SPECIFIC Nutrition – Kidney diets

La revolución en las dietas renales para perros e gatos

Las nuevas dietas hidrolizadas SPECIFIC Kidney Support y las versiones actualizadas de las dietas SPECIFIC Kidney Support ofrecen una acción integral, actuando sobre el eje intestino-riñón y contribuyendo a mantener el bienestar del animal. La nueva fórmula multiactiva para el eje intestino-riñón conserva todas las características básicas de una dieta renal, pero además incorpora un conjunto ampliado de componentes diseñados específicamente para el cuidado del riñón.

Proteínas hidrolizadas- altamente digestibles e hipoalergénica (presentes en FKD-HY, FKW-HY, CKD-HY y CKW-HY)
Niveles excepcionalmente altos de ácidos grasos Omega-3 EPA y DHA
AuraGuard y fibras beneficiosas – favorecen la integridad de la barrera intestinal y promueven una microbiota saludabl
Zeolita – contribuye a reducir la acumulación de urea y toxinas
Niveles controlados de proteïna, fósforo y sodio

SPECIFIC Derma and Allergy diet Range

Chronic kidney disease and the importance of nutrition

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 slow down the progression of kidney failure, improve quality of life and reduce risk of secondary complications. By choosing the best possible nutrition, you can prolong the lifespan of your furry patient and ensure their vitality at every stage of 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

Leave behind 2 p new Kidney diets

Technical brochure 8 p new Kidney diets

Posters New Kidney diets

Pet owner materials

Materials for social media

Nutritional management of cats and dogs with CKD

The goals of nutritional management in CKD patients are:

To reduce or improve clinical signs
To reduce progression rate of the disease and extend survival time
To reduce electrolyte, calcium, phosphorus and acid-base imbalances
To provide adequate nutrition

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% moisture. Science shows that several additional nutritional adjustments can benefit CKD patients, especially to support gut health.

Phosphorus restriction

Patients with CKD have a reduced capacity to excrete phosphorus, which successively leads to hyperphosphatemia, secondary hyperparathyroidism, precipitation of calcium phosphate in the kidneys, loss of nephrons, progression of renal failure and shorter survival time. Studies on phosphorus restriction in cats and dogs showed reduced plasma phosphorus, parathyroid hormone (PTH) levels, kidney mineralisation, fibrosis and inflammation,²⁹ enhanced survival time and maintenance of kidney function.^12,16

Watch our video and learn more about phosphorus restriction and CKD.

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

Protein restriction

Excretion of waste products from protein metabolism (urea, creatinine, uremic toxins indoxyl sulphate (IS) and para-cresyl sulphate (pCS)) is compromised 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 cats and dogs with CKD.

Older studies showed that dietary protein restriction decreases levels of waste products like urea and creatinine and reduces proteinuria and glomerular damage.¹ More recent studies show that dietary protein restriction decreases blood levels of IS and pCS from undigested proteins in healthy dogs and cats,^14,33 as well as in cats with early CKD.¹⁵

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

Watch our video and learn more about protein restriction and CKD.

Balanced potassium levels

Balanced potassium levels are important to decrease the risk of hypokalaemia frequently found in cats with CKD¹¹ and hyperkalaemia, which is more common in dogs.³¹

Additional nutritional considerations for support of chronic kidney disease

Highly digestible, high in energy and highly palatable diets
High levels of omega-3 fatty acids EPA and DHA, found in fish oils^6,28
Gut supporting ingredients (polyphenols, pre-, pro-, and postbiotics) to support the microbiome^3,18
Dietary zeolite to bind ammonium in the gut²⁵
Reducing risk of metabolic acidosis by adding an alkalising agent
Reduction of sodium level to help support in case of hypertension
Adding antioxidants to help reduce oxidative stress⁸

Also to ensure adequate hydration, regular monitoring of biochemical markers and body condition assessments are key to support these patients and improve their quality of life. Watch our video and learn more about BCS in cats. Click here

The gut-kidney axis

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.^10,32 It is often difficult to say if dysbiosis or leaky gut is a cause or a result of CKD.

