important to provide sufficient
energy to minimize catabolism of either dietary or endogenous protein.
Protein catabolism contributes to the production of nitrogenous waste
products and the clinical symptomology of uremia. Non-protein energy can
be provided as either carbohydrate or fat. Fat is preferred for the patient
with renal failure as it aids palatability and increases the energy density
of the diet. This translates to less total volume of food fed on a daily
basis compared with maintenance diets RENAL LPTM/MC
(low protein canned), RENAL LP 11TM/MC
(low protein dry), RENAL MPTM/MC (medium
protein canned), and RENAL MP 14TM/MC
(medium protein dry) are formulated with relatively high fat contents
and energy density.
Protein:
Dogs with chronic renal failure have a reduced ability to excrete both
nitrogenous and non-nitrogenous protein catabolites. The accumulation
of these metabolic by-products in the circulation is one of the major
causes of uremic symptoms and laboratory abnormalities with renal failure.
Clinical studies have shown that modifying dietary
protein intake can reduce blood urea nitrogen (an index of nitrogenous
waste products) and provide clinical benefits. In addition to reducing
the level of nitrogenous waste products, protein restriction may also
reduce the intake of dietary phosphorus. Protein restriction also decreases
the renal solute load, thereby, lessening the severity of the polyuria
and polydipsia.
Although protein restriction has positive effects
with respect to the amelioration of clinical signs, care must be taken
to ensure that the patient still receives adequate dietary protein to
meet or exceed the minimum daily requirements. Very low protein diets,
coupled with poor food intake, have been associated with protein malnutrition,
loss of lean body mass, and hypoalbuminemia.
It has been recommended that dogs with chronic renal
failure should receive at least 2 grams of protein per kilogram body weight
per day. In this scenario large breed dogs (i.e. > 80 lbs.) may actually
be protein malnourished if fed severely protein restricted diets.
Large breed patients, even with late stage renal failure, would most appropriately
receive RENAL MPTM/MC (medium protein
canned) or RENAL MP 14TM/MC (medium
protein dry) rather RENAL LPTM/MC (low
protein canned) or RENAL LP 11TM/MC
(low protein dry).
Minerals:
Dietary phosphorus restriction has been shown to slow the progression
of renal disease. Hyperphosphatemia is a common finding in chronic renal
failure. Increased serum phosphorus concentrations lead to a decrease
in the activity of the enzyme alpha-hydroxylase in the kidney contributing
to a decreased production of calcitriol and an increased production of
parathyroid hormone.
Parathyroid hormone is considered a uremic toxin.
It contributes to anemia, neurotoxicity, soft tissue calcification, and
renal osteodystrophy. Phosphorus restriction decreases the production
of parathyroid hormone and slows the progression of renal disease.
Systemic hypertension has been reported in dogs with
chronic renal failure. Hypertension has also been implicated in the progression
of renal failure. Sodium homeostasis is primarily regulated by the kidney.
With advanced renal failure, the kidneys can no longer excrete adequate
amounts of sodium. The excess dietary sodium may contribute to hypertension.
Therefore, dietary sodium intake should be controlled to assist the management
of hypertension.
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Special
Tips:
| 1. |
Inappetance is a common symptom in
dogs with renal failure. Therefore, food intake should be monitored
to ensure adequate daily caloric intake. Warming the food to body
temperature and adding water to the dry diets may improve palatability.
Try feeding "little and often” and, if necessary, enteral
feeding should be considered. |
| 2. |
Dogs with renal disease are at risk of becoming
dehydrated. Therefore, counsel the owner to be aware of this risk.
In addition, accommodations may need to be made to allow the dog outdoor
access to urinate more frequently. |
| 3. |
Restricting protein intake reduces renal solute
load and reduces urine volume. Dogs in the early stages of renal failure
that present with polyuria/polydypsia as the only clinical symptom
will often improve with the reduction in protein intake on RENAL LPTM/MC
(low protein canned), RENAL LP 11TM/MC
(low protein dry), RENAL MPTM/MC
(medium protein canned), and RENAL MP 14TM/MC
(medium protein dry) diets. |
| 4. |
Changing from a regular maintenance
diet to RENAL MPTM/MC (medium protein
canned), and RENAL MP 14TM/MC (medium
protein dry) represents a significant reduction in protein intake.
