In cooperation with

Timely Topics in Nutrition

Evaluation of recipes for home-prepared diets
for dogs and cats with chronic kidney disease
Jennifer A. Larsen, dvm, phd, dacvn; Elizabeth M. Parks, ba;
Cailin R. Heinze, vmd, ms, dacvn; Andrea J. Fascetti, vmd, phd, dacvim, dacvn

Objective—To evaluate recipes of diets recommended for animals with chronic kidney
disease (CKD), compare nutritional profiles for those recipes to requirements for adult dogs
and cats, and assess their appropriateness for the management of CKD.
Design—Evaluation study.
Sample—Recipes of 67 home-prepared diets promoted for use in dogs (n = 39 recipes)
and cats (28) with CKD.
Procedures—Recipes were analyzed with computer software to determine calories,
macronutrient calorie distribution, and micronutrient concentrations and were assessed
for appropriateness for the management of CKD.
Results—Assumptions were required for the analysis of every recipe, and no recipe met all
National Research Council nutrient recommended allowances (RA) for adult animals. Com-
pared with RAs, concentrations of crude protein or at least 1 amino acid were low in 30 of 39
(76.9%) canine recipes and 12 of 28 (42.9%) feline recipes. Choline was most commonly be-
low the RA in both canine (37/39 [94.9%]) and feline (23/28 [82.1%]) recipes; selenium (34/39
[87.2%] canine and 9/28 [32.1%] feline recipes), zinc (24/39 [61.5%] canine and 19/28 [67.9%]
feline recipes), and calcium (22/39 [56.4%] canine and 7/28 [25.0%] feline recipes) concentra-
tions were also frequently below recommendations. The median phosphorus concentration
in canine and feline recipes was 0.58 and 0.69 g/1,000 kcal, respectively.
Conclusions and Clinical Relevance—Many problems with nutritional adequacy were
detected, and use of the recipes could result in highly variable and often inappropriate
diets. Many recipes would not meet nutritional and clinical needs of individual patients and
should be used cautiously for long-term feeding. (J Am Vet Med Assoc 2012;240:532–538)

N utritional therapy is considered a cornerstone in

the management of dogs and cats with CKD and
generally includes reductions in intake of dietary pro- CKD
Abbreviations
Chronic kidney disease
tein, phosphorus, and sodium; modifications in intake DM Dry matter
of calcium and potassium when necessary; enhance- ME Metabolizable energy
ment in the intake of water, water-soluble vitamins, MER Maintenance energy requirement
MR Minimal requirement
and omega-3 fatty acids; and alkalinization. A number
NRC National Research Council
of commercially available diets have been specifically RA Recommended allowance
formulated for this purpose; however, some pet own-
ers prefer to use home-prepared diets for a number of
From the Department of Molecular Biosciences (Larsen, Fascetti) and
Veterinary Medical Teaching Hospital (Parks), School of Veterinary
reasons, such as a perception of poor quality of com-
Medicine, and Department of Animal Science, College of Agricul- mercially available options. Other clients desire to
tural and Environmental Sciences (Heinze), University of Califor- participate in the treatment of an ill pet and wish to
nia-Davis, Davis, CA 95616. Ms. Parks’ present address is Veteri- deepen the human-animal bond by personally prepar-
nary Medical Center, College of Veterinary Medicine, University of ing their pet’s meals. Furthermore, some patients will
Minnesota, Saint Paul, MN 55108. Dr. Heinze’s present address is not eat commercially available diets or cannot tolerate
Department of Clinical Sciences, Cummings School of Veterinary
Medicine, Tufts University, North Grafton, MA 01536.
them because of concurrent disease (eg, fat intolerance
Dr. Larsen is an owner in DVM Consulting Incorporated, which or adverse food responses).
maintains Balance IT software. Clients often seek information about dietary op-
Address correspondence to Dr. Larsen (jabones@ucdavis.edu). tions for their pets from websites or books. In many

