kidney disease dog care
Kidney Disease in Dogs: Signs, Symptoms, and Treatment
Your dogs kidneys are essential organs that filter waste products from the bloodstream. When the kidneys are weakened, either by acute or chronic kidney disease, your dogs health could suffer. Because kidney disease progresses over time, its important to learn the common symptoms so tha you can recognize them. If you catch kidney disease in dogs early on, treatment can slow down the progression and allow your dog to live longer.
What Is Kidney Disease in Dogs?
Kidney disease in dogs is sometimes called renal or kidney insufficiency because it occurs when a dogs kidneys stop doing their job as efficiently as they should. The main job of the kidneys is to help clear and excrete waste products from the blood and convert them to urine, says Dr. Jerry Klein, Chief Veterinary Officer for the AKC. If the kidneys are not working properly, these waste products can build up in the blood, causing detrimental effects.
Dogs can get either acute kidney disease, which develops suddenly, or chronic kidney disease (CKD), which develops slowly and worsens over an extended period. Both involve loss of kidney function, but they result from different circumstances. Acute kidney disease is a sudden attack or injury to the kidney, whereas chronic kidney disease is a slow, degenerative loss of kidney function, Dr. Klein explains.
What Causes Kidney Disease in Dogs?
Dr. Klein warns that kidney disease could be caused by a lot of things, including infection (such as with the bacteria that causes leptospirosis), trauma, genetics, drugs, toxins, cancer, mechanical obstructions (like kidney stones), and degenerative diseases (where the job and form of the affected body part get worse over time). Anything that decreases blood flow to the kidneys, such as dehydration or heatstroke, can cause the kidneys to fail.
Acute kidney disease in dogs can be caused by exposure to hazardous materials, including toxic plants such as lilies, certain drugs, harmful foods such as grapes or raisins, or antifreeze. Puppy-proofing your home and yard can keep your dog away from potentially harmful items or foods that could be toxic.
Chronic kidney disease in dogs is also associated with growing older. Because kidney tissue cant regenerate once its damaged, the kidneys can wear out over time. As small-breed dogs often live longer than large-breed dogs, they tend to show early signs of kidney disease at an older age10 years old or more, compared to as young as 7 for the large breeds.
What Are the Symptoms of Kidney Disease in Dogs?
The earliest signs of kidney disease in dogs are increased urination and therefore increased thirst. Other symptoms dont usually become apparent until about two-thirds of the kidney tissue is destroyed. So, in the case of CKD, the damage may have begun months or even years before the owner notices. Because of this, its common for the signs of kidney disease in dogs to seem like they came out of the blue when in fact, the kidneys have been struggling for a long time.
Other signs of chronic kidney disease in dogs to watch for include:
Dr. Klein says there are some rarer symptoms of kidney disease in dogs to be aware of, as well. On occasion, there can be abdominal painurinary obstructions or stonesand in certain instances, one can see ulcers in the oral or gastric cavity. In extreme cases, little or no urine is produced at all.
What Are the Stages of Chronic Kidney Disease in Dogs?
Kidney disease in dogs is measured in stages. Many veterinarians use the IRIS scale, which has four stages. Blood work measurements like creatinine and SDMA (biomarkers for kidney function) allow your vet to assign your dog to a particular stage which will determine the exact treatment.
Dr. Klein explains, The stages determine how well the kidneys can filter waste and extra fluid from the blood. As the stages go up, the kidney function worsens. In the early stages of CKD, the kidneys are still able to filter out waste from the blood. In the latter stages, the kidneys must work harder to filter the blood and in late stages may stop working altogether.
How Is Kidney Disease in Dogs Treated?
Dialysis (a medical procedure that removes waste products and extra fluid from the blood) is far more common in humans than in dogs, although peritoneal (kidney) dialysis can be performed in some cases. On rare occasions, surgical kidney transplant is possible in dogs.
But Dr. Klein specifies that depending on the type and stage of kidney disease, the main treatments for CKD are diet changes and administration of fluids, either directly into the veins (intravenous) or under the skin (subcutaneous). The balancing and correction of electrolytes are extremely important in the management of kidney patients, he explains.
Proper nutrition is needed, and there are many available diets formulated for cats and dogs with kidney issues, some by prescription only. Your veterinarian can help guide you to the most appropriate diet for your pet.
Because kidney disease, particularly in the late stages, can cause a dog to lose their appetite, it can be difficult to encourage your dog to eat enough. Dr. Klein advises, There are medications used as appetite stimulators available, such as the prescription drug mirtazapine. Capromorelin has recently been FDA-approved for dogs to address appetite in chronic kidney disease.
When Do You Need to Call Your Vet?
The prognosis and expected life span for a dog with kidney disease depend on the type of disease, the speed of progression, and underlying conditions present in the dog. However, the more serious the disease, the poorer the outcome. Thats why its so crucial to catch the illness early on.
According to Dr. Klein, In chronic kidney disease, there are methods, such as diets and medications, that can be used to lessen the burden of work the kidneys need to do and may help slow down the progression from one stage to the next. In acute kidney disease, there is less time and fewer choices available to prevent further damage to the kidneys and to try to jump-start the kidneys to get them to function normally.
Regular veterinary exams, including bloodwork, are an excellent way to spot kidney problems before the outward symptoms become apparent. And if you notice any of the above signs, dont hesitate to get your dog to the vet for further testing. It can make a huge difference in preserving kidney function and your dogs well-being for as long as possible.
19 Best Dog Foods for Kidney Disease
One in ten dogs will be affected by kidney disease, and older dogs are significantly more prone to this disease. Although there is not much you can do to reverse a kidney disease diagnosis, there is a lot you can do to improve your dogs overall health. Armed with adequate information and a good diet, you can help your dog live a healthy life with kidney disease. In some cases of acute kidney failure, you may even be able to turn the prognosis around.
Kidneys are in charge of waste removal from the blood, which comes out as urine. Dogs kidney disease can either be acute or chronic. Acute kidney disease occurs suddenly, whereas the chronic condition develops over a long time and is common in aged dogs. Acute kidney disease can be reversed, while chronic kidney disease cannot.
The two types of kidney disease are listed below.