Watch our video and learn about the gut-kidney axis

The different parts in the gut-kidney axis

Dysbiosis and the microbiome

Dysbiosis is when the equilibrium between microbiota, the epithelial barrier and the immune response is disrupted, with reduced diversity, a decrease in beneficial saccharolytic bacteria and an increase in pathogenic bacteria. It can be induced by undigested food, dietary changes, increased uremic toxins, use of antibiotics, etc. 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.^21,35

Watch our video and learn more about dysbiosis.

Leaky gut

In leaky gut, harmful molecules can pass between the epithelial cells into the bloodstream. It is of particular concern for the progression of CKD because endotoxins, like bacterial lipopolysaccharides (LPS) and uremic toxin precursors, can stimulate and increase systemic inflammation and oxidative stress.^3,34 There is a correlation between increased intestinal permeability and CKD.

Watch our video and learn more about leaky gut.

Uremic toxins

Uremic toxins are part of the self-perpetuating process in the gut-kidney axis in dogs and cats with CKD. IS and pCS accumulate in the blood because of decreased excretion in the kidneys, increased production of precursors from dysbiosis and undigested protein in the colon. This affects the production of beneficial short-chain fatty acids (SCFA), increases the risk of leaky gut and favours uremic toxin producing bacteria, which contributes to disease progression with direct nephrotoxic effects and increases the risk of heart disease.²²

Watch our video and learn more about uremic toxins in the gut kidney axis.

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

Nutrition plays an important role in the processes related to the gut-kidney axis, to decrease the risk of gut dysbiosis and leaky gut, to slow down the progression of kidney failure and to help maintain nutritional status and quality of life.

Watch our video and learn about how nutrition helps in pets with CKD

High digestibility, high in energy and highly palatable diets

It is essential that renal diets for dogs and cats with CKD are highly digestible, high in energy and highly palatable to meet the nutrient requirements and reduce metabolic waste, lowering the production of uremic toxins and inflammatory mediators. It also allows for maximum absorption of essential nutrients (proteins, fats, carbohydrates, vitamins and minerals) and calories (even with reduced consumption), and it helps reduce anorexia, malnutrition, weight loss and muscle breakdown, which is common in patients with CKD.

Watch our video and learn more about how optimal diet can help in CKD.

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.

Registrer for the Dechra Academy

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

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 loss of muscle mass and cachexia.

EPA and DHA omega-3 and CKD progression

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
Synthesise the metabolites resolvins and protectins, potent anti-inflammatory mediators blocking the actions of pro-inflammatory eicosanoids and helping to clear the site of inflammation³⁰
Increase the bioavailability of the vasodilator
nitric oxide, which can reduce systemic and intraglomerular blood pressure and reduce proteinuria⁶
Reduce the risk of thrombosis and inhibit production of pro-fibrotic growth factors such as TGF-β¹³, reducing progression of renal fibrosis
Support the gut microbiome and gut immunity by increasing SCFA production, reducing inflammatory mediators and improving intestinal immunity^17,20

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

In dogs with induced CKD, high doses of EPA and DHA reduced proteinuria and prevented glomerular hypertension and decreased the production of pro-inflammatory eicosanoids - with reduction of histopathologic lesions and contributed to a prolonged lifespan.^6,7

Different sources of Omega-3

Therapeutic kidney diets are often supplemented with high concentrations of omega-3 fatty acids, but it is important to remember that vegetable sources of omega-3 fatty acids contain ALA (a-linolenic acid) and not EPA and DHA. ALA can enzymatically be converted to EPA and DHA, but the action of these enzymes are very low in cats and dogs. Only omega-3 from marine sources is high in EPA and DHA omega-3. Therefore, information on the specific source and concentration of EPA and DHA in the diet is important for the clinician.