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cases, veterinarians may be asked for home-prepared Materials and Methods
recipes or to assess a recipe. Veterinarians should
understand the information that is available to own- Sample—Books (books for a veterinary audience
ers who wish to use home-prepared diets and be as well as books for pet owners) and websites were
able to confidently advise clients on the advantages searched for recipes of home-prepared diets for dogs
and disadvantages of the use of home-prepared di- and cats. Recipes were included if they were specifi-
ets. In other studies,1–3,a investigators detected major cally recommended for use in animals with CKD and if
concerns with regard to the nutritional adequacy of the ingredients and preparation instructions were suf-
home-prepared diets, and the adverse effects of feed- ficiently detailed to enable computer analysis.
ing unbalanced diets have been reported.4–8 Recipes Analysis of recipes—Qualitative analysis of each
are readily available in books and via the Internet; recipe included an assessment of the specificity of in-
however, there is no oversight or standardization, gredients and preparation instructions as well as the
and these recipes may be inappropriate and even po- target animal and calorie information. For recipes with
tentially harmful. allowances for substitutions or ranges in amounts, a
The nutrient requirements for dogs and cats with mean value was determined for the ingredients (eg, a
CKD have not been established; however, except for a specification of 2 cups of pasta or rice was analyzed as
few major minerals (phosphorus, sodium, calcium, and 1 cup pasta plus 1 cup rice, and a specification of 1 to 2
potassium), there are no indications for dietary intakes eggs was analyzed as 1.5 eggs). When specifications for
below those recommended for healthy animals. The supplement-type products were vague (eg, vitamins for
NRC has established MR or adequate intake values as cats or multiple vitamin-mineral tablet), national brand
well as an RA for all essential nutrients for the various productsb–i were used. Common and widely available in-
physiologic states of dogs and cats.9 When supporting gredient types and varieties were used to satisfy vague
data are available, the safe upper limit is also provided. instructions (eg, regular ground beef was analyzed as
The MR values are based on data from peer-reviewed ground beef that contained 20% fat). Quantitative analy-
literature and represent the minimal consistent dietary sis was performed by use of diet formulation softwarej
concentrations of essential nutrients that will support and both open-sourcek and proprietaryl nutrient-analysis
health. An MR has been established for adult dogs for databases. One ingredientm that was recommended as
crude protein, all amino acids, calcium, magnesium, so- the source of taurine in several recipes was analyzed at
dium, iodine, and riboflavin and for adult cats for crude the University of California-Davis Amino Acid Labora-
protein, sulfur-containing amino acids (eg, methionine, tory for determination of taurine concentration by use
methionine plus cystine, and taurine), lysine, calcium, of an automated analyzern in accordance with a previ-
phosphorus, magnesium, sodium, iodine, pyridoxine, ously described technique.14 Quantitative analysis of
pantothenic acid, folic acid, and choline. recipes included calculation of total energy, energy den-
Because data are not available to support MR val- sity, moisture content, and the proportion of calories
ues for every nutrient for all life stages of dogs and contributed by protein, fat, and carbohydrate on an ME
cats, adequate intake was instead established in those basis and determination of concentrations of essential
situations. These represent presumed dietary concen- nutrients. Linoleic acid and arachidonic acid were the
trations of nutrients that support a specific life stage only fatty acids assessed. Physiologic fuel values (kcal/g
as extrapolated from other life stages, other species, metabolized of fat, protein, and carbohydrate) applied
or other information. An RA value has been estab- to recipe analyses were those used for specific human
lished for all essential nutrients. These values are food types15 because of the expected higher digestibil-
based on the MR or adequate intake plus a safety fac- ity of these ingredients, compared with digestibility for
tor to account for uncertain bioavailability, which re- commercial pet foods. When possible, the value for
mains undetermined for most nutrients of most foods the calculated energy provided was compared with the
in healthy dogs and cats. The impact of other variable calories specified in the recipe as well as the calculated
conditions, such as age, disease state, medication in- MER (in kcal/d) of the target animal. For dogs, this was
teractions, and many other factors, is also unknown. calculated by use of the following equation for inactive
The safety margin inherent in the RA could also be pet dogs9: kilograms of body weight0.75 X 95. For cats,
important when developing home-prepared diets be- this was calculated by use of the following equation for
cause the nutrient concentrations are estimates deter- lean domestic cats9: kilograms of body weight0.67 X 100.
mined on the basis of ingredient databases and pre- The preceding equations use metabolic body weight (ie,
sumed digestibility factors. body weight in kilograms raised to the 0.75 and 0.67
We hypothesized that few recipes would provide power for dogs and cats, respectively). These equations
all essential nutrients at concentrations adequate for cannot be directly converted to a value for body weight
adult maintenance as recommended by the NRC9 and in pounds. Therefore, if the body weight has been re-
that some recipes would not include modifications ap- corded in pounds, it must be divided by 2.2 to convert
propriate for animals with CKD. The objectives of the it to kilograms for use in these equations.
study reported here were to evaluate recipes for home- Essential nutrient concentrations were assessed
prepared diets promoted for use in dogs and cats with on an energy basis to account for differences in energy
CKD, compare the nutritional profiles of those recipes density of the diets; these were compared with the RA
with the NRC’s RAs for dietary intake of essential nutri- and, when available, MR for adult dogs and cats for
ents for adult dogs and cats,9 and assess modifications maintenance.9 Iodine, chloride, and vitamin K could
for appropriate use in the management of CKD.10–13 not be assessed because of a dearth of analysis data for

