SPECIFIC diets for Chronic Kidney Disease (CKD)

SPECIFIC offers a complete range of diets for the management of chronic kidney disease in dogs and cats, including high digestible and highly palatable hydrolysed kidney diets. We have both dry and wet diets for both dogs and cats and our new hydrolysed kidney diets are state of the art nutrition for renal care in dogs and cats. the most important features are:

Highly digestible and with hydrolysed protein - can reduce unremic toxins
Uniquely high levels of omega-3 (EPA / DHA) from fish - to reduce inflammation and glomerular hypertension
Gut supporting ingredients - for a healthy gut microbiome and gut barrier integrity
High palatability - support appetite maintanance of lean body mass
Restricted protein, phosphorous and sodium level

SPECIFIC Derma and Allergy diet Range

What is Chronic Kidney Disease in cats and dogs

Chronic kidney disease (CKD) is common, especially in elderly cats and dogs. It is a lifelong progressive and irreversible disease that affects the kidneys' ability to filter waste products and maintain electrolyte and fluid balance.

Nutrition is an important part of the management of CKD in dogs and cats to help to slow down the progression of the kidney failure, improve quality of life, and prevent secondary complications.^42,43,71 By choosing the best possible nutrition you can prolong the life span of your furry patient and secure their vitality throughout their life.

Learn what happens to the kidneys throughout disease progression with the interactive 4D Kidney Model

click here

Support materials for download

WHITE PAPER - Chronic Kidney Disease (CKD) in dogs and cats and the impact of nutrition

Materials for vets and nurses

Info. folder SPECIFIC hud-/allergiprodukter

SPECIFIC hud- & allergi produktväljare

SPECIFIC Infoblad Allergen Management Plus

Allergic De rmatitis in Dogs and Cats

Posters SPECIFIC hud och allergiprodukter

SPECIFIC Omega-3 dos per dag

SPECIFIC Energi-trappa

SPECIFIC Omega-3 trappa

Pet owner materials

SPECIFIC djurägarhemsida

Djurägarfolder SPECIFIC hud och allergifoder

Födoämnesdagbok för djurägare

Materials for social media

Material för sociala medier för nedladdning

Video allergier och hudproblem

Nutritional management for cats and dogs with CKD

The goals of the nutrition intervention in CKD patients are.^42,43,71

To prevent or improve the clinical signs
To reduce progression rate of the disease and extension of the survival time
To reduce electrolyte (calcium and phosphorus) and acid-base imbalances
To provide adequate nutrition³⁰

Science show that several nutritional adjustments, especially reduced phosphorous and protein levels can benefit CKD patients, more recent studies indicates that support gut health can make an impact and slow down the progression of kidney disease.

Reduced phosphorus and protein levels

European legislation, (R 2020/354), indicates mandatory characteristics for the support of renal function in case of chronic renal insufficiency with maximum levels of phosphorus (≤ 5 g/kg for dogs and ≤ 6.5 g/kg for cats) and protein (≤220 g/kg for dogs and ≤320 g/kg for cats) in a complete renal diet with 12% moist.²⁰

Clinical trials with cats and dogs with CKD have shown that renal diets with reduced phosphorus and protein levels reduced plasma levels of phosphorus, PTH, urea and creatine and was associated with reduced uremic episodes, less renal-related deaths, improved body condition and reduced clinical signs^{7,21,39,44,66} as well as better quality of life and a longer median survival time.^21,25,60,63

Phosphorus restriction

Phosphorus restriction

Patients with CKD have a reduced capacity to excrete phosphorus, which successively leads to hyperphosphatemia, secondary hyperthyroidism, precipitation of calcium phosphate in the kidneys, loss of nephrons and results in further progression of renal failure^24,73 and shorter survival time.^25,60 Studies on cats and dogs on phosphorus restriction showed reduced plasma phosphorus, PTH, kidney mineralization, fibrosis and inflammation⁶⁵ and enhance survival time and maintenance of kidney function, as measured by GFR.31

If plasma phosphorus concentrations of cats or dogs with CKD remain too high on a phosphorus restricted diet, phosphorus binders can be used, as supplement or in the diet, to limit intestinal absorption.^42,43 CatneyOne from Dechra is a lanthanum carbonate phosphorus binder. Read more about CatneyOne.

