Nutrition of Dogs with Kidney Disease

Među bubrežnim bolestima koje se javljaju u pasa nesumnjivu važnost imaju kronična bolest bubrega te akutno zatajenje bubrega. Kada govorimo o kroničnoj bolesti bubrega, govorimo o sindromu ireverzibilne prirode u kojem susrećemo postepenu insuficijenciju bubrežnih funkcija. Sama terapija pasa usmjerena je dakle na ublažavanje simptoma bolesti, što za posljedicu ima poboljšanje kvalitete života. Gledano s ovoga aspekta, uspijeh u liječenju pacijenata teško se postiže bez uključivanja dijetalne prehrane u sam protokol liječenja. Plan dijetalne prehrane uvjetovan je kliničkim stadijem bolesti koji je dodijeljen dotičnom pacijentu, isto tako, on ima individualnu ovisnost i zahtjeva evaluaciju te prema potrebi i modulaciju u određenim vremenskim intervalima. Prva stavka nutritivnog plana jest povećanje unosa vode u pasa sa uvrđenom dehidracijom. Daljnje potrebe tiču se zadovoljavanja energetskih potreba pacijenata radi sprečavanja malnutricije i pogoršanja azotemije, pri čemu masti pružaju adekvatnu opskrbu energijom. Jedno od najvažnijih načela prehrane jest redukcija i selekcija proteina. S obzirom da većina bubrežnih toksina potječe od metabolizma proteina, strategija nalaže kvantitativno smanjenje i kvalitativno povećanje unosa proteina (proteini animalnog porijekla). Što se tiče unosa lipida, u hrani je potrebno povećati količinu omega-3 masnih kiselina, a smanjiti unos zasićenih masti i kolesterola. Sljedeća stavka nutritivnog plana su elektroliti, točnije fosfor, čiji bi unos hranom trebalo smanjiti, pošto zbog smanjenja glomerularne filtracije često dolazi do hiperfosfatemije. Još jedna komplikacija ove bolesti jest i hipertenzija koja zahtjeva antihipertenzivnu dijetu, točnije, smanjen unos natrija hranom. U prehranu pasa trebali bi uključiti suplemente za nadoknadu gubitka kalija (kalijev glukonat, itd.), ukoliko je u psa utvrđena hipokalijemija. Često su psi sa kroničnom bolesti bubrega u stanju metaboličke acidoze kad je indikativna alkalizirajuća nutritivna potpora, konkretnije, primjena natrijevog ili kalcijevog bikarbonata. U slučaju pasa sa akutnim zatajenjem bubrega, kao sindromom u kojem dolazi do naglog pogoršanja bubrežne funkcije i posljedično azotemije, bez uključivanja nutritivne potpore u liječenje, mogućnost stabilizacije i oporavka pacijenta značajno se umanjuje. Primarno, njena svrha je minimaliziranje negativnog nutritivnog balansa, koji se javlja kao posljedica gubitka proteina i energije. Zbog nadmoći kataboličkih procesa kod ove bolesti pažnja se, s dijetalnog aspekta. posvećuje optimalnom unosu proteina, kao i odgovarajućem energetskom unosu putem hrane. Općenite preporuke uključuju i ograničen unos kalija i fosfora poradi sprečavanja akumulacije istih. Uremični psi često odbijaju hranu čime potrebiti unos kalorija nije zadovoljen. Ovakvo stanje je apsolutna indikacija za enteralnu prehranu pomoću hranidbenih sondi, dok je neupjeh u zadovoljavanju hranidbenih potreba spomenutiom načinom prehrane indikacija za parenteralnu prehranu.Among kidney diseases that occur in dogs, chronic kidney disease and acute renal failure undoubtedly carry great importance. Chronic kidney disease is a syndrome of irreversible and progressive nature where we are met with gradual and progressive renal insufficiency. Therapy in dogs is therefore focused on alleviating symptoms of the disease, which results in an improvement in the quality of life. With this in mind, the success of treatment in kidney patients is difficult to achieve without including a diet aspect into the treatment protocol. The diet plan depends on the patient's clinical stage, as well as individual dependency, thus requiring evaluation and possibly modulation at specified time intervals. The first aim of the agenda is to increase water intake in dehydrated dogs. Further purposes are related to meeting patients' energy requirements of patients to prevent malnutrition and azotemia progression, whereby fats provide an adequate supply of energy. One of the most important principles of the diet is based on reduction and selection of proteins. Considering that most kidney toxins are derived from protein metabolism, the diet strategy aims to reduce the quantity while increasing the quality of proteins in the diet (proteins of animal origin). Regarding lipid intake, it is necessary to increase the amount of omega-3 fatty acids, and decrease saturated fat and cholesterol intake. The next aim of the nutritional plan has to do with electrolytes, namely phosphorus, which should be reduced in the diet, as a decrease in glomerular filtration of phosphorus often leads to hyperphosphatemia in kidney patients. Another complication of the disease is hypertension, which requires an anti-hypertensive diet, precisely, a reduced sodium intake. If hypokalemia is determined in the dog, the diet should be supplemented to offset the loss of potassium with e.g. potassium gluconate. Dogs with chronic kidney disease are often in a state of metabolic acidosis, in which case, alkalizing nutritional support is indicated, more specifically, administration of sodium or calcium bicarbonate. In the case of dogs with acute renal failure, a syndrome in which there is rapid deterioration of renal function and, consequently, azotemia, the possibility of stabilization and recovery of the patient is significantly reduced when nutritional support is excluded from the treatment protocol. Primarily, its purpose is to minimize the negative nutritional balance, which occurs because of protein and energy losses, of course, on the individual level. Due to the overpowering catabolic processes that take place with this disease, special attention is devoted to having the optimum protein intake, as well as an appropriate intake of energy through food. General recommendations include limiting the intake of potassium and phosphorus in order to prevent their accumulation. Uremic dogs often refuse to eat, and so do not fulfill their caloric requirement. This situation is an absolute indication for enteral feeding using probes, while parenteral nutrition is indicated in cases where nutritional requirements are failed to be met via feeding probes