- Acute
- This is sudden onset renal failure
- Prompt treatment can sometimes resolve the failure before it becomes long term
- Recovery depends upon the level of damage done to the kidneys
- If left untreated, acute kidney disease can quickly become fatal
- Chronic
- This is the most common disease in older dogs
- Unfortunately, it is typically irreversible
- Early management can help slow the progression
- Upon diagnosis, chronic kidney disease will be classified as stage I through IV
- Other functions of your dogs kidneys
- Balancing the water level
- Regulating the blood pressure
- Regulating the red blood cells
- Regulating the acid level
How can Dietary Management help dogs with kidney disease?
While its impossible to repair damage to the kidney tubules, you can help the remaining kidney tubules work more efficiently by feeding your dog the correct diet. This will help reduce the clinical signs by preventing the accumulation of waste products in the blood. It will help to slow down the progression of the disease.
Feeding your dog a lower protein diet than usual will help reduce the buildup of unwanted waste products such as urea. But its important to not reduce the level of protein too much, or your dog wont get enough protein for cell replacement and body regulation.
You should also reduce the level of phosphorus in your dogs diet. Specially designed low-phosphorus diets are available from your vet. When the kidney cannot remove phosphorus from the blood, a series of chemical processes leads to the loss of function of more kidney tubules.
Since dogs with kidney disease sometimes have poor appetites, they need to eat enough to stay at a normal weight. Losing weight, particularly muscle tissue, can add stress to their kidneys. An ideal diet will have a high concentration of calories, yet still, be low in protein and phosphorus.
What are the characteristics of foods for dogs with kidney disease?
Dog owners should keep in mind that commercial dog foods can help prevent kidney disease or improve the lives of dogs who already live with kidney disease. The only dog foods currently available to treat kidney disease are those that require veterinary authorization. Below is a list of requirements for foods you feed your dog with kidney disease.
- Lower in protein: High protein content increases the strain on the kidneys.
- Reduced salt content: It lowers the workload on the kidneys and helps affected dogs maintain a reasonable blood pressure level.
- Reduced phosphorus: Limiting the amount of phosphorus and protein in a dogs diet can help delay the progression of chronic kidney disease.
- Omega-3 fatty acids: can help reduce inflammation which can ease the progression of chronic kidney disease.
Note that it is often wise to consider wet or canned options for dogs with kidney disease. Dogs suffering from kidney disease need more water than healthy dogs, so youll not only want to encourage your dog to drink lots of water. You may want to give your dog food with much greater water content, like quality canned wet food.
Which breeds are predisposed to joint issues?
Based on their build and genetic history, some breeds are predisposed to chronic renal failure. Some of those breeds are listed below.
- Bull Terriers
- Cairn Terriers
- English Cocker Spaniels
- German Shepherds
- Samoyeds
- Shih Tzus
- Soft Coated Wheaten Terriers
- Poodles
- Rottweilers
- Doberman Pinscher
- Lhasa Apso
What are the tell-tale signs of kidney failure in dogs?
Our canine companions cant tell us when they feel under the weather. Therefore it is up to dog owners to be alert to any signs of health problems. Below are some red flags to indicate your precious canine companion has kidney problems.
- Loss of appetite
- Vomiting
- Extreme lethargy and excessive sleeping
- Problems or straining when urinating
- Weakness
- Disorientation
- Increased or decreased thirst
- Shivering or trembling
Knowing which dog food would be the best choice for your dog is tough. Below are five bests to help you choose the best dog food to control your canine companions kidney disease.
What are the best dog food brands to consider?
Several matters must be considered when choosing the best dog food. Your dogs age, breed, life stage, and overall health matter, along with your budget. Sometimes, it is necessary to go for the best dog food at the most reasonable price. Below is a list of some bests for buying dog food for a dog with kidney problems.
Image | Product | Features | Price |
---|---|---|---|
Best Overall | Royal Canin Veterinary Diet Canine Urinary SO
| 10 | Check Price on AmazonCheck Price on Chewy |
Best for Adult Dogs | Royal Canin Veterinary Diet Canine Renal Support S Dry Dog Food
| 9.9 | Check Price on AmazonCheck Price on Chewy |
Best for Senior Dogs | Holistic Select Natural Grain Free Dry Dog Food, Senior Chicken Meal & Rice Recipe
| 9.8 | Check Price on AmazonCheck Price on Chewy |
Best Value | Blue Buffalo Natural Veterinary Diet KS Kidney Support Dry Dog Food, Chicken 6-lb bag
| 9.7 | Check Price on AmazonCheck Price on Chewy |
Best Wet Food | Chicken Soup for The Soul Puppy - Chicken, Turkey & Duck Classic Wet Dog Food Pate
| 9.6 | Check Price on AmazonCheck Price on Chewy |
Note: All the prices in this article are as of April 6, 2022.
What are the 10 Best Dog Food Choices for Kidney Disease
Below is a list of the best dog foods formulated to prevent or control arthritis and joint health in dogs.
Founded in 1968 in France, Royal Canin is engaged in producing and supplying nutritional food for dogs and cats.
- Formulated to help dissolve pure struvite stones
- Lowers risk of crystal formation
- Helps increase urine production to help dilute excess minerals
The company has a geographical presence on five continents with 12 production facilities. Headquartered in St. Charles in Missouri, Royal Canin USA owns and operates two pet food manufacturing plants in Missouri and South Dakota.
NOTE This item needs authorization from your veterinarian.
Royal Canin Urinary SO is a veterinary-exclusive dry dog food developed to nutritionally support your adult dogs urinary tract and bladder health. This formula promotes a urinary environment unfavorable to the formation of both struvite and calcium oxalate crystals. It increases the amount of urine your dog produces to help dilute excess minerals that can cause crystals and stones. Relative Super Saturation (RSS) methodology is used to help lower the ion concentration in urine, which contributes to stone formation.
- Royal Canin Urinary SO is veterinary-exclusive dry dog food for dogs with urinary health concerns.
- Helps dissolve pure struvite stones and helps prevent calcium oxalate stones.
- Lowers the risk of crystal formation using RSS methodology for bladder health.
- Supports urinary health with an exclusive S/O Index and creates an environment unfavorable to crystal formation in the bladder.
- Helps prevent struvite stones from reoccurring.
This specialized nutrition, with a reduced level of magnesium, helps dissolve pure struvite stones and prevent struvite stones from forming. Lower urinary tract issues may be a recurring concern for some dogs like Bull Terriers. Talk to your veterinarian about keeping your dog on this urinary dog food for long-term urinary support.