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ingredients. For some ingredients, vitamin D concen- Body weight of the target animal was provided for 22
trations were also not available; other nutrients were (56.4%) canine and 2 (7.1%) feline recipes, and the
defined for all ingredients. amount of calories was provided for 22 (56.4%) canine
and 20 (71.4%) feline recipes. Among the canine reci-
Statistical analysis—A Shapiro-Wilk test was used pes for which calorie information was provided, 19 of
to confirm data were nonparametric. Spreadsheet soft- 22 (86.4%) were within 10% of the calories calculated
wareo was used to calculate descriptive statistics (me- by use of the computer software, but only 5 (22.7%)
dian and range). The denominators used to calculate approximated the MER of the target animal within a
proportions corresponded to the number of recipes for margin of 20%. Some sources provided different recipes
which data were available for each variable. that varied in energy content by up to 67% for a dog of
the same weight. Among the feline recipes for which
Results calorie information was provided, 18 of 20 (90%) were
Sample—Thirty-nine recipes intended for the within 10% of the calories calculated by use of the soft-
management of CKD in dogs were identified. Of these, ware, and 1 of 2 approximated the MER of the target
35 were published in books16–25 (2 books for a veteri- animal within a margin of 20%.
nary audience and 8 books for pet owners) and 4 were Although some recipes were intended to provide
from online sources.26,27 Twenty-eight recipes intended the daily energy needs of a specific target animal, others
for the management of CKD in cats were identified, 26 instructed that a pet should be fed as much as it would
of which were published in books18,20–25,28 (1 book for a eat. In some cases, sources provided guidance for de-
veterinary audience and 7 books for pet owners) and termining the amount to feed a dog or cat of a particu-
2 of which were from online sources.26,29 Recipes were lar weight by use of the energy density of the diet and
selected from 14 sources; 9 of the sources were written tables with energy requirements of animals of various
or provided by veterinarians. Many of the recipes from body weights and life stages. Some recipes stated that
books were also reproduced on numerous websites. Ad- the amount fed should be adjusted on the basis of body
ditionally, in 2 cases, recipes from books varied with the weight or that the owner should judge the amount to
edition of the book. In these cases, both versions of the feed; however, guidelines were not listed.
recipe were analyzed. The recipes obtained from 1 on-
line source were removed from that website after they Quantitative analysis of canine recipes—The ca-
were initially accessed. nine recipes provided a median of 845 kcal (range, 573
to 1,729 kcal), energy density of 4,590.6 kcal/kg of DM
Analysis of recipes—Assumptions were necessary (2,086.6 kcal/lb of DM) with a range of 4,014 to 5,962
for base ingredients in 29 of 39 (74.4%) canine and 28 kcal/kg of DM (1,824.5 to 2,710.0 kcal/lb of DM), and
of 28 (100%) feline recipes, including cooking method, moisture content of 71% (range, 52.2% to 81.3%). The
specific cut of meat, percentage of fat in ground meats, energy distribution had a wide range; the proportion
type of meat (species), type of carbohydrate (ie, grain of calories (percentage of ME) provided by protein, fat,
length of rice or use of peeled potatoes vs potatoes from and carbohydrate ranged from 7.8% to 37%, 13.5% to
which the skin was not removed), or type of vegetable 60.4%, and 13.9% to 73.3%, respectively. Medians and
oil. Furthermore, many recipes specified volume rather ranges of crude protein and amino acid concentrations
than weight measurements of meat, which necessitated were summarized (Table 1). Adequacy of protein and
estimations of amounts. amino acids was a concern because 30 of 39 (76.9%)
Similarly, specifications for supplement-type prod- recipes were below the RA for crude protein or at least 1
ucts were vague for most recipes, with only 1 canine amino acid. Only arginine, isoleucine, and lysine were
recipe and no feline recipes providing precise instruc- provided in adequate concentrations in all recipes.
tions. For example, many recipes included a multivita- All canine recipes were adequate in crude fat con-
min with no quantities or specifics or listed a quantity tent. Five (12.8%) canine recipes were below the RA
with no brand or type specification. When supplement- for linoleic acid. Only 4 (10.3%) canine recipes includ-
type products were specified, the information was ed a specific dose of fish oil as a source of long-chain
vague, such as dog, human, or kid’s chewable products. omega-3 fatty acids; however, some sources included a
Many recipes included vitamin C or other supplement- recommendation for an omega-3 fatty acid nutritional
type products that do not provide essential dietary nu- product as a general guideline.
trients in dogs or cats. One source included baking soda Mineral and vitamin concentrations provided by ca-
(sodium bicarbonate) as a source of calcium, which it is nine recipes were often inadequate (Table 2). Calcium
not. In a few cases, the information for supplement-type concentration was below the RA in 22 (56.4%) recipes,
products was scattered throughout a book and difficult and calcium was provided at more than twice the RA in
to locate or the information in a book differed from that 7 (17.9%) recipes and at > 3 times the RA in 1 (2.6%)
provided by the related website. Overall, some type of recipe. Although there is no MR for adult dogs, the
assumption was necessary for every recipe. phosphorous concentration was below the RA in 27 of
None of the recipes specified appropriateness 39 (69.2%) recipes and at or above the RA in 12 (30.8%)
for specific types or severity of CKD. Many recipes recipes. Twenty (51.3%) recipes provided a calcium-
stated that the information provided was a guideline to-phosphorus ratio < 1:1, and 5 (12.8%) recipes pro-
and should be adjusted with veterinary supervision. vided a ratio > 3:1. Some ingredients did not define a
Both a specific body weight of the target animal and value for vitamin D concentration but would have been
the amount of calories provided were given for 13 of expected to provide this nutrient via products such as
39 (33.3%) canine and 1 of 28 (3.6%) feline recipes. raw ground chicken, cooked ground beef (10% fat),

