Since the only effective therapy for end-stage uremia (i.e., intensive fluid therapy, renal transplantation, and/or dialysis) is often prohibitively expensive, a goal of therapy should be to prevent progression of kidney disease to end-stage failure. However, dogs and cats with mild renal dysfunction often suffer progressive decrements of renal function and ultimately die of terminal renal failure. The progression to end-stage uremia can be attributed to either the primary kidney disease or its inherent progression, as described above.

In the absence of clinical signs of uremia, the principal rationale for dietary restriction of nutrients is to limit the progression of kidney disease. In the management of progressive kidney disease, a variety of recommendations have been considered for dogs and cats with azotemic kidney disease: (1) restriction of dietary protein intake; (2) restriction of dietary phosphorus intake; (3) restriction of dietary sodium intake; (4) modification of dietary lipid intake; and (5) dietary alkalinization.

Properly managed intervention plays a central role in the management of the uremic syndrome through control of dietary intake of calories, phosphorus, sodium, potassium, protein, and acid. In affected animals, the kidney is susceptible to self-perpetuating injury which may be modified by adjustments in dietary intake of phosphorus in dogs and cats, and polyunsaturated fatty acids in dogs. Successful dietary intervention must be individualized to each patient on the basis of data obtained from historical, clinical, and laboratory evaluations. Veterinarians should not confuse the act of offering a special diet to the patient with the actual ingestion of the proper level of nutrients by that patient. The former is common clinical practice; the latter is our therapeutic goal.

References: NAVRG Survey, 2005; Brown SA, College Vet Med Univ Georgia, Athens, GA; sbrown@vet.uga.edu