Where most maintenance diets contain 70-100 grams of protein per 1000
kcal RENAL MPTM/MC (medium protein
canned), and RENAL MP 14TM/MC (medium
protein dry) contain approximately 50 and 40 grams of protein per
1000 kcal, respectively. Changing to RENAL LPTM/MC
(low protein canned), RENAL LP 11TM/MC
(low protein dry) or RENAL LP 11TM/MC
(low protein dry) diets may not be necessary initially to obtain significant
improvement in clinical signs. Dogs may prefer RENAL MPTM/MC
(medium protein canned), and RENAL MP 14TM/MC
(medium protein dry) because of the higher protein contents compared
RENAL LPTM/MC (low protein canned)
or RENAL LP 11TM/MC (low protein
dry) diets. |
| 5. |
Even if the goal is to eventually
switch the dog onto RENAL LPTM/MC
(low protein canned) or RENAL LP 11TM/MC
(low protein dry), it is helpful for the dog to make this transition
by initially changing to RENAL MPTM/MC
(medium protein canned), and RENAL MP 14TM/MC
(medium protein dry) diet for 7-10 days before transitioning to the
higher protein restriction of RENAL LPTM/MC
(low protein canned) or RENAL LP 11TM/MC
(low protein dry) diets. |
RENAL LPTM/MC
(low protein canned), RENAL LP 11TM/MC
(low protein dry), RENAL MPTM/MC
(medium protein canned), and RENAL MP 14TM/MC
diets have similar nutrient profiles when compared on an energy
basis with the exception of protein. Having two different protein
levels, each in both dry and canned format, allows protein delivery
to be tailored to the individual dog based on the dog’s
body size and the severity of clinical signs of uremia.
|
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REFERENCES:
Hopwood-Courville RM, Vaden SL, Hurley
KJ, et al. Protein modification in dogs with non-azotemic protein-losing
nephropathy. J Vet Intern Med 2003;17:404.
Bauer JE, Markwell
PJ, Rawlings JM, et al. Effects of dietary fat and polyunsaturated fatty
acids in dogs with naturally developing chronic renal failure. J Am Vet
Med Assoc 1999;215:1588-91.
Markwell PJ,
Bauer JE, Rawlings JM, et al. The impact of dietary fat and polyunsaturated
fatty acids on renal disease: a short review of data from clinical and
experimental studies. Journal of Animal Physiology and Animal Nutrition
1998;80:234-238.
Bauer JE, Crocker
RC, Markwell PJ, et al. Dietary n-6 fatty acid supplementation improves
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Markwell PJ,
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p71.
Bauer JE, Crocker
R, Markwell PJ, et al. Urinary eicosanoids in polyunsaturated fatty acid
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Prevention 1996.
Crocker R, Bauer
J, Malcik K, et al. Effects of urinary polyunsaturated fatty acids on
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JE, Crocker R, et al. Lipoprotein metabolism and LCAT activities of dogs
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McAlister KG,
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Bauer J, Zoran
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Smith BHE, Rodriguez
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Smith BHE, Markwell
PJ, Rodriguez-Garcia MC, et al. The dietary management of canine renal
failure caused by leishmaniasis. Proceedings of the European Society of
Veterinary Internal Medicine Congress 1994 p 67.
Smith BHE, Frith
N, Markwell PJ. Effects of dietary management of renal disease on certain
biochemical parameters. Animal Chemical Society Newsletter 1994.
Zoran D, Harte
J, Senior D, et al. Effects of polyunsaturated fatty acids on indices
of renal function. Proceedings of the American College of Veterinary Internal
Medicine Forum:1994 p 998.
Leibetseder
JL, Neufeld KW. Effects of medium protein diets in dogs with chronic renal
failure. J Nutr 1991;121:S145-S149.
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