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Table 1—Median and range values for concentrations of crude protein and amino acids in 39 canine and 28 feline recipes of home-
prepared diets for the management of CKD.

Canine Feline

Variable NRC’s RA Median Range No. (%) NRC’s RA Median Range No. (%)
(/1,000 kcal)* (/1,000 kcal) (/1,000 kcal) below RA (/1,000 kcal)* (/1,000 kcal) (/1,000 kcal) below RA
Crude protein (g) 25.00 33.60 18.00–88.20 6 (15.4) 50.00 55.80 30.40–77.90 7 (25.0)
Arginine (g) 0.88 1.97 1.08–5.04 0 1.93 3.57 1.90–5.21 1 (3.6)
Histidine (g) 0.48 0.92 0.48–2.33 1 (2.6) 0.65 1.54 0.74–2.32 0
Isoleucine (g) 0.95 1.51 0.97–4.25 0 1.08 2.69 1.45–3.73 0
Methionine and 1.63 1.19 0.74–3.07 28 (71.8) 0.85 2.27 1.19–3.32 0
cystine (g)
Leucine (g) 1.70 2.51 1.63–7.19 3 (7.7) 2.55 4.31 2.33–6.13 1 (3.6)
Lysine (g) 0.88 2.34 1.06–6.20 0 0.85 4.28 1.95–6.61 0
Phenylalanine and 1.85 2.70 1.51–7.57 1 (2.6) 3.83 4.25 2.54–5.85 8 (28.6)
tyrosine (g)
Threonine (g) 1.08 1.34 0.73–3.29 9 (23.1) 1.30 2.30 1.24–3.20 1 (3.6)
Tryptophan (g) 0.35 0.34 0.09–0.90 20 (51.3) 0.33 0.58 0.28–0.77 3 (10.7)
Valine (g) 1.23 1.83 1.07–4.65 1 (2.6) 1.28 2.89 1.69–4.01 0
Taurine (g)† NA NA NA NA 0.10 0.37 0.12–393.79 0

*Information obtained from an NRC publication.9 †Taurine is not a required nutrient for canine maintenance, according to the NRC.
NA = Not applicable.