Protein restriction and highly digestible protein

Excretion of waste products from protein metabolism (urea, creatinine, uremic toxins indoxyl sulphate (IS) and para-cresyl sulphate (pCS)) is reduced in CKD, leading to a build-up of toxins in the body and increased blood levels which can cause nausea, vomiting, inappetence and reduced food intake, as well as disease progression in CKD.^1,49,64

Dietary protein restriction to dogs and cats lower production of waste products, the workload on the kidneys and accumulation of toxins in the blood. Older studies showed decreased urea and creatinine levels, proteinuria and glomerular damage.^1,64 More recent studies show decreased blood levels of IS and pCS, metabolised from undigested proteins, in healthy dogs and cats^27,77 as well as in cats with early CKD.²⁸

With a diet restricted in protein, the protein needs to have a high biological value and be highly digestible.⁴⁷

Balanced potassium levels

Balanced potassium levels, with increased levels to decrease the risk of hypokalaemia frequently found in cats with CKD²², and decreased levels in canine diets to lower the risk of hyperkalaemia which is more common in dogs.⁷⁰ Both conditions can contribute to further reduction of renal function.^23,42

Additional Nutritional Considerations

Additional Nutritional Considerations to help slow down the progression of CKD

Highly digestible, high in energy and highly palatable diets.^38,48
Highly digestible omega-3 fatty acids EPA and DHA, found in fish oils.^11,13,63
Gut supporting ingredients (polyphenols, pre-, pro-, and postbiotics) to support the microbiome. ^4,5,34
Dietary zeolite to bind ammonium in the gut.⁵⁸
Preventing metabolic acidosis by adding an alkalizing agent.⁴²
Reduction of sodium level to prevent hypertension.⁸⁰
Adding antioxidants to help reduce oxidative stress.^13,87

Ensuring adequate hydration and regular monitoring of biochemical markers and body condition assessments are key to support these patients and improve their quality of life.^42,43

Video assessing body condition

What is the gut kidney axis

Here we need an illustration and an animation for the website

There is a close relationship between the gut microbiome and renal health, the so-called gut-kidney axis. This is a bidirectional relationship between the gut and the kidney – where kidney disease triggers gut dysbiosis which in turn exacerbates the progress of kidney disease and can develop a self-perpetuating process of inflammation, intestinal permeability (leaky gut) and dysbiosis^18,46,76,82, it is often difficult to say if dysbiosis or leaky gut is a cause to or a result of CKD.⁸³

The different parts in the gut-kidney axis

The microbiome and dysbiosis

The microbiome in the gut consists of approximately 10¹⁰ to 10¹⁴ microorganisms (bacteria, viruses, fungi and protozoa). Dysbiosis is when the equilibrium between microbiota, epithelial barrier, and immune response is disturbed, with reduced diversity, a decrease in beneficial saccharolytic bacteria and an increase in pathogens. It can be induced by undigested food, change in dietary composition, increased uremic toxins, use of antibiotics, etc.⁷⁵ Dysbiosis can lead to dysregulation of metabolic processes, cardiovascular disease, impaired intestinal barrier “leaky gut”, systemic inflammation and increased uremic toxins which can increase progression of CKD in humans, dogs and cats.^{45,72,78,82,84}

Leaky gut

In leaky gut the function of the tight junctions between the epithelial cells in the intestinal barrier is altered and harmful molecules can pass between the epithelial cells into the blood stream. An imbalanced microbiota in dysbiosis produces less of the beneficial metabolites, mainly SCFAs, that plays a key role in the maintenance of the tight junctions.^74,79 Leaky gut is of particular concern for progression of CKD because endotoxins, like bacterial lipopolysaccharides (LPS) and uremic toxin precursors stimulates production of pro-inflammatory cytokines (TNF-α, IL-6), which increase systemic inflammation and oxidative stress.^3,34,82 There is a correlation between increased intestinal permeability and CKD severity and elevated serum levels of zonulin and LPS can serve as indicators for increased intestinal permeability.⁶⁷

Uremic toxins

Uremic toxins are part of the self-perpetuating process since dogs and cats with CKD have more uremic toxins IS and pCS in their blood, because of decreased excretion in the kidneys^29,35 and increased production of precursors from dysbiosis and undigested protein in the colon.⁸¹ This affects the production of beneficial SCFA⁸², increases the risk of leaky gut and favour uremic toxin producing bacteria81 which contributes disease progression with direct nephrotoxic effects and with increased the risk of heart disease.⁵⁰

Animals with gut dysbiosis and CKD can have a variety of gastrointestinal disorders, such as diarrhoea, constipation, and vomiting leading to malnutrition and nutritional deficiencies, decreased appetite, weight loss and renal cachexia.³⁸

Animation Gut Kidney Axis

Nutritional management of CKD in dogs and cats to support gut-kidney axis

Nutrition plays an important role in the processes related to the gut-kidney axis and to decrease the risk of gut dysbiosis and leaky gut. The goal is to reduce the level of systemic uremic toxins and inflammatory mediators to slow down the progression of kidney failure.

