low phosphorus diet for dogs with kidney disease
Low-phosphorus diet: Helpful for kidney disease?
Why is a low-phosphorus diet useful in managing kidney disease? What foods contain phosphorus?
Answer From Rachael Majorowicz, R.D.N., L.D.Phosphorus is a mineral that's found naturally in many foods and also added to many processed foods. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Healthy kidneys remove extra phosphorus from the blood.
If your kidneys don't work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death.
If you need to limit phosphorus
How much phosphorus you need depends on your kidney function. If you have early-stage kidney disease or you're on dialysis, you may need to limit phosphorus. Nearly every food contains some phosphorus, so this can be hard to do.
Current guidelines recommend choosing natural foods instead of processed foods that have phosphorus added to them. Your body absorbs less of the phosphorus from natural foods, and natural foods offer better nutrition overall. For many years, people who needed to limit phosphorus were told to limit healthy foods such as whole grains, legumes and other plant-based foods. Recent research shows that this isn't necessary.
Check food labels carefully
Manufacturers may add phosphorus when processing foods to thicken them, improve taste, prevent discoloration or preserve them. Check food labels to see whether any ingredients contain "phos" in the term. When trying to limit phosphorus, avoid foods that list terms with "phos" among the ingredients.
Examples of phosphorus added to food include:
- Calcium phosphate
- Disodium phosphate
- Phosphoric acid
- Monopotassium phosphate
- Sodium acid pyrophosphate
- Sodium tripolyphosphate
Check the online ingredient lists or ask your dietitian about alternatives.
The best way to limit phosphorus in your diet is to limit foods that contain the most phosphorus, including:
- Fast foods, foods sold at gas stations, and other packaged and convenience foods
- American cheese, canned or jarred processed cheese spreads, and prepared cheese products in block form
- Fresh or frozen meats that have added flavor or fluids to keep them moist or "phos" in the ingredients
- Cola and pepper-type sodas, many flavored waters, many bottled or canned teas, fruit punch, energy or sports drinks, many powdered drink mixes, beer, and wine
The table below gives examples of foods lower in phosphorus that you can substitute for foods higher in phosphorus. Although a food or drink may be low in phosphorus, you still need to watch portion sizes and limit the number of servings you eat or drink each day.
| Higher phosphorus foods | Lower phosphorus foods |
|---|---|
| Fast foods, convenience foods, restaurant meals and gas station foods | Homemade meals or snacks made from fresh ingredients or options without "phos" in the ingredients |
| Milk, pudding, yogurt, soy milk, and nondairy creamers and enriched milks | Unenriched almond or rice milk |
| Processed cheeses and cheese spreads | A small amount of brie, Swiss, cheddar, or mozzarella cheese |
| Fat-free cream cheese or fat-free sour cream | Regular or low-fat cream cheese or sour cream |
| Ice cream or frozen yogurt | Sherbet, sorbet or frozen fruit pops |
| Quick breads, biscuits, cornbread, muffins, pancakes or waffles | Fresh dinner rolls, bread, bagels or English muffins |
| Processed meats, such as bacon, bologna, chicken nuggets, ham and hot dogs, and fresh or frozen meat, poultry or seafood with "phos" in the ingredients | Lean beef, eggs, lamb, wild game, or poultry, seafood or other fish without "phos" in the ingredients |
| Chocolate or caramel, including chocolate drinks and candy bars | Jelly beans, hard candy, fruit snacks or gumdrops (in moderation) |
| Colas and pepper-type sodas, some flavored waters, bottled teas, energy or sports drinks, beer, wine, and some drink mixes (any with "phos" in the ingredients) | Lemon-lime soda, ginger ale, root beer, plain water and some drink mixes (any without "phos" in the ingredients); fresh-brewed coffee (made from beans) or brewed tea (made from tea bags); lemonade |
Seek professional help
For help creating a meal plan that meets your needs, work with a registered dietitian. A dietitian can make sure that you get enough nutrition while following your doctor's medical recommendations.
Your doctor may also recommend a phosphate binder medication to help control the amount of phosphorus your body absorbs from foods. These medications only help a little. You'll still need to limit the amount of phosphorus in your diet.
With
Rachael Majorowicz, R.D.N., L.D.