Table 2—Median and range values for concentrations of selected vitamins and minerals in 39 canine and 28 feline recipes of home-
prepared diets for the management of CKD.

Canine Feline

Variable NRC’s RA Median Range No. (%) NRC’s RA Median Range No. (%)
(/1,000 kcal)* (/1,000 kcal) (/1,000 kcal) below RA (/1,000 kcal)* (/1,000 kcal) (/1,000 kcal) below RA
Minerals
Calcium (g) 1.00 0.90 0.09–3.22 22 (56.4) 0.72 1.21 0.37–2.54 7 (25.0)
Phosphorus (g) 0.75 0.58 0.28–1.26 27 (69.2) 0.64 0.69 0.50–1.17 12 (42.9)
Magnesium (mg) 150.00 0.20 0.07–0.45 13 (33.3) 100.00 130.00 90.00–280.00 4 (14.3)
Sodium (mg) 200.00 0.34 0.02–2.36 27 (69.2) 170.00 480.00 110.00–1,410.00 6 (21.4)
Potassium (g) 1.00 1.65 0.29–4.66 16 (41.0) 1.30 1.44 0.63–2.52 9 (32.1)
Iron (mg) 7.50 16.74 3.64–44.46 7 (17.9) 20.00 23.81 7.42–43.28 8 (28.6)
Copper (mg) 1.50 1.34 0.25–4.59 20 (51.3) 1.20 1.69 0.57–3.46 3 (10.7)
Zinc (mg) 15.00 12.51 3.07–97.77 24 (61.5) 18.50 13.80 3.80–28.31 19 (67.9)
Manganese (mg) 1.20 3.13 0.08–6.86 4 (10.3) 1.20 2.53 0.32–4.96 1 (3.5)
Selenium (µg) 87.50 0.05 0.02–0.19 34 (87.2) 75.00 100.00 30.00–190.00 9 (32.1)

Vitamins
Vitamin A (µg) 379.00 437.78 4.23–7,363.20 17 (43.6) 250.00 688.53 79.21–5,316.24 2 (7.1)
Vitamin E (mg) 7.50 26.49 3.61–120.20 3 (7.7) 10.00 21.02 1.90–379.97 3 (10.7)
Thiamine (mg) 0.56 2.08 0.13–18.31 3 (7.7) 1.40 11.49 0.59–160.50 3 (10.7)
Riboflavin (mg) 1.30 2.04 0.23–18.21 11 (28.2) 1.40 12.56 0.37–161.21 2 (7.1)
Pyridoxine (mg) 0.38 2.98 0.66–17.84 0 0.63 13.40 1.01–162.02 0
Niacin (mg) 4.25 21.30 1.17–51.43 2 (5.1) 10.00 39.38 17.11–189.27 0
Pantothenate (mg) 3.75 9.23 1.47–20.49 7 (17.9) 1.44 18.78 2.51–176.83 0
Cobalamin (µg) 8.75 0.01 0–40.00 22 (56.4) 5.60 30.00 2.00–100.00 1 (3.5)
Folate (µg) 67.50 356.60 21.50–1,128.40 3 (7.7) 188.00 612.10 156.60–1,376.50 2 (7.1)
Biotin (µg)† NA NA NA NA 18.75 40.00 30.00–5,370.00 2 (7.1)
Choline (mg) 425.00 169.05 11.26–469.61 37 (94.9) 637.00 211.82 4.19–876.24 23 (82.1)

†Biotin is not a required nutrient for canine maintenance, according to the NRC.
See Table 1 for remainder of key.

