{"id":4963,"date":"2014-01-01T21:10:27","date_gmt":"2014-01-01T21:10:27","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=4963"},"modified":"2022-03-24T10:22:39","modified_gmt":"2022-03-24T10:22:39","slug":"nutritional-management-of-renal-disease-an-evidence-based-approach","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/","title":{"rendered":"Nutritional Management of Renal Disease: An Evidence-Based Approach"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">Successful treatment of chronic kidney disease involves a multimodal approach to identify and eliminate exacerbating factors together with implementation of veterinary therapeutic renal diets and medical management.<\/span><\/p>\n<hr \/>\n<div>\n<div class=\"orange-box\">\n<p align=\"LEFT\"><strong><em>T<\/em><em>oday\u2019s Veterinary Practice<\/em> <\/strong>is delighted to announce that the <strong>American College of Veterinary Nutrition <\/strong>(acvn.org) has partnered with TVP to bring our readers the <strong>NUTRITION NOTES<\/strong> column.<\/p>\n<p align=\"LEFT\">The primary objectives of the ACVN are to:<\/p>\n<ul>\n<li>Advance the specialty area of veterinary nutrition<\/li>\n<li>Increase the competence of those practicing in this field<\/li>\n<li>Establish requirements for certification in veterinary nutrition<\/li>\n<li>Encourage continuing education for both specialists and general practitioners<\/li>\n<li>Promote evidence-based research<\/li>\n<li>Enhance dissemination of the latest veterinary nutrition knowledge.<\/li>\n<\/ul>\n<p align=\"LEFT\">The ACVN achieves these objectives in many ways, including designating specialists in animal nutrition, providing continuing education through several media, supporting veterinary nutrition residency programs, and offering a wide array of resources related to veterinary nutrition.<\/p>\n<p align=\"LEFT\">By bringing this column to <em>TVP<\/em> readers, the ACVN is reaching out to all veterinary professionals to provide the highest quality, cutting-edge information on companion animal nutrition, contributed by their foremost nutrition specialists.<\/p>\n<hr \/>\n<\/div>\n<\/div>\n<p><span class=\"s1\">Chronic kidney disease (CKD) is the most common type of renal disease in senior patients, but can occur in animals of all ages. Estimated incidence of CKD in all dogs and cats is 0.5% to 1.5%, respectively, and, in cats over 15 years of age, 30%.<\/span><span class=\"s4\"><sup>1<\/sup><\/span><span class=\"s1\"> In senior patients, CKD commonly results in morbidity and mortality.<\/span><span class=\"s4\"><sup>2<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">CKD is defined as <em>the presence of structural or functional abnormalities of one or both kidneys that have been present for an extended period of time, usually 3 months or longer<\/em>. It is characterized by irreversible and progressive loss of kidney function, leading to azotemia, uremia, and clinical signs associated with diminishing renal function.<\/span><\/p>\n<blockquote>\n<p align=\"LEFT\">A uremic crisis is defined as a patient having at least 2 of the following clinical signs: depression, lethargy, anorexia, vomiting, ammonia breath odor, or uremic stomatitis.<\/p>\n<\/blockquote>\n<p class=\"p1\"><span class=\"s1\">Successful treatment of CKD requires a multi-modal approach, which involves identifying and eliminating exacerbating factors, combined with appropriate dietary and medical management.<\/span><span class=\"s4\"><sup>3-5<\/sup><\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>EVIDENCE-BASED THERAPIES<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Many therapeutic interventions have been developed or advocated for management of CKD; however, evidence of efficacy or effectiveness of these interventions is often lacking or highly variable. If current recommendations undergo the scrutiny of evidence-based medicine, very few meet the criteria to receive a Grade I designation (<b>Table 1<\/b>).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><strong>Dietary management of CKD is one of the few current recommendations for management of CKD in dogs and cats that has Grade I evidence<\/strong>.<\/span><span class=\"s4\"><sup>4-9<\/sup><\/span><span class=\"s1\"> As a result, dietary management remains the cornerstone of therapy for CKD.<\/span><\/p>\n<p class=\"p1\"><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-4923 size-full aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\" alt=\"Screen Shot 2015-06-18 at 4.33.56 PM\" width=\"439\" height=\"518\" \/><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>COMPARISON OF DIETARY THERAPIES<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Research has shown that, for managing CKD in dogs and cats, veterinary therapeutic renal diets are superior to maintenance diets (<b>Table 2<\/b>).