First 5 Ingredients:
- Brewers Rice
- Corn
- Chicken Fat
- Chicken By-Product Meal
- Brewers Rice Flour
Royal Canin Urinary SO is available in 6.6-lb, 17.6-lb, and 25.3-lb bags.
Founded in 1968 in France, Royal Canin is engaged in producing and supplying nutritional food for dogs and cats.
- Crafted with an energy-dense formula to reduce meal volume
- Antioxidants, fish oil and low phosphorus help support kidney function
- Savory flavor to help stimulate appetite
The company has a geographical presence on five continents with 12 production facilities. Headquartered in St. Charles, Missouri, Royal Canin USA owns and operates two pet food manufacturing plants in Missouri and South Dakota.
Royal Canin Veterinary Diet Renal Support S is a highly palatable dry dog food specially formulated to care for the kidney health of adult dogs like Cairn Terriers under veterinary supervision. S stands for Savory, and this formula can help stimulate your dogs appetite. The crescent-shaped dry kibble can be mixed with other Royal Canin Renal Support formulas, which have a variety of palatable aromas and dry or wet forms to help find the right combination to get your dog eating again.
- A veterinary-exclusive dry dog food for adult dogs to support kidney health.
- S = Savory to help stimulate appetite in dogs and encourage eating with crescent-shaped kibble.
- Helps compensate for decreased appetite with a highly palatable energy-dense formula to reduce meal volume.
- Helps promote kidney function with a precise antioxidant complex, fatty acids from fish oil, low phosphorus, and targeted protein levels.
- Works in conjunction with a variety of appetite-stimulating Royal Canin Renal Support Wet and Dry Dog Food varieties.
This energy-dense diet provides nutritional support in smaller portions since dogs with kidney challenges have decreased appetites. Plus, it contains a precise antioxidant complex, fatty acids from fish oil, low phosphorus, and targeted protein levels to help support kidney function.
First 5 Ingredients:
- Corn
- Brewers Rice
- Chicken Fat
- Brown Rice
- Chicken By-Product Meal
Royal Canin Veterinary Diet Adult Renal Support S Dry Dog Food is available in 5.5-lb and 17.6-lb bags
NOTE This item needs authorization from your veterinarian.
Holistic Select dog food is manufactured by Wellpet LLC, headquartered in Tewksbury, Massachusetts, founded in 1926.
- Limited ingredient recipe enhanced with digestive enzymes to easily break down food
- Antioxidants, taurine and omega fatty acids support whole-body health
- Contains natural fibers
Wellness uses minimum ingredients but aims for maximum nutrition while ensuring that its recipes care for the overall health and specific health problems. Holistic Select is manufactured at the companys facility located in Monmouth, Illinois, USA.
Senior dogs like English Cocker Spaniels need special food. Formulated with your dogs golden years in mind, Holistic Select Natural Grain-Free Dry Dog Food, Senior Chicken Meal, and Rice Recipe is a delicious canine palate pleaser. Grain-free, with the right amount of protein, fat, and fiber to support a slowing metabolism, you can be confident youre giving him the best.
The formula also has controlled mineral levels, such as phosphorus and sodium, to help support kidney health. Also, vital nutrients like antioxidants, L-carnitine, and omega-3 fatty acids help maintain your pals overall health and body condition. This wholesome, natural diet offers beneficial nutrition and a taste your furry best friend will love.
- Includes multiple ingredients that support your dogs overall digestive health.
- Omega-3 fatty acids help your pup achieve healthy skin and coat.
- Antioxidants, glucosamine, probiotics, and taurine all contribute to a healthy heart.
- Healthy, nutritious recipes are also formulated to please your pups palate.
- Made in the USA with high-quality ingredients sourced from around the globe.
Holistic Selects Senior Dog formula contains active probiotics and digestive enzymes to help support the absorption and utilization of vital nutrients throughout your dogs entire body. This recipe is specially formulated to meet the caloric needs of senior dogs. It includes healthy protein for muscle maintenance and glucosamine for healthy hips and joints.
First 5 Ingredients:
- Chicken Meal
- Chickpeas
- Peas
- Lentils
- Dried Ground Potatoes
By combining their unique digestive health support ingredients with delicious fruits, vegetables, proteins, and omega fatty acids, Holistic Select foods can help your pet achieve whole-body health.
Holistic Selects Senior Dog formula is available in 12-lb and 24-lb bags.
Bill Bishop and his sons Billy and Chris founded Blue Buffalo in 2003 in Wilton, Connecticut, to honor their beloved family dog, Blue.
- Features controlled levels of protein to help manage kidney workload
- Phosphorus and sodium help support kidney health
- Does not contain corn, wheat or soy
NOTE This item needs authorization from your veterinarian.
The Bishop family became increasingly concerned with the quality of Blues food when Blue had a bout with cancer at a young age. On April 24, 2018, General Mills, Inc. Minneapolis announced its acquisition of Blue Buffalo Pet Products, Inc.
Blue Buffalo Natural Veterinary Diet KS Kidney Support Grain-Free Dry Dog Food lets you feed your German Shepherd or another canine companion the finest natural ingredients in a special veterinary diet at an affordable price. Made with controlled protein levels from chicken to help manage your dogs kidney workload. The grain-free formula also has controlled mineral levels, such as phosphorus and sodium, to help support kidney health. Also, vital nutrients such as antioxidants, L-carnitine, and omega 3 fatty acids help maintain your pals overall health and body condition. This wholesome, natural diet has beneficial nutrition and a taste your furry best friend will love.
- Kidney support dry dog food with controlled protein levels to help manage your furry pals kidney workload.
- The veterinary diet has controlled levels of phosphorus and sodium to help support kidney health for a happy and thriving dog.
- Enhanced with antioxidants, L-carnitine, and omega 3 fatty acids for your dogs overall health and body condition.
- Made without the grains many pet parents choose to avoid, making this holistic formula great for doggies with sensitive tummies.
- Prescription-only food is made with the finest ingredients that benefit nutrition and offer a taste your furry best friend will love.
It is also worth noting that this best dog food for kidney disease has a reasonably low phosphorus content, even for dry options, at 0.55%. Even better, the Blue Buffalo Natural Veterinary Diet Kidney Support employs excellent manufacturing processes to ensure that its food does not contain artificial flavors or preservatives.
First 5 Ingredients:
- Deboned Chicken
- Potato Starch
- Pea Starch
- Peas
- Potatoes
Blue Buffalo Natural Veterinary Diet KS Dry Dog Food Available in 6-lb and 22-lb bags.