High digestibility, high in energy and highly palatable diets

For dogs and cats with CKD high digestible, high in energy and highly palatable diets are essential to meet the nutrient requirements.³⁰ The aim for a renal diet is to reduce the production of metabolic waste and allow for maximum absorption of essential nutrients (proteins, fats, carbohydrates, vitamins and minerals) and calories, even with reduced consumption. This helps to prevent anorexia, malnutrition, weight loss and muscle breakdown, which is common in patients with CKD^38,48 and to maintain nutritional status and quality of life.

Sometimes medication can be needed to stimulate appetite and help with anorexia.

The Dechra academy provides a range of on-line learning including this course related to kidney disease

The Role of Nutrition in Managing Kidner Disease

This training addresses the role of diet as part of a multimodal approach to the management of chronic kidney disease in dogs and cats, in particular the value of a high digestibility and hydrolysed protein diet and the importance of high levels of anti-inflammatory omega-3 and -6 fatty acids.

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Already registered for the Dechra Academy? - go directly to the course:

Access the modul on managing Kidney Disease

Dechra Academy The Role of Nutrition in Managing Allergies and Atopic Dermatitis

Benefits of Omega-3 EPA and DHA in CKD in dogs and cats

Animation on how EPA and DHA

It is well known that high levels of omega-3 fatty acids EPA and DHA in diets can help modulate systemic and renal inflammation, have beneficial effects on cardiovascular and kidney health and reduce the risk of secondary complications.^{8,10,11,15,41,63,88}

EPA and DHA omega-3 can help to slow down progression of CKD in several ways

Reduce inflammation and oxidative stress by interfering with the production of pro-inflammatory eicosanoids (prostaglandins (PGE2) and leukotrienes (LTB4)).³²
Synthetize the metabolites resolvins and protectins, potent anti-inflammatory mediators blocking the actions of eicosanoids and helps to clear the site of inflammation.⁶⁹
Increase the bioavailability of the vasodilator nitric oxide, which can reduce systemic and intraglomerular blood pressure and reduced proteinuria.¹¹
Reduce the risk of thrombosis² and inhibit production of pro-fibrotic growth factors such as TGF-β (transforming growth factor beta)²⁶, reducing progression of renal fibrosis.

Omega-3 and the gut in case of CKD

Omega-3 and the gut

Recent evidence show that intake of omega-3 fatty acids can affect the gut microbiome through increased numbers of SCFAs, reduced levels of inflammatory mediators and improved intestinal immunity.^33,40 Through its effect on microbiome and gut immunity, omega-3 supplementation could have a beneficial effect on the gut-kidney axis.

Other benefits with omega-3 in dogs and cats with CKD

In dogs with induced CKD, high dosages of EPA and DHA reduced proteinuria, prevented glomerular hypertension and decreased the production of pro-inflammatory eicosanoids - with reduction of histopathologic lesions.^11,12 Omega-3 fatty acids may also contribute to maintenance of body weight and muscle mass due to cachexia in dogs and cats with CKD.^14,32

EPA and DHA dosage to decrease progression of CKD

EPA and DHA dosage

Data on the effect of EPA and DHA in cats is limited to one retrospective study where cats with CKD fed a renal diet with an EPA content of 95 to 127 mg EPA/kg body weight was associated with the longest survival time.⁶³ With a rough ratio of 1:1 of EPA:DHA in fish oil, the dosage of EPA+DHA in this renal diet was around 190 to 254 mg/kg body weight. Also other studies indicates that high intake of EPA and DHA help to maintain kidney function and can contribute to prolonging the lifespan of the animal with CKD.^11,12,14,63 In one study on dogs the minimum dose of EPA+DHA that showed a reduction in glomerular hypertension and proinflammatory eicosanoids was equivalent to 130 to 140 mg EPA+DHA /kg 0.75 body weight.⁸

Omega-3 in kidney support diets

Therapeutic kidney diets are often supplemented with high concentrations of omega-3 fatty acids, but it is important to remember that the omega-3 fatty acid ALA (α‐Linolenic acid) does not contain EPA and DHA and that its conversion to EPA and DHA is residual in cats and dogs. Therefore, information on the specific concentration of EPA and DHA in the diet is important for the clinician.