<\/span><span class=\"s4\"><sup>4,6-9<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Although these studies in both dogs and cats demonstrate that feeding a therapeutic renal diet to patients with CKD is superior to feeding a maintenance diet, the diets in these studies varied in many of the key nutrients for management of CKD, including dietary protein, phosphorus, and fatty acid composition. Therefore, it is unknown which component(s) of the therapeutic renal diets resulted in the benefits observed in these studies.<\/span><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2.png\"><img decoding=\"async\" class=\"size-large wp-image-9055 aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-373x1024.png\" alt=\"NN-2\" width=\"373\" height=\"1024\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-373x1024.png 373w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-109x300.png 109w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-768x2111.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-559x1536.png 559w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2-745x2048.png 745w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/NN-2.png 1018w\" sizes=\"(max-width: 373px) 100vw, 373px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<h2><span class=\"s1\"><b>KEY NUTRIENTS IN DIETARY MANAGEMENT<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Commercial therapeutic renal diets vary in their nutritional composition; turn to page 53 for tables detailing the nutritional composition of these diets. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In the cats in Study 4 (<b>Table 2<\/b>), median survival time was longest in cats fed the diet with the highest eicosapentaenoic acid (EPA) content and one of the highest potassium levels. Survival times were lowest for the diet <em>not<\/em> supplemented with EPA and the lowest potassium content.<\/span><span class=\"s4\"><sup>8<\/sup><\/span><span class=\"s1\"> Unfortunately, the identity of the therapeutic renal diets evaluated in this study was not provided, and it is likely that diet composition has changed since this study was published. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The majority of work performed to determine which nutrients are beneficial at what levels in the management of CKD has been done in dogs. The remainder of this article will focus on research results from these studies.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Phosphorus<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">A study was conducted in dogs to determine the effects of high (H) and low (L) levels of dietary phosphorus and protein on renal function and survival in adult dogs with induced CKD.<\/span><span class=\"s4\"><sup>10<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Four diet groups (<em>n<\/em> = 12\/group) were fed one of 4 experimental diets for 24 months after surgical reduction of renal mass. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The experimental diets (<b>Table 3<\/b>) contained varying levels of protein and phosphorus listed on a percent dry matter basis (DMB). Diet 4 was most consistent with many veterinary therapeutic renal diets. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Results showed that: <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">When renal function was reduced to the point that moderate azotemia (serum creatinine, 3\u20134 mg\/dL) occurred, dietary phosphorus restriction was associated with a longer period of stable glomerular filtration rate (GFR) and improved survival. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Dogs fed high dietary protein had no functional or morphologic evidence of adverse effects compared with dogs fed low dietary protein. <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><strong>Therefore, this study showed that survival of dogs with induced CKD was enhanced by phosphorus restriction but not by protein restriction<\/strong>.<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.12-PM.png\"><img decoding=\"async\" class=\"alignnone wp-image-4925 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.12-PM-e1456238884205.png\" alt=\"Screen Shot 2015-06-18 at 4.34.12 PM\" width=\"436\" height=\"147\" \/><\/a><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Omega-3 Polyunsaturated Fatty Acids<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Dogs lack the ability to synthesize omega-6 and omega-3 polyunsaturated fatty acids (PUFAs); therefore, they are considered dietary essential fatty acids.<\/span><span class=\"s4\"><sup>11<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Dogs require linoleic acid (LA), an omega-6 PUFA, and have the enzyme capability to convert linoleic acid into arachidonic acid (AA), another omega-6 PUFA.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">However, dogs are unable to convert omega-6 PUFAs into omega-3 PUFAs. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Not all omega-3 PUFAs are metabolically equivalent: <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Plant-based sources of omega-3 PUFAs, such as flaxseed, linseed, and canola oil, are rich in alpha-linolenic acid (ALA). <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Marine algae and oily cold water fish are good sources of EPA and docosahexaenoic acid (DHA). <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Conversion Rates<\/b>. While LA is readily converted to AA, ALA converts to EPA and DHA much more slowly. This conversion rate is &lt; 10% in humans, and believed to be rather limited in dogs as well.<\/span><span class=\"s4\"><sup>12<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Omega-3 PUFA Benefits<\/b>. While dietary ALA has some benefits in healthy dogs and management of some dermatologic diseases,<\/span><span class=\"s4\"><sup>13<\/sup><\/span><span class=\"s1\"> the majority of therapeutic benefits from omega-3 fatty acids result from:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">EPA: Anti-inflammatory and prostaglandin effects<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">DHA: Central nervous system development and retinol function, which are critical during pregnancy and early life.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">These omega-3 PUFAs are used in dietary management of kidney disease, cardiovascular disease, idiopathic hyperlipidemia, inflammatory and immune diseases, and osteoarthritis.<\/span><span class=\"s4\"><sup>11-13<\/sup><\/span><\/p>\n<p class=\"p1\"><strong><span class=\"s1\">Therefore, when using omega-3 PUFAs for dietary management of medical conditions, the source should also already contain EPA and DHA because the conversion rate of ALA to EPA and DHA may be too slow to benefit the patient.<\/span><\/strong><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Additional Benefits<\/b>. When nephrons are destroyed in CKD, the remaining viable nephrons hypertrophy in an attempt to compensate, resulting in a maladaptive increase in glomerular capillary pressure (GCP). Dietary omega-3 fatty acid supplementation in the form of fish oil can have beneficial effects in reducing GCP. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In studies by Brown, et al,<\/span><span class=\"s4\"><sup>14-16<\/sup><\/span><span class=\"s1\"> the effects of various dietary omega-6:omega-3 ratios on glomerular hypertension in a canine remnant kidney model were evaluated. <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Three groups of 6 dogs were fed diets with omega-6:omega-3 ratios of 50:1, 25:1, and 5:1 for 10 weeks. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Omega-3 PUFA supplementation was supplied in the form of fish oil, which is rich in EPA and DHA. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Results showed the omega-6:omega-3 diet with the 5:1 ratio normalized GCP in dogs with reduced kidney function to a level consistent with that found in dogs with normal kidney function.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Antioxidants<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">A free radical is any atom or molecule that has a single unpaired electron. Normal aerobic metabolism, along with many environmental factors, contributes to the formation of reactive oxygen species (ROS) in the body. ROS can damage membrane lipids, nucleic acids, and proteins in the body that, in turn, contribute to disease processes. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><strong>Oxidative Stress.<\/strong> Normally, antioxidant defense mechanisms adequately remove ROS as they are formed; however, these mechanisms become inadequate as animals age, and progressive oxidative damage is a consistent feature of aging unless adequate dietary sources of antioxidants are provided. Keep in mind, though, that oversupplementation of dietary antioxidants may be as detrimental as deficiency of dietary antioxidants. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Since CKD occurs most commonly in older dogs:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Oxidative stress can be a contributing factor to the decline in GFR associated with CKD. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Renal oxidative stress is a problem because surviving hypertrophied nephrons become adaptively hyperfunctional, leading to a dramatic increase in cellular oxidative phosphorylation.<\/span><span class=\"s4\"><sup>16<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Optimum Supplementation<\/b>. In a study by Brown,<\/span><span class=\"s4\"><sup>16<\/sup><\/span><span class=\"s1\"> the effects of omega-3 fatty acid and antioxidant supplementation were evaluated separately and in combination in 6- to 8-year-old beagle dogs with induced CKD. Four groups of 8 dogs were fed one of 4 diets (<b>Table 4<\/b>).