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Jan. 11, 2023- Making sense of phosphorus. Renal Dietitians. https://renalnutrition.org/files/archives/Vol37_No1_2018_PATIENT.pdf. Accessed Nov. 3, 2020.
- Ikizler TA, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. American Journal of Kidney Diseases. 2020; doi:10.1053/j.ajkd.2020.05.006.
- Yu ASL, et al., eds. Chronic kidney disease-mineral bone disorder. In: Brenner & Rector's The Kidney. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 3, 2020.
- Majorowicz R (expert opinion). Mayo Clinic. Nov. 12, 2020.
- Eating right for chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition. Accessed Nov. 3, 2020.
- FoodData Central. U.S. Department of Agriculture, Agricultural Research Service. https://fdc.nal.usda.gov. Accessed Nov. 3, 2020.
- Berkoben M, et al. Management of hyperphosphatemia in chronic kidney disease. https://www.uptodate.com/contents/search. Accessed Nov. 3, 2020.
Phosphorus and Your Diet
What To Feed a Dog With Kidney Disease
Nutrition plays a big role in the management of dogs with kidney disease. Because dogs with kidney disease usually arent feeling well, the first step is often to merely get your dog to eat anything.
Kidney disease can make dogs nauseated, and they can also develop ulcers in their mouth or stomach, which makes eating painful. A feeding tube may be necessary to get dogs with severe kidney disease the nutrition they need.
Once your dogs condition is more stable, you can turn your attention to providing more optimized nutrition. Kidney diets for dogs have to tick a lot of boxes. Heres a guide that explains nutritional needs and what to feed a dog with kidney disease.
What To Look For in a Kidney Diet for Dogs
Kidney diets for dogs are significantly different from regular dog foods. However, no single kidney diet is going to be best for every dog throughout the rest of their life.
For example, a dog in the early stages of kidney disease could thrive on a kidney diet with more protein, but as their disease progresses, a diet lower in protein and phosphorus might better control their symptoms.
As a rule of thumb, good kidney diets for dogs tend to have anutrient profilethat looks like this:
Nutrient | Grams/1000 kcal |
Protein | 31-41 |
Phosphorus | 0.5-0.8 |
Sodium | 0.4-1.2 |
EPA and DHA | 0.4-1.2 |
Unfortunately, it can be hard tofind this information on dog food labelsor on pet food manufacturers websites. If you are having trouble getting the numbers, your veterinarian can help you pick a good kidney diet based on your dogs needs.
Here are several important elements to look for in kidney diets for dogs:
Taste
The most important characteristic of a kidney diet for dogs can be the hardest to achieve: It has to be delicious! Thats because the metabolic and physical changes associated with kidney disease can lessen a dogs appetite.
To counteract this effect, kidney diets need to smell and taste great. After all, a kidney diet that isnt eaten isnt going to do a dog any good. Kidney diets should also be calorie- and nutrient-dense, so dogs can eat less and still get a lot of nutrition.
Hydration and Water Content
Kidney diets should also contain a lot of water. Dogs with kidney disease struggle to maintain their hydration. All dogs always need to have access to bowls of fresh clean water, but a diet that has high water content is a great way to boost a pets water intake when they have kidney disease.
Wet foods are almost always a better option for dogs with kidney disease than dry foods. If you are feeding your dog kibble, ask your veterinarian about adding water to the dry food or other ways you can supplement their water intake.
It's also important to keep an eye on the sodium levels in kidney diets for dogs. Too much sodium increases the chances that your dog will becomedehydrated.
The Right Amount of the Right Protein
Next comes the balancing act that is protein. Dogs with kidney disease need protein, but not too much. The breakdown products of protein digestion are responsible, in large part, for making dogs with kidney disease feel yucky.
The goal is to feed just enough protein to meet a dogs needs for muscle maintenance, immune function, and the other vital jobs proteins have in the bodybut not to feed too much more. Extra protein will only be turned into calories that can be more safely provided by carbohydrates and fats.
Protein quality is also important. Proteins should be highly digestible and supply all the essential amino acids dogs need.
Low Phosphorus Levels
Theres a close relationship between protein intake and blood phosphorus levels. Dogs with kidney disease gradually lose the ability to excrete phosphorus in their urine, so it backs up in the bloodstream. Reducing phosphorus intake has been shown to slow the progression of kidney disease in dogs and increase their lifespan.