Diagram of EPA/DHA in competitor diets

Managing uremic toxins with diet and use of adsorbents and phosphate binders

In patients with CKD uremic toxins IS and pCS accumulates in the blood because of decreased excretion in the kidneys and they play a key role in the progression of CKD. Nutritional management to decrease the level of IS and pCS are reduced protein level and highly digestible protein⁴⁷, use of pre-, pro- and postbiotics, and enrichment with antioxidants⁵⁶ and aims to improve quality of life and slow down the progression of CKD.

Uremic toxin production

Uremic toxin precursors indole and P-cresol are produced in the gut when the amino acids tryptophan, phenylalanine, and tyrosine are digested by the intestinal microbiota. The precursors are metabolised in the liver into the uremic toxins IS and pCS.⁵⁷ IS and pCS are excreted by the kidneys in healthy cats and dogs, whereas in patients with CKD they accumulate in the blood and play a key role in the progression of CKD when stimulating production of mediators (TGF-β), contributing to renal fibrosis and inflammation.^54,55,56,78 In the gut the toxins can increase oxidative stress, production of pro-inflammatory cytokines and disrupt tight junctions which contribute to dysbiosis and leaky gut.^46,51,56,78

Both IS and pSC plasma levels has been shown to be predictors of the progression of CKD in cats and dogs and can serve as a biomarker of the risk of disease progression.¹⁷

Use of adsorbents and phosphate binders

Adsorbents that can bind uremic toxins and precursors in the gut can be beneficial. Porus One for cats from Dechra is an adsorber composed of Renaltec, a new compound with micropores that bind to uremic toxin precursors and prevents them to be absorbed to the blood.

Phosphate binders like Catney One for cats from Dechra based on lanthanum carbonate that reduce the absorption of phosphate to avoiding the risk of developing hypercalcemia can help decrease the level of uremic toxins. Catney One binds phosphate as early as in the acidic environment of the stomach and continue to be 100% effective in the basic or neutral environment in the intestine. Since phosphate is principally absorbed in the small intestine early binding prevents it from being absorbed. Lanthanum carbonate phosphate binders help to remedy electrolyte imbalance and does not lead to hypercalcaemia, which can be a risk with a calcium carbonate binder.

In cats the new SPECIFIC Kidney Support diets can safely be combined with CatneyOne and PorusOne for a triple effect to support renal function in cats with CKD.

More information about Catney One and Porus One

Kidney Support diets from SPECIFIC

In chronic kidney disease a highly digestible diet that support a healthy intestine and the gut-kidney axis is key to reduce the level of uremic toxins in the blood and slow down the progression of kidney failure. That's why New SPECIFIC Kidney Support diets work in a multi-action way and will help to reduce the amount of uremic toxins in the blood, support gut health and reduce inflammation, on top of that they have a superior palatability helping to keep the animal in a good body condition. Together this will help to slow down the progression of the kidney failure and prolong the life of the animal.

SPECIFIC Heart & Kidney Support Hydrolysed CKD-HY/CKW-HY for dogs
SPECIFIC Kidney Support Hydrolysed FKD-HY/FKW-HY for cats

The new kidney support diets from SPECIFIC have a multi-action formula with all the basic characteristics of a kidney diet with

reduced phosphorus
protein and sodium
highly digestible ingredients

They also have a package of other kidney supporting characteristics:

based on hydrolysed proteins for optimal protein absorption
enriched with a package of gut supporting nutrients to support the gut barrier integrity and a healthy microbiome - AuraGuard for gut barrier integrity, beneficial fibres for a healthy microbiome and zeolite for binding pathogens.
uniquely high levels of omega-3 fatty acids EPA and DHA to decrease inflammation and prilong the lifespan of the animal

This multi-action gut-kidney formula will give your furry patients the daily dose of vitality they deserve and will prolong the progression of kidney disease.