NOTE This item needs authorization from your veterinarian.
Chicken Soup for the Soul Pet Food was founded in 2004, says Jeanne Blandford, the companys Senior Director of Marketing.
- Great-tasting, delicious blend of chicken, turkey and duck
- Made from simple, high-quality ingredients
- Does not contain by-product meals, artificial flavors and preservatives
The family-owned and operated company comprises a small team working closely to develop premium, healthy pet foods made from high-quality ingredients. Chicken Soup for the Souls pet products are manufactured by Diamond Pet Foods. This much larger national brand owns four state-of-the-art manufacturing facilities in the US.
Give your older Samoyed pup everything he needs to keep him feeling his best with Chicken Soup for the Soul Mature Canned Dog Food. This diet contains real chicken as the first ingredient to maintain lean muscles. It is also blended with turkey, duck, and salmon, making for a taste your furry friend will love. Chicken Soup for the Soul Mature Dog Food has no by-product meals, wheat, corn, or soy, and it is a complete and balanced option for your canine companion.
- A mature diet with real chicken and turkey as the first two ingredients.
- Blended with turkey, duck, and salmon for a taste your pup will love.
- Contains no wheat, corn, or soy for dog food you can trust.
- Formulated without artificial colors, preservatives, or flavors.
Chicken Soup for the Soul Classic Life Stage recipes are prepared with real chicken and turkey as the top ingredients. Also, with wholesome grains, fruits, veggies, and herbs to provide natural nourishment. They never use any by-product meals, corn, wheat, or soy in their wet or dry formulas and would never add artificial flavors, colors, or preservatives to your best buddys dinner.
First 5 Ingredients:
- Chicken
- Chicken Broth
- Turkey Broth
- Turkey
- Chicken Liver
Chicken Soup for the Soul Mature Chicken, Turkey & Duck Recipe Canned Dog Food is available in cases of 12 x 13-oz cans.
Instinct Pet Food was founded in 2002 and has been producing frozen and freeze-dried raw pet food in their company-owned Lincoln, Neb., facilities. The corporate offices are located in St. Louis.
Give your Shih Tzu or another breed dog simple and essential nutrition with Instinct Limited Ingredient Diet Grain-Free Recipe with Real Lamb Freeze-Dried Raw Coated Dry Dog Food. Because when your dog has food sensitivities, knowing exactly whats in his food is essential. This recipe features a purposefully short ingredient list, made with just one animal protein and one vegetable. The limited ingredient recipe includes just one animal protein and one vegetable for pets with food sensitivities.
- Made with grass-fed lamb, an easily digestible protein that provides all the essential amino acids your pooch needs.
- Guaranteed levels of natural omegas and antioxidants promote healthy skin and coat, plus immune health.
- Made in the USA using premium ingredients sourced worldwide, with the pure nutrition of raw in every piece.
- Never contains any grain, dairy, eggs, chicken, beef, fish, sweet potato, potato, chickpeas, corn, wheat, soy, artificial colors, or preservatives.
Guided by the purity and simplicity of raw nutrition, its the simple and essential food that your dog needs to thriveand its all made in the USA with the finest ingredients from around the world.
First 5 Ingredients:
- Lamb Meal
- Lamb
- Tapioca
- Peas
- Canola Oil (preserved with Mixed Tocopherols and Citric Acid)
Instinct Limited Ingredient kibble is purposefully crafted with a simple ingredient list for pets with food sensitivities. Unlike most other pet foods, each recipe contains just one animal protein and one vegetable.
Instinct by Natures Variety Limited Ingredient Diet Grain-Free Recipe with Real Lamb Dry Dog Food is available in 4-lb and 20-lb bags.
Forza10 was founded in 1995 by veterinarian Sergio Canello, an expert who has dedicated 40 years of his life to discovering and treating the true causes of inflammatory, chronic, and autoimmune diseases in pets.
Through extensive research and work with veterinarians, researchers, and European universities, Forza10 has developed targeted and scientifically tested diets to help combat various health issues in dogs and cats.
Soft Coated Wheaten Terriers with kidney problems need special diets. The Forza10 Nutraceutic Active Kidney Renal Support Diet Dry Dog Food is just what the doctor ordered. Formulated especially for dogs with renal failure and heart disease who need low protein, phosphorous, or sodium diets. This complete and balanced formula provides optimal nutrition with therapeutic plant and fruit extracts for better health. Its made with limited ingredients and without by-products or fillers that can trigger allergies, with single-source protein and carbohydrates that are easy on delicate pets.
- Formulated to help renal and cardiac problems with lower protein, phosphorous, and sodium content than regular diets.
- Limited-ingredient formula avoids potential allergens and additives that can make ailing pets sicker.
- Contains no corn, wheat, soy, by-product meals, GMOs, or artificial ingredients.
- Gluten-free carbohydrate sources and single-source protein can help pets with allergies and sensitivity.
- Omega-6 and -3 fatty acids and therapeutic plant and fruit extracts support health for better overall well-being.
Forza10 Active Kidney Renal is designed to help support renal and cardiac health in dogs. It is made with Icelandic wild-caught anchovy, rich in omegas for healthy skin and coat. Further kidney support comes from Cranberries, dried dandelion, and dried clover. This scientifically tested diet is free from all the bad stuff; never any GMOs, by-products, corn, wheat, soy, artificial preservatives, colors, or flavors.
First 5 Ingredients:
- Rice
- Pea Starch
- Vegetable Oil
- Hydrolyzed Fish Protein
- Hydrolyzed Potato Protein
Forza10 recipes are supported by numerous scientific studies conducted in association with veterinarians and European universities and published in prestigious international scientific journals.
Forza10 Nutraceutic Active Kidney Renal Support Diet Dry Dog Food is available in 8.8-lb bags.
Nutro Natural Pet Food, founded in 1926, was acquired by Mars Inc. in 2007. Mars Inc. was established in 1911 and is now based in McLean, Virginia.
Mars Inc. has two dry pet food manufacturing facilities for NUTRO products located in Henderson, North Carolina, and Victorville, California. They also have wet food manufacturing facilities in Columbus, Ohio, Fort Smith, Arkansas, and North Sioux City, South Dakota. Wet food packed in cans and trays is manufactured there.