and some cuts of lamb. Of 36 recipes for which vitamin content of 63.4% (range, 57.3% to 71.6%). The energy
D was defined for all ingredients expected to contribute distribution had a wide range; the proportion of calories
to the vitamin D content, 15 (41.7%) were below the (percentage of ME) provided by protein, fat, and carbo-
RA and 1 (2.8%) exceeded the safe upper limit. Even hydrate ranged from 11.4% to 28%, 31.2% to 73.4%, and
when disregarding phosphorus concentrations, none of 0.7% to 57.4%, respectively. Medians and ranges of crude
the canine recipes provided all essential nutrients at or protein and amino acid concentrations were summarized
above the RA for adult maintenance of a target animal. (Table 1). Adequacy of protein and amino acids was a
concern because 12 of 28 (42.9%) feline recipes were be-
Quantitative analysis of feline recipes—The feline low the RA for crude protein or at least 1 amino acid.
recipes provided a median of 396 kcal (range, 259 to 1,667 All feline recipes were adequate in crude fat, ara-
kcal), energy density of 5,171 kcal/kg of DM (2,350.5 chidonic acid, and linoleic acid content. No recipes
kcal/lb of DM) with a range of 4,372.6 to 6,584.1 kcal/kg included a specific dose of fish oil as a source of long-
of DM (1,987.5 to 2,992.8 kcal/lb of DM), and moisture chain omega-3 fatty acids; however, some sources in-

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cluded a recommendation for an omega-3 fatty acid Many of the recipes assessed in the study reported
nutritional product as a general guideline. here did not provide calorie information or target ani-
Mineral and vitamin concentrations provided by mal body weight. Although the data for most recipes
feline recipes were often inadequate (Table 2). Calci- that provided calorie information were consistent with
um concentration was below the RA in 7 (25%) reci- that calculated by use of the software, few approximat-
pes, and calcium was provided at more than twice the ed the MER of the target animal when that informa-
RA in 11 (39.3%) recipes and at > 3 times the RA in tion was provided. Because few sources provided the
3 (10.7%) recipes. All recipes provided phosphorus at equation used to estimate energy requirements, this
concentrations above the MR for adult cats, with 12 of discrepancy may have reflected differences in energy
28 (42.9%) recipes below the RA and 16 of 28 (57.1%) calculations. The equation for the calculation of en-
above the RA. Seven (25%) recipes provided a calcium- ergy needs of neutered, less active pets was used in
to-phosphorus ratio < 1:1, and 6 (21.4%) recipes pro- this study; compared with those determinations, many
vided a ratio > 3:1. Of 21 recipes for which vitamin D recipes overestimated the energy requirement of a tar-
was defined for all ingredients expected to contribute to get animal. Moreover, although it is known that en-
the vitamin D content, only 1 (3.6%) was below the RA; ergy requirements are not linear with body size, several
none exceeded the safe upper limit. Even when disre- sources included a recommendation to double the rec-
garding phosphorus concentrations, none of the feline ipe amounts for animals twice the size of a target ani-
recipes provided all essential nutrients at or above the mal. Additionally, some sources provided recipes that
RA for adult maintenance of a target animal. differed widely in caloric content for target animals of
the same body weight.
Quantitative analysis revealed large variations in
Discussion the calories provided and the macronutrient profile of
To our knowledge, the study reported here was the the recipes. Deficits in crude protein and many amino
first in which recipes for home-prepared diets intended acids, vitamins, and minerals were common in both ca-
for the management of CKD were assessed. An objective nine and feline recipes. Furthermore, although many
of the study was to compare the nutritional profiles of recipes provided essential nutrients at concentrations