An important way to reduce phosphorus levels in the diets of dogs with kidney disease is to not overfeed protein and to ensure thatproteins relatively low in phosphorusare included in the diet. Plant-based sources of protein tend to be lower in phosphorus than animal-based sources of protein.
Supplements
Nutritional supplements can also help dogs with kidney disease. Supplements often included in kidney diets for dogs include:
Omega-3fatty acids:eicosapentaenoicacid (EPA) and docosahexaenoic acid (DHA), which can reduce inflammation in the bodyincluding in the kidneysand possibly improve kidney function
Antioxidants,which neutralize free radicals that can further damage the kidneys
Fermentable fiber,which helps get rid of protein digestion waste products in poop. This allows dogs to eat more protein than they might be able to otherwise.
Prescription Kidney Diets vs. Homemade Kidney Diets for Dogs
What abouthomemade kidney diets for dogs? Astudypublished in 2012 showed how hard it is to find nutritionally complete and balanced kidney diet recipes in books and online. Of the 39 recipes evaluated, none met all the National Research Councils recommended nutrient allowances for adult dogs.
In contrast, prescription kidney diets produced by reputable dog food manufacturers undergo testing to ensure they are safe for long-term feeding and have a positive effect on a dogs health.
How To Cook for Dogs With Kidney Disease
One big benefit of homemade kidney diets, however, is taste. If your dog simply wont eat anything else, a homemade kidney diet is worth considering. To avoid nutrient deficiencies or excesses, make sure a veterinary nutritionist or a service likeBalanceIT, which requires veterinarian approval, is involved in formulating recipes for your dog.
Common Prescription Kidney Diets for Dogs
After a dog has been diagnosed with kidney disease and their condition is stabilized, veterinarians typically recommend switching over to a prescription kidney diet. Your veterinarian may have recommended a particular food based on the details of your dogs case. Here are three popular options:
Hill's Prescription Diet k/d Kidney Careis available in wet and dry formulations and different flavors:
How To Transition Your Dog to a Kidney Diet
special attention to how you make the transition. Do notchange your dogs foodwhile they are still nauseated or feeling bad. They may associate their symptoms with their new food and refuse to eat it.
Once your dog has a good appetite, start making the switch very slowly. Give them lots of time to get used to the new flavors, textures, and ingredients. This reduces the chance of food refusal and lets your dogs digestive system adapt.
Here is a timetable for taking two weeks to switch your dog to a new diet:
Days 1 and 2:Mix 5% of the new food in with 95% of the old food
Days 3 and 4:Mix 10% of the new food in with 90% of the old food
Days 5 and 6:Mix 20% of the new food in with 80% of the old food
Days 7 and 8:Mix 40% of the new food in with 60% of the old food
Days 9 and 10:Mix 60% of the new food in with 40% of the old food
Days 11 and 12:Mix 80% of the new food in with 20% of the old food
Days 13 and 14:Mix 90% of the new food in with 10% of the old food
Day 15:Try 100% of the new food
If at any point your dog turns their nose up at their food or develops signs of digestive upset, move back a step in the timetable and proceed more slowly.
Signs to Watch for After Starting Your Dog on a Kidney Diet
Dont give up if you initially have trouble switching your dog to a kidney diet. Call your veterinarian if your dog wont eat the recommended food. They can help by:
Recommending an appropriate food topper to make the food more appealing. Avoid products that are high in phosphorus and salt.
Prescribing medications to reduce nausea, stomach inflammation, ulcers, or other symptoms that may be reducing your dogs appetite
Recommending a different prescription kidney diet or, if necessary, a suitable over-the-counter food
Referring you to a veterinary nutritionist to get recipes for homemade kidney diets
Talking to you about the benefits of a feeding tube
Many dogs with kidney disease live happily for quite a long time, particularly if they get the right kind of nutrition. Onestudyshowed that on average, dogs who were fed a kidney diet lived 13 months longer than those who ate regular dog food. Thats certainly a goal worth striving for!
Featured image: iStock.com/RichLegg
WRITTEN BY
Jennifer Coates, DVMVeterinarian
Dr. Jennifer Coates is an accomplished veterinarian, writer, editor, and consultant with years of experience in the fields of veterinary...