Help your favorite Poodle furball get fit with nutritious and delicious Nutro Ultra Adult Weight Management Chicken, Lamb & Salmon Recipe Dry Dog Food. These tasty, dry recipes are specially formulated for overweight adult dogs to help manage a healthy weight. Their recipes start with real chicken as the main ingredient, no chicken by-product meal here. Add lamb, salmon, and a blend of 15 superfoods, and you have a mouthwatering, healthy meal.
- The protein-rich formula features chicken, lamb, and salmon.
- A recipe specially formulated for overweight adult dogs to help with healthy weight management.
- Contains a blend of 15 superfoods, high-quality real ingredients, and vitamins and minerals to provide complete and balanced nutrition for your adult dog.
- Ingredients are sourced from trusted farmers and rigorously tested for quality and food safety.
- No artificial preservatives, flavors, or colors. It is also free of chicken by-product meal, corn, wheat, and soy protein.
The high-quality, non-GMO ingredients are sourced from trusted farmers. They provide a balanced, nutrient-rich diet that will satisfy your dog and help him thrive. There are no artificial flavors, colors, or preservatives, and it is free of corn, wheat, and soy protein. If your sidekick is struggling with weight gain, help him keep off the pounds with this flavorful and nourishing kibble.
First 5 Ingredients:
- Chicken
- Chicken Meal (source of glucosamine and chondroitin
- Whole Grain Brown Rice
- Whole Grain Sorghum
- Whole Grain Barley
Nutro Ultra dry dog food contains a unique and exclusive blend of 15 superfoods, bringing together high-quality animal protein, whole grains and seeds, and fruits and vegetables to help your dog thrive.
Nutro Ultra Adult Weight Management Chicken, Lamb & Salmon Recipe Dry Dog Food is available in 15-lb and 30-lb bags.
Lotus was a family-owned and operated enterprise from the beginning. In 2003, they created Lotus because of their love for pets and knew they could make something better.
They produce small batches of kibble that are oven-baked and small batches of cans made in their own micro-cannery. Lotus dry foods are manufactured in a bakery in Canada. Their wet foods are made in a company-owned micro-cannery in California.
Lotus Oven-Baked Sardine & Herring Recipe Grain-Free Dry Dog Food combines real sardine and herring. Along with recognizable fruits and vegetables like dried peas, carrots, apples, spinach, blueberries, etc. The beneficial olive and salmon oils blend provides your Lhasa Apso with healthy omega fatty acids. At the same time, vitamins, antioxidants, and nutrients help support her overall health. Plus, this kibble tastes just like an oven-baked fish cookie that your canine companion wont be able to resist.
- 100% grain-free for sidekicks with sensitivities.
- Oven-baked to help preserve protein, amino acids, vitamins, and antioxidants from fruits and vegetables.
- Features fresh fish as the only animal protein source, making it perfect for pups on a limited ingredient diet.
- Low in starch and less processed than other kibbles.
- Contains optimized calcium and phosphorus.
Lotus Oven-Baked Sardine & Herring Recipe Grain-Free Dry Dog Food contains 100% all-natural ingredients. It is an original recipe made of ingredients sourced in the USA. Baked in authentic ovens, and although baking is a painstakingly slow process, the results are worth it.
First 5 Ingredients:
- Sardine
- Herring
- Dried Potatoes
- Dried Peas
- Dried Egg Product
Most of the ingredients in Lotus products are sourced in the U.S. or Canada. They obtain deboned lamb, lamb meal, and New Zealand Green Mussels from New Zealand, and Lotus is ethoxyquin-free.
Lotus Oven-Baked Grain-Free Sardine & Herring Recipe Dry Dog Food is available in 4-lb, 10-lb, and 20-lb bags.
Mike Florian, a Canadian Founder & President of FirstMate Pet Foods. It is a family-owned pet food manufacturing company with a large, modern facility located in Chilliwack, just outside Vancouver.
The company produces high-quality diets that meet all nutritional requirements, from puppies and kittens to aging pets.
Specifically, FirstMate Dog Food offers a high protein content of 23%. It does not provide too many calories at only 3125 kcal/kg though that protein content is too high for some kidney cases. Firstmate Pet Foods Pacific Ocean Fish sits in the middle of dry dog foods with a phosphorus content of 0.75%.
- A small bite, single-source protein diet with wild herring eliminates the risk of allergies derived from chicken. A great hypoallergenic formula.
- Grain-free recipe for a simple, easily digestible meal ideal for rotation or elimination diets.
- Rich in omega 3 and 6 fatty acids, promoting healthy skin and a shiny coat.
- Wheat-free, corn-free recipe, an excellent choice for dogs prone to kidney problems and food sensitivities.
- Made in Canada with the best ingredient quality available
On the plus side, this dog food for kidney disease avoids further weight management issues for Rottweilers or other dogs with kidney problems. This outcome is because of making their food grain and gluten-free. It also does not hurt that the Firstmate Pet Foods Pacific Ocean Fish includes plenty of additional nutrients. These nutrients include omega acids and glucosamine for joint health.
First 5 Ingredients:
- Potato
- Pacific Ocean Fish Meal
- Tomato Pomace
- Chicken Fat (Preserved with Mixed Tocopherols)
- Fish Oil
Firstmate Pet Foods Pacific Ocean Fish Dry Dog Food is available in 5-lb and 14.5-lb bags.
Dr. Harvey is a wealth of information and has helped thousands of pet parents discover the enormous benefits of feeding real, fresh food.
He has dedicated his life to teaching the principles of using a holistic approach to nutrition and wellness for all of our pets.
Please be advised that Dr. Harvey Cohen is not a veterinarian. He may educate you about feeding guidelines and about vitamin and herbal supplements. However, he does not prescribe products or treatments for medical conditions. The educational information Dr. Harvey Cohen provides is not a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. Always consult your veterinarian before starting any new treatment approaches to determine if it is suitable for your canine companion.
Dr. Harveys Canine Health Dog Food is a natural, organic dog food pre-mix used to make a fresh, healthy, homemade meal by mixing it with protein and oil. It is made from 6 certified organic grains, 9 vegetables, and 14 herbs. Known as The Miracle, it uses only the finest organic and all-natural human consumption ingredients to create a tasty pre-mix your Doberman Pinscher will love.
- Holistic blend of 6 organic grains and 9 dehydrated vegetables.
- Improves vitality, joint flexibility, digestion, and appetite.
- Supports skin and coat health.
- Loved by even the pickiest eaters.