readily accessible recipes with established RAs for essen- below the MR for maintenance, even more provided
tial nutrients of adult dogs and cats. Despite the fact that concentrations between the MR and the RA. Whether
most of the recipes in this study were written or pro- these nutrients would be provided to any particular ani-
vided by veterinarians, the results indicated that many mal in sufficient quantities would be highly dependent
recipes for home-prepared diets that owners may use for on energy intake as well as digestibility and bioavail-
dogs and cats with CKD may be inappropriate. ability of the nutrients. Accuracy of the ingredient da-
Although recipes for home-prepared diets for pets tabase as well as the cooking and preparation methods
with CKD are readily available to pet owners through will also influence the actual concentration of any nu-
books and websites, these recipes differ widely with trient in the final diet.
regard to the nutritional profile. Also, regardless of the The goals for management of CKD in dogs and
training and credentials of the individual formulating the cats are to delay progression of disease and reduce the
recipe, vague specifications for ingredients and instruc- impact of clinical signs of disease. Generally accepted
tions for diet preparation may result in a highly variable strategies for the nutritional management of CKD pa-
end product when the recipe is prepared by different pet tients include reduced intake of protein, phosphorus,
owners. It was necessary to make 1 or more assumptions and sodium; modified intake of calcium and potassium,
to analyze every recipe in this study. Although attempts when necessary; and enhanced intake of water, water-
were made to approximate a realistic outcome by use soluble vitamins, and omega-3 fatty acids. Additionally,
of ingredients that were widely available and typically systemic alkalinization is promoted through protein re-
found in grocery stores, inherent variability and regional striction and the use of sodium bicarbonate, potassium
differences in the commonality of some items will influ- citrate, or calcium carbonate. Several studies have been
ence the reproducibility of the analyses. The tools and conducted to evaluate the effect of commercially avail-
resources used to formulate the recipes will also have a able therapeutic diets formulated for the management
substantial impact on the nutritional analysis; however, of CKD in dogs31,32 and cats.33–35 However, there is a
most sources did not cite the reference requirements, lack of data on the effects of any 1 strategy or of modi-
software, or nutritional databases used in the process. fying specific dietary variables on the basis of stage and
A recipe for a useful home-prepared diet for pets manifestation of the disease.
with any disease should be specific enough to reduce Many of the recipes were low in protein. Although
variability in ingredient selection and diet preparation the requirements of dogs and cats with CKD for protein
so that the intended nutritional profile of the final diet and other essential nutrients are unknown, there is no
would be as constant as possible regardless of who ob- reason to assume these are less than the requirements
tains the ingredients and prepares the meals. A cus- for adult maintenance of dogs and cats. Currently, all
tomized approach that would account for the energy commercially available veterinary therapeutic diets for
requirements and the particular type and stage of dis- use in managing CKD provide protein in concentra-
ease of a specific pet would also be beneficial because tions that meet or exceed the NRC’s RAs (25 and 50 g
owners may lack the ability to make appropriate ad- of crude protein/1,000 kcal for dogs and cats, respec-
justments to a general recipe; this approach has been tively). However, in the recipes analyzed in the present
advocated by veterinary nutritionists.30 study, there was a wide range of crude protein concen-