EPA and DHA dosage for support of CKD

In a retrospective study on cats with CKD, a renal diet with an EPA content of 0.47 g/MJ was assosiated with a longer survival time than diets with lower levels.²⁸ In one study on dogs with induced CKD, a dose of EPA+DHA equivalent to 130 to 140 mg EPA+DHA /kg 0.75 body weight caused a reduction in glomerular hypertension and proinflammatory eicosanoids.⁵

Watch our video and learn more about how omega-3 can help in CKD.

Diagram of EPA/DHA in competitor diets

Watch our video and learn more about omega-3.

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

In patients with CKD, uremic toxins IS and pCS accumulate in the blood because of decreased excretion in the kidneys and play a key role in the progression of CKD. Nutritional management aims to decrease plasma levels through reduced protein levels and highly digestible protein, use of pre-, pro- or postbiotics, and enrichment with antioxidants.

Uremic toxin production

Uremic toxin precursors indole and P-cresol are produced in the gut when the amino acids tryptophan, phenylalanine and tyrosine are metabolised by the intestinal microbiota. In the liver, the precursors are metabolised into the uremic toxins IS and pCS.²⁴ IS and pCS stimulate production of mediators such as TGF-β, contributing to renal fibrosis and inflammation. In the gut, they can increase oxidative stress, production of pro-inflammatory cytokines and disrupt tight junctions, which contributes to dysbiosis and leaky gut.^22,34

Both IS and pSC plasma levels have been shown to be predictors of progression of CKD in cats and dogs and can serve as a biomarker of the risk of disease progression.⁹

Use of adsorbents and phosphate binders

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

Also, lanthanum carbonate (Catney One from Dechra for cats) used as a phosphate binder indirectly can help reduce uremic toxin levels while minimising the risk of hypercalcaemia.

The new SPECIFIC Kidney Support diets can safely be combined with Catney One and Porus One for a triple effect to support renal function in cats with CKD.

More information about Catney One and Porus One

Watch our video and learn more about uremic toxins in CKD.

New and updated SPECIFIC Kidney Support diets

New SPECIFIC Kidney Support Hydrolysed diets and updated SPECIFIC Kidney Support and Heart & Kidney Support diets work in a multi-action way with support of the gut-kidney axis, helping to keep the animal in good condition.

The new multi-action gut-kidney formula has all the basic characteristics of a kidney diet with reduced phosphorus, protein and sodium and highly digestible ingredients, together with a uniquely high content of anti-inflammatory Omega-3s and added zeolite. But it also has an extended package of kidney supporting characteristics.

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

By introducing highly digestible hydrolysed proteins for optimal absorption, zeolite and fermentable fibres and AuraGuard for gut barrier integrity, they help to protect kidney function by supporting the gut-kidney axis, strengthening the gut microbiome and supporting muscle mass.

The formula also can help to lower uremic toxins in the blood and reduce inflammation. On top of that, it offers superior palatability. It’s the daily dose of vitality they deserve.

Hydrolysed proteins - highly digestible and hypoallergenic
Uniquely high levels of the Omega-3 fatty acids EPA and DHA
Controlled levels of protein, phosphorus and sodium
AuraGuard – supports gut barrier integrity
Beneficial fibres – supports a healthy gut
Zeolite – helps reduce toxic urea build up

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

By introducing zeolite, fermentable fibres and AuraGuard for gut barrier integrity, they help to protect kidney function by supporting the gut-kidney axis, strengthening the gut microbiome and supporting muscle mass.

The formula also can help to lower uremic toxins in the blood and reduce inflammation. On top of that, it offers superior palatability. It’s the daily dose of vitality they deserve.

Controlled levels of protein, phosphorus and sodium
Uniquely high levels of the Omega-3 fatty acids EPA and DHA
AuraGuard – supports gut barrier integrity
Beneficial fibres – supports a healthy gut
Zeolite – helps reduce toxic urea build up

References

Referenses

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SPECIFIC diets for management of Kidney Disease

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La revolución en las dietas renales para perros e gatos