- No preservatives, dyes, or chemicals.
Over the years, Dr. Harveys Canine Health has helped thousands of dogs strengthen their kidney function and restore their health, wellness, and energy. And Canine Health can help your beloved companion, too.
First 5 Ingredients:
- Organic Rolled Oats
- Organic Barley
- Organic Triticale
- Organic Spelt
- Organic Brown Rice
Dr. Harveys Canine Health is a revolutionary holistic pre-mix dog food that provides an ideal foundation of healthy and nutritious vegetables, herbs, grains, vitamins, and minerals. You simply add your choice of fresh protein at mealtime. A key component of treating kidney disease is controlling the quality AND quantity of meat. By adding fresh protein, youll be in complete control of both.
Dr. Harveys Canine Health Miracle Dry Dog Food is available in 5-lb bags.
SPECIFIC is Dechra Veterinary Products brand of cat and dog nutrition. Established in 1819, Dechra Pharmaceuticals PLC is based in England.
NOTE This item needs authorization from your veterinarian.
The Dechra Veterinary Products North America is located in Kansas City, at the heart of the Animal Health Corridor. It is an area recognized globally for its concentration of animal health businesses. Their years of experience in animal healthcare allow them to design foods like SPECIFIC CKD Heart & Kidney Support Dry Dog Food.
It is a complete and balanced diet designed to provide nutritional support for adult Doberman Pinschers and other dogs with reduced heart, kidney, and/or liver function. The formula contains high levels of Omega-3, reduced protein, and a careful balance of essential vitamins and minerals. SPECIFIC Heart & Kidney Support will help manage your dogs blood pressure while reducing the workload on their kidneys. Additional Taurine and L-Carnitine also help to support the function of the heart.
- Kidney Support: Restricted phosphorus levels support normal blood pressure and kidney function.
- Reduced Kidney Workload: Lower protein levels have been combined with proteins of high biological value to provide all the protein requirements even with the reduced levels
- EPA & DHA: Help support kidney function, maintain lean body mass, improve appetite and maintain normal blood pressure
- Water retention: Reduced sodium levels help avoid water retention, essential for kidney, liver, and heart patients.
SPECIFIC Heart & Kidney Support also has a restricted protein level and added potassium citrate to help prevent the formation of calcium oxalate, urate, or cysteine stones.
First 5 Ingredients:
- Rice
- Wheat
- Maize
- Fish Oil
- Pork Fat
The onset of CKD is slow and difficult to see. Providing supportive treatment can help your dog become and stay stable for a longer period of time. However, chronic kidney disease is usually irreversible.
Specific CKD Heart & Kidney Support Dry Dog Food is available in 4.4-lb, 15.4-lb, and 26.5-lb.
NOTE This item needs authorization from your veterinarian.
Dechra Veterinary Products, established in 1819, is the owner of the SPECIFIC brand.
NOTE This item needs authorization from your veterinarian.
Dechra Veterinary Products North America is located in Kansas City, while Dechra Pharmaceuticals PLC is based in England. Their years of experience in animal healthcare allow them to design foods with nutrient profiles to provide the optimum nutrition for maintaining and restoring good health in cats and dogs. Good nutrition delivers the right mix of nutrients for each and every stage resulting in good health, vitality, and energy.
SPECIFIC Dog CKW Heart & Kidney Support Wet Dog Food (Terrine) was created by dog nutrition and veterinary experts to be tasty and nutritious. Those experts are also pet owners. They understand that, as a dog daddy, you want the best for your Bull Terrier or other canine companions. They combine the high-quality ingredients your dog deserves with the nutritional know-how to support your dogs condition. Suppose youre looking for a renal diet for your dog. In that case, this particular diet is specially formulated to provide all nutrients in the right amounts your dog needs.
SPECIFIC Heart & Kidney Support also has a restricted protein level and added potassium citrate to help prevent the formation of calcium oxalate, urate, or cysteine stones.
- Formulated by dog nutrition experts to provide nutritional support for dogs with reduced heart, kidney, and/or liver function.
- Supports kidney function with high levels of omega-3 and restricted phosphorus content.
- Supports heart function with L-carnitine and taurine.
- Supports healthy blood pressure and water balance with reduced salt content.
- Supports during liver insufficiency to maintain normal blood ammonia and liver copper levels by reduced dietary protein and copper content.
- Helps reduce the formation of calcium oxalate, urate, or cystine crystals with reduced protein content, added potassium citrate, and induction of alkaline urine.
First 5 Ingredients: (by volume, the first ingredient is water sufficient for processing)
- Rice
- Wheat
- Maize
- Fish Oil
- Pork Fat
High Omega 3 levels from fish and krill can support kidney function in dogs with chronic renal failure. In dogs with cardiac disease, omega-3 fatty acids can help support normal cardiac rhythm, healthy blood pressure, and maintenance of lean body mass.
Specific Dog CKW Heart & Kidney Support Wet Dog Food (Terrine) is available in cases of 6 x 10.5-oz
NOTE This item needs authorization from your veterinarian.
Castor and Pollux All ORGANIX recipes are made in an organically certified facility in the USA. Founded in 2000, Castor & Pollux was a leader in organic and natural pet food.
ORGANIX was the first certified organic dog and cat food to meet all of the requirements established by the USDAs National Organic Program. Merrick Pet Care bought Castor and Pollux in 2012, and Nestle Purina PetCare Company acquired Merrick Pet Care in a buyout agreement in 2015.
Castor & Pollux Organix Grain-Free Organic Turkey & Vegetable Recipe Adult Canned Dog Food provides balanced, grain-free nutrition for happy, healthy adult dogs. Featuring 95% certified organic, grain-free ingredients like organic turkey and vegetables, this pate-style meal brings your best buddy a lifetime of complete and balanced nutrition. Organix is good for your dog and good for your peace of mind.
- Increased calories are great for Cairn terriers or other breeds dogs recovering from illness or injury, needing to gain back lost weight.
- Natural turkey is the #1 ingredient, ideal for dogs that prefer the taste of turkey
- Omega 3 and 6 fatty acids contribute to healthy skin and a luxurious coat. The calcium and phosphorus ratio helps support healthy bones and teeth.
- Include minimally processed fruits and vegetables that provide a source of antioxidants and vitamins
- Made in an organically certified kitchen without corn, wheat, soy, artificial colors, or preservatives with probiotics to support digestion.
