D
ietary therapy has remained the cornerstone of management of chronic renal failure for decades. The goals of dietary modification are to (1) meet the patient's nutrient and energy requirements, (2) alleviate clinical signs and consequences of the uremic intoxication, (3) minimize disturbances in fluid, electrolyte, vitamin, mineral, and acid-base balance, and (4) slow progression of the renal failure. Recommendations regarding dietary therapy and other components of conservative medical management must be individualized based on clinical and laboratory findings. Chronic renal failure is progressive and dynamic, and therefore serial clinical and laboratory assessment and modification of therapy in response to changes in the patient's condition are integral to successful therapy.
ENERGY
Sufficient energy must be provided to prevent endogenous protein catabolism, which results in malnutrition and exacerbation of azotemia. Although the energy requirements of dogs and cats that have chronic renal failure (CRF) are unknown, they are believed to be similar to those of healthy dogs and cats. Dogs should be fed 132 ร (body weight in kilograms) 0.75 per day and cats require 50 to 60 kcal/kg/d. Maintenance energy requirements may vary among individuals, and therefore energy intake should be customized based on serial determinations of body weight and body condition score. Carbohydrates and fats provide the nonprotein sources of energy in the diet. Typically diets designed for managing CRF are formulated with a high fat content because fat provides approximately twice the energy per gram than carbohydrate. This formulation results in an energy-dense diet that allows patients to obtain nutritional requirements from a smaller volume of food. A smaller volume of food minimizes gastric distention, which reduces the likelihood of nausea and vomiting.