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trations provided, with several recipes containing crude reported separately and glomerular filtration rate was
protein concentrations below the RA for adult dogs and not assessed. Perhaps of more concern is the adverse
many others that had or even exceeded a crude protein effect of inadequate intake of sodium. Activation of the
concentration twice the RA for adult dogs. Although renin-angiotensin-aldosterone system and resultant
there is a lack of research on the optimal protein in- hypokalemia in cats consuming low-sodium diets have
take for dogs and cats with CKD, clinical experience been reported,41 and progressive renal injury from hypo-
supports the belief that a customized approach can ac- kalemic nephropathy is a concern. Although nearly
commodate different stages and types of disease. Ani- one-fourth of the feline recipes were below the RA for
mals with early stages of CKD are unlikely to develop sodium intake,9 none exceeded 50% of the concentra-
adverse effects from consumption of diets with protein tion associated with increases in relevant biochemical
concentrations that exceed the RA, whereas animals variables reported in another study.42
with more advanced disease may benefit (a reduction With regard to other nutrients that may be re-
in clinical signs associated with uremia) from dietary quired at modified concentrations in diets formulated
protein concentrations that are closer to the RA. Fur- for CKD, many of the canine and feline recipes as-
thermore, investigators in 1 study36 found that a dietary sessed in the present study provided deficient or ex-
protein concentration of approximately 33 g/1,000 kcal cessive concentrations of calcium, potassium, and
(similar to the concentration in many therapeutic diets water-soluble vitamins. Clearly, this is not ideal for
formulated for dogs with CKD) reduced proteinuria in healthy pets and is likely even of more concern for
dogs with glomerular nephropathy, compared with re- dogs and cats with CKD. Because not all animals re-
sults for dogs fed dietary protein at concentrations of quire the same degree and type of modifications, it is
72 g/1,000 kcal. This finding supports the belief that recommended that clinicians consider individualized
adjustment of dietary protein intake for renal pro- clinical data for each patient. For example, although
teinuria independent of stage of CKD is an important hypokalemia is sometimes detected in animals with
consideration in affected dogs. Finally, it is clear that polyuria secondary to CKD, hyperkalemia is also
despite adequate crude protein intake, adequacy of es- found in a portion of the patient population.43,44 Final-
sential amino acids is important for any animal. The ly, a few canine recipes and no feline recipes included
inadequacy of the amino acid profile provided by the a specific recommendation for supplementation with
recipes assessed here was a major concern, especially omega-3 fatty acids, which has been found to reduce
for canine recipes. inflammation and systemic blood pressure as well as
The role of phosphorus in CKD is fairly clearly de- preserve renal function in dogs with experimentally
fined, and reduction of dietary intake to near or below induced CKD.45,46 To our knowledge, similar investi-
the NRC’s RAs has long been the mainstay of CKD treat- gations in cats with CKD have not been reported.
ment. The objectives of this dietary modification are to None of the recipes assessed in the study reported
control hyperparathyroidism and delay disease progres- here provided adequate concentrations of all essential nu-
sion.37–39 Only 2 canine recipes were below the RA for trients, compared with the NRC’s RAs for adult dogs and
phosphorus (there is no MR for phosphorus for adult cats. Furthermore, many recipes did not accommodate
dogs). Although many feline recipes were between the currently accepted nutritional strategies for managing
RA and the MR, none were below the MR. However, CKD, and none provided guidelines for use at any particu-
many recipes exceeded the RA, with 2 canine and 2 fe- lar stage or type of disease. Recipes of home-prepared diets
line recipes providing > 150% of the RA for phospho- that are intended for the management of CKD should be
rus. Similarly, commercially available therapeutic diets used under appropriate veterinary supervision and moni-
marketed for CKD provide phosphorus at concentra- toring. Consideration should be given to collaborating
tions that range from 50% to 160% and 125% to 200% with a board-certified veterinary nutritionist to develop a
of the RA for dogs and cats, respectively. The impact of comprehensive and customized nutritional management
consuming any diet with concentrations of phosphorus plan including follow-up and adjustments as needed.
that markedly exceed the RA cannot be predicted for
any particular patient but likely depends on CKD stage a. Lauten SD, Smith TM, Kirk CA, et al. Computer analysis of nu-
and other specific underlying physiologic processes. trient sufficiency of published home-cooked diets for dogs and
cats (abstr). J Vet Intern Med 2005;19:476.
The role of dietary intake of sodium in animals b. Centrum multivitamin/multimineral supplement, Pfizer Inc,
with CKD has not been fully characterized. Because Kings Mountain, NC.
of the increased incidence of hypertension in patients c. Centrum Kids multivitamin/multimineral supplement, Pfizer
with CKD, there have been concerns regarding a po- Inc, Kings Mountain, NC.
tential lower sodium tolerance and worsening of hyper- d. One-a-Day Maximum multivitamin/multimineral supplement,
Bayer HealthCare LLC, Morristown, NJ.
tension in some patients. Studies of dogs40 and cats41 e. Vetri-Science Nu-Cat tablets, FoodScience Corp, Essex Junc-
with experimentally induced CKD have not indicated tion, Vt.
an association between sodium intake and hyperten- f. Vetri-Science Canine Plus tablets, FoodScience Corp, Essex
sion or progression of renal dysfunction. In 1 study42 Junction, Vt.
of 36 cats (6 of which had naturally occurring CKD), g. Virbac Pet-Tabs, Virbac Corp, Fort Worth, Tex.
there was no effect of a high-sodium diet, compared h. Vital Vities for Dogs, Deserving Pets, Clearwater, Fla.
i. Vital Vities for Cats, Deserving Pets, Clearwater, Fla.
with the effects of a low-sodium diet, on blood pressure j. Balance IT, Davis Veterinary Medical Consulting Inc, Davis, Calif.
variables, although increases in serum concentrations k. USDA, Agricultural Research Service, USDA National Nutrient
of creatinine, phosphorus, and SUN were reported for Database for Standard Reference. Release 22. 2009.
all cats; however, data for the group with CKD were not l. Davis Veterinary Medical Consulting Inc, Davis, Calif.

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