The dedication of Castor & Pollux to high-end ingredients positions them well for dogs with kidney disease or multiple issues.
First 5 Ingredients: (by volume, the first ingredient is water sufficient for processing)
- Organic Turkey, Organic Chicken, Organic Carrots
- Organic Chicken
- Organic Pea Flour
- Organic Carrots
- Organic Potatoes
You also do not have to worry about moisture with a 78% content. This dog food for kidney disease also includes flaxseed, blueberries, and coconut flour. In fact, the Castor & Pollux Organix Organic Grain-Free Turkey & Vegetable is one of the cleanest options of dog food available. With no pesticides, fertilizers, artificial preservatives, growth hormones, or antibiotics found.
Castor & Pollux Organix Organic Grain-Free, Turkey & Vegetable Wet Dog Food is available in cases of 12 x 12.7-oz cans.
Founded in 1968 in France, Royal Canin is engaged in producing and supplying nutritional food for dogs and cats.
The company has a geographical presence on five continents with 12 production facilities. Headquartered in St. Charles in Missouri, Royal Canin USA owns and operates two pet food manufacturing plants in Missouri and South Dakota.
If you have an English Cocker Spaniel or another dog with chronic kidney disease, you must avoid choosing dog foods rich in protein. Also, pay more attention to wet dog foods in place of dry formulations because they have much more water, and thats why this dog food recipe is listed here.
- Formulated for small dogs up to 22 pounds over 8 years
- Highly palatable for the older dog as their sense of smell can begin to decline
- Designed for appetite stimulation
- Reduced phosphorous level to help support kidney health
- 25% less phosphorous when compared to Beauty Adult
As previously mentioned, the food contains water, known as the first ingredient. The primary source of protein is chicken. It also ensures to give your four-leg friend healthy skin and a shiny coat as there are some rice, fish oil, corn, and dried beef in the ingredients. The formula includes vitamins and minerals for your dogs complete nutrition every day.
First 5 Ingredients:
- Pork By-Products
- Pork Liver,
- Chicken
- Chicken Liver
- Corn Flour
Royal Canin Canine Health Nutrition Mature 8+ Wet Dog Food is available in cases of 24 x 5.2-oz cans.
Many pet owners choose this brand because its great dog food for kidney disease and budget-friendly. It can help support kidney function and health since they pack it with a reduced amount of phosphorus.
In 1948, Hill Packing Company in Topeka, Kansas, became the licensed producer of Canine K/D.
This item needs authorization from your veterinarian.
In 1968, the food line was made available through veterinarians and pet professionals as Hills Science Diet. In 1976, the Colgate-Palmolive Company purchased Hills Pet Nutrition, and today, Hills pet food products are available in 86 countries worldwide.
The Hills Prescription Diet k/d Kidney Care Beef & Vegetable Stew Canned Dog Food is clinically proven nutrition that can help transform your German Shepherds life. As dogs age, damage to the kidney tissues may occur, which affects the kidneys role to function correctly and filter toxins and waste from the blood.
- Protects vital kidney and heart function with proven nutrition developed by nutritionists and veterinarians.
- Boosts vitality and energy and supports the natural ability to build lean muscle daily.
- Made with controlled phosphorus and low sodium, plus therapeutic levels of l-carnitine and omega-3 fatty acids.
- Also includes high levels of essential amino acids, which are the building blocks of protein.
- Made in the USA and clinically tested to improve and lengthen the quality of life.
Kidney damage is irreversible and will lead to further loss of kidney function. This may also decrease their appetite, which could eventually result in the loss of muscle mass. And so, Hills nutritionists and veterinarians created this special diet. It supports your dogs kidney function and helps to sustain muscle mass. In fact, the nutrition of k/d is clinically tested to improve and lengthen the quality of life.
First 5 Ingredients:
- Water
- Beef
- Carrots
- Rice
- Chicken Fat
Hills Prescription Diet k/d Kidney Care Beef & Vegetable Stew Canned Dog Food is available in cases of 12 x 12.5 oz cans.
In May 2018, Amazon brought the Wag name back as one of its private-label brands after failing as part of another Amazon subsidiary in 2017.
Wag specializes in high-quality dog and cat food, and Wag dog food is manufactured in California.
Easy to digest and deliciously moist, this beef and vegetable recipe from Wags latest wet dog food range wont stay in your dogs food bowl for too long. The main ingredients are packed with quality protein, with beef complemented by chicken and a rich beef broth, boosted by chicken fat and egg white.
- Turkey broth & turkey are the first two ingredients
- Made with sweet potatoes with chunks of meat in gravy
- No added grain; No added corn, wheat, or soy; No added artificial colors and flavors or chemical preservatives
- Made in the USA with globally sourced ingredients from trusted suppliers
- Serve by itself or mixed in with kibble
As with the whole Wag pet food range, there are no grains in this super-moist formula, which certainly doesnt skimp on taste. Although a stew consistency, there are still large chunks of meat for your German Shepherd to chew and get satisfaction.
Transition guidance: Gradual transitioning is essential to help avoid dietary upsets. Please allow 7-10 days (10-14 days for sensitive dogs) to ease the transition from your dogs current food.
First 5 Ingredients:
- Beef Broth
- Beef
- Chicken
- Carrots
- Dried Egg Whites
This is good wet dog food for dogs who may struggle eating dry food or just prefer a moister diet. However, because Wag dog food is rich, you need to ease their transition to the Wag dog food way of life.
Wag Wet Canned Dog Food, Beef & Vegetable Stew Recipe is available in cases of 12 x 13.2-oz cans.
Weruva was founded in 2006, named after David and Stacie Formans three rescued cats Webster, Rudi, and Vanessa.
Weruva is headquartered in Natick, MA, but their human-style foods are made in Thailand. The manufacturing facilities also make food for people and export it to the US, EU, Australia, and Japan. Thailand is a world leader in producing foods for people and, in Weruvas case, pets around the globe. The USFDA recognizes the Thai FDA, and the facility where Weruva is made is USFDA certified.
Treat your Poodle to the tasty nutrition of the Weruva Dogs in the Kitchen Pooch Pouch Party. Variety Pack Grain-Free Dog Food Pouches. Tear open a pouch for a culinary experience your furry friend will look forward to in every bowl. The variety pack includes recipes with real meat as the top ingredient like lamb, chicken, beef, and wild-caught salmon for easily-digestible protein to support healthy muscles. Every bite is loaded with vitamins, minerals, omegas, and antioxidants for overall health.