SPECIFIC Heart & Kidney Support CKD / CKW for dogs
SPECIFIC Kidney Support FKD / FKW / FKW-P for cats

The updated kidney support diets from SPECIFIC have a multi-action formula with all the basic characteristics of a kidney diet with

reduced phosphorus
protein and sodium
highly digestible ingredients

They also have a package of other kidney supporting characteristics:

enriched with a package of gut supporting nutrients to support the gut barrier integrity and a healthy microbiome - AuraGuard for gut barrier integrity, beneficial fibres for a healthy microbiome and zeolite for binding pathogens.
uniquely high levels of omega-3 fatty acids EPA and DHA to decrease inflammation and prolong the lifespan of the animal.

SPECIFIC Kidney Diets - FAQ

Är det nödvändigt att göra ett eliminationstest?

Födoämnesallergi kan endast diagnostiseras med hjälp av eliminationstest, det finns inga andra tillförlitliga tester. För att kunna ställa rätt diagnos är det därför viktigt att utföra ett elimineringstest med efterföljande provokation med djurets tidigare foder och sedan enskilda proteinkällor. Om djurägaren inte villig eller kapabel att utföra ett eliminationstest kan man göra ett foderbyte till en hypoallergen diet och helt enkelt utvärdera hur djuret svarar på detta. Då får man dock inte reda på vilket födoämne som djuret faktiskt är allergisk emot, eller om det underliggande problemet faktiskt var en födoämnesallergi eller inte. Djuret kan ha blivit bättre av någon annan orsak under tiden som den stått på det hypoallergena fodret.

Är det möjligt att vara allergisk mot källor till omega-3- och omega-6-fettsyror?

Ja, det är möjligt att uppvisa en reaktion mot källor till omega-3- och omega-6-fettsyror (t.ex. fetter och oljor). Allergeniciteten hos ätliga oljor och fetter är relaterad till förekomsten av restprotein i produkten. Det finns uppgifter på att proteininnehållet i "råa" livsmedelsklassade oljor är i storleksordningen 0,1–0,3 mg/ml. I raffinerade oljor reduceras denna nivå cirka 100-faldigt. Studier har visat att just den "råa" oljorna kan framkalla allergiska reaktioner hos känsliga allergiska individer. Det antas att raffinerade oljor inte utgör en risk för att framkalla allergiska reaktioner hos majoriteten av allergiska individer.

De typer av fett som används i hypoallergena dieter bör vara testade för eventuella proteinrester och man bör ta med i beräkningen att även en raffinerad olja kan innehålla spår av potentiella allergener i form av proteinrester.

Det fläskfett som används i SPECIFICs hypoallergena foder har kontrollerats med PCR-test som visat att det är fritt från fläskprotein och därför inte ska framkalla någon allergisk reaktion hundar eller katter med allergi mot fläskprotein.

Även fiskoljan som används i de hypoallergena SPECIFIC-dieterna har testats med PCR-analys och är fria från fiskprotein, och därmed säkra att utfodra till individer med allergi mot fisk.

Hur lång tid tar det att se en allergisk reaktion mot ett foder och hur snabbt kan man se förbättring av symtom?

Hundar och katter med födoämnesallergi, som är utan kliniska symtom på en viss hypoallergen diet och byts till en annan hypoallergen diet, kan uppvisa ett återfall av kliniska symtom inom en period på några timmar upp till 2–3 veckor. Det beror på vilken typ av reaktion de får av allergenet.

Hos individer som för närvarande lider av symtom på födoämnesallergi i form av magtarm problem så ser man ofta en förbättring på dagar upp till 2-3 veckor, medan det vid hudsymtom kan ta upp till 6–10 veckor innan en tydlig förbättring ses när man byter till en hypoallergen kost som djuret tolererar. Ett eliminationstest, vid hudrelaterade symtom, bör därför utföras under ca 8 veckor för att man ska få en tillräcklig förbättring av hudens kondition (Olivry et al 2015). Nya forskningsrön visar också att man kan göra eliminationstestet under en kortare period (3-4 veckor) om man kombinerar en hypoallergen diet med ett antiinflammatoriskt läkemedel som påskyndar förbättringen av hudsymtomen.

For further information including answers to questions about SPECIFIC:

Visit SPECIFIC FAQ page

References

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SPECIFIC diets for management of Kidney Disease

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SPECIFIC diets for Chronic Kidney Disease (CKD)