- Grain-free wet food variety pack features real meat for animal-sourced protein to support lean muscles.
- Paw-licking palatability from real au jus is great for picky eaters, with zero grains, gluten, or carrageenan.
- Packed with essential nutrients for overall health, like omegas for a shiny coat and antioxidants.
- Provides a 100% complete and balanced diet for dogs and is enhanced with vitamins and minerals.
- Easy-to-use, meal-portioned pouches can be served on their own or as delicious kibble toppers or mix-ins.
Weruva Dogs in The Kitchen, Pooch Pouch Party! Variety Pack with Chicken Breast & Pumpkin Au Jus Dog Foods health features of Vitamins & Minerals, Digestive Health, and Urinary Tract Health
First 5 Ingredients:
- Chicken
- Chicken Broth
- Pumpkin
- Locust Bean Gum
- Sunflower Seed Oil
Weruva Dogs in the Kitchen Pooch Pouch Party! Variety Pack Grain-Free Dog Food Pouches are available in 12 x 2.8-oz pouches.
Dave Ratner, the owner of Daves Pet Food, founded the company in 1999. The wet and dry dog food sold by Daves Pet Food Company is manufactured in South Dakota, New Jersey, Canada, and Thailand.
Daves Pet Food offers Simply the Best. The food is designed specifically for dogs with digestion and gas problems. According to Daves, its Simply the Best dog food product contains about 75% animal-source protein. On average, it is about 85% digestible. Ingredients such as egg, chicken, and rice are included in the highly digestible formulation.
Dogs like Rottweilers, Doberman Pinschers, and other breeds prone to developing kidney problems can benefit more from Daves Dog Food Restricted Bland Diet than most, thanks to a phosphorus content of only 0.06%. Other benefits are listed below.
- High moisture content
- A lower phosphorus content
- Suitable for many issues
- This formula is grain and carrageenan-free
This wet kidney care dog food also contains a moisture content of 80%, which helps kidneys by increasing the amount of water consumed. Daves Pet Food Dog Food Restricted Bland Diet is not meant for long-term exclusive use as it only provides 1165 kcal/kg and has an average protein level for wet dog food.
First 5 Ingredients: (by volume, the first ingredient is water sufficient for processing)
- Chicken
- White Rice
- Rice Flour
- Natural Flavor
- Guar Gum
Thankfully, this dog food for kidney diseases restricted bland diet formula makes it an excellent option for dogs with several digestive issues to help soothe inflammation. Daves Pet Food Dog Food Restricted Bland Diet is grain and carrageenan-free for weight management and reduced toxicity.
Daves Pet Food Restricted Protein Diet Dog Food Restricted Protein and Phos Dog Food is available in cases of 12 x 13-oz cans.
What are the Facts that you Should Know about Dog Foods and Joint Health?
Although dogs of all ages or life stages can develop kidney problems, the age of onset is often related to the dogs size. For most small dogs, the early signs of kidney disease occur between ten to fourteen years of age. In contrast, large dogs typically have a shorter life span. They may undergo kidney failure as early as seven years of age.
What do chronic renal failure and chronic kidney mean?
Many people think that chronic kidney failure or chronic renal failure means that the kidneys have stopped working and are not making urine. This is not the case. By definition, chronic renal failure (CRF), or chronic kidney disease (CKD), is the kidneys inability to efficiently filter the blood of waste products, not the inability to produce urine. Ironically, most dogs in kidney failure produce large quantities of urine, but the bodys toxic wastes are not being effectively eliminated.
In dogs, chronic kidney disease is associated with aging and, in simple terms, can be considered to be the wearing out of the kidney tissues over months or years. Clinical signs of kidney failure often only become evident when about 2/3 of the kidneys are dysfunctional.
What should a commercial diet for kidney health consist of?
For a dog with kidney disease, quality commercial dog food should consist of the following:
- Animal Protein
- Whole Fruits and Vegetables
- Fresh
- Moisture Content between 80 -85%
- Easily Digestible Proteins
Your dogs food should also meet the standards set by The Association of American Feed Control Officials (AAFCO), which regulates the sale and distribution of food and drugs for animals.
What are the other dog foods for different health conditions similar to arthritis and joint health?
Best Dog Foods for Joint Care and Arthritis
- Royal Canin Large Joint Care Dry Dog Food
- VICTOR Purpose Performance Formula Dry Dog Food
- Hills Prescription Weight & Joint Care Dry Dog Food
- Hills Science Diet Small Adult Healthy Mobility
- AvoDerm Advanced Senior Health
Best Dog Foods for Acid Reflux
- Natural Balance L.I.D. Limited Ingredient Diets
- Taste of the Wild Pacific Stream Grain-Free Dry Dog Food
- Hills Science Diet Adult Grain-Free Dry Dog Food
- Blue Buffalo Basics Skin & Stomach Care, Natural Puppy Dry Dog Food
- Castor & Pollux ORGANIX Organic Senior Recipe Grain-Free Dry Dog Food
Most Frequently Asked Questions About Best Dog Foods For Specific Breeds With Arthritis and Joint Health problems?
In addition to the 12 Best Dog Foods for joint health discussed above, below are additional top-quality dog foods for specific breeds with joint health issues.
What is the Best Dog Food for Bull Terriers with Kidney Disease?
What is the Best Dog Food for Senior German Shepherds with Kidney Disease?
- Holistic Select Senior Health Chicken Meal & Lentils Recipe Dry Dog Food: Formulated with your dogs golden years in mind, Holistic Select Natural Grain-Free Dry Dog Food, Senior Chicken Meal, and Rice Recipe is a delicious canine palate pleaser. Grain-free, with the right amount of protein, fat, and fiber to support a slowing metabolism, you can be confident youre giving him the best.
What is the Best Dog Food for Poodles with Kidney Disease?
What is the Best Dog Food for Samoyeds with Kidney Disease?
- Forza10 Dry Dog Food Renal Active Dry Dog Food: Formulated especially for dogs with renal failure and heart disease who need low protein, phosphorous, or sodium diets, this complete and balanced food provides optimal nutrition with therapeutic plant and fruit extracts for better health. Its made with limited ingredients and without by-products or fillers that can trigger allergies, with single-source protein and carbohydrates that are easy on delicate pets.
What is the Best Dog Food for Doberman Pinschers with Kidney Disease?