<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.18-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4926 size-full aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.18-PM-e1456238932897.png\" alt=\"Screen Shot 2015-06-18 at 4.34.18 PM\" width=\"433\" height=\"249\" \/><\/a><\/p>\n<p class=\"p1\"><strong><span class=\"s1\">The results demonstrated that veterinary therapeutic renal diets supplemented with omega-3 PUFAs from fish oil in combination with antioxidants appear to better slow progression of CKD than diets supplemented with only one or the other or none at all.<\/span><\/strong><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Protein<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The traditional approach to dietary management of CKD in dogs was reduction of protein intake to less than the minimum levels for adult maintenance (18% DMB) recommended by the Association of American Feed Control Officials (AAFCO). The rationale for this approach considered that: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Reduced protein diets decrease production of nitrogenous waste products excreted by the kidneys <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Protein is one of the major contributors to phosphorus in the diet; reduction of dietary protein also reduces dietary phosphorus levels, which has shown benefit in management of CKD in dogs.<\/span><span class=\"s4\"><sup>10<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Amount of Dietary Protein<\/b>. However, reduced dietary protein for management of CKD in dogs is not necessarily beneficial.<\/span><\/p>\n<ol class=\"ol1\">\n<li class=\"li1\"><span class=\"s1\">Senior dogs are less efficient at metabolizing dietary protein than younger dogs and, thus, require more dietary protein to maintain protein reserves and maximize protein turnover rates.<\/span><span class=\"s4\"><sup>17,18<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">In humans, loss of lean body mass often accompanies dietary protein restriction, and can result in loss of physical strength, motor coordination, and impaired immune function.<\/span><span class=\"s4\"><sup>19,20<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Loss of lean body mass has also been associated with increased rates of morbidity and mortality in humans, and a similar result was observed in a study in dogs (<b>Table 5<\/b>).<\/span><span class=\"s4\"><sup>21<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Work by Finco and Brown<\/span><span class=\"s4\"><sup>10<\/sup><\/span><span class=\"s1\"> demonstrated that dietary phosphorus restriction, but not dietary protein restriction, was beneficial in dogs with CKD.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">In a study by Kealy,<\/span><span class=\"s4\"><sup>21<\/sup><\/span><span class=\"s1\"> 26 healthy pointers, ages 7 to 9 years, were fed a 16.5% or 45.6% protein diet for 2 years. The results of the study are outlined in <b>Table 5<\/b>.<\/span><\/li>\n<\/ol>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.24-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4927 size-full aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.34.24-PM-e1456239219313.png\" alt=\"Screen Shot 2015-06-18 at 4.34.24 PM\" width=\"476\" height=\"127\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">Recently, it has been shown that dietary protein levels can be increased in dogs with CKD without adversely affecting life expectancy. However, the diet must be phosphorus restricted, using protein sources naturally lower in phosphorus concentration, such as soy isolate.<\/span><span class=\"s4\"><sup>5<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Enteric Dialysis<\/b>. In addition, by using nonrenal methods of excreting urea from the body, such as enteric dialysis, it may be possible to increase dietary protein fed to dogs with CKD without increasing nitrogen excretion burden on the kidneys. To promote enteric dialysis, diets can be supplemented with certain types of fermentable fiber, such as beet pulp, fructooligosaccharide (FOS), and gum arabic.<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9056 aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial-739x1024.png\" alt=\"010214 NN ent dial\" width=\"450\" height=\"624\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial-739x1024.png 739w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial-216x300.png 216w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial-768x1065.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-ent-dial.png 1020w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">A study evaluated 12 healthy adult dogs that, for 14 days, were fed either a normal maintenance diet or the same diet supplemented with a fermentable fiber blend, which included beet pulp, FOS, and gum arabic.<\/span><span class=\"s4\"><sup>22<\/sup><\/span><span class=\"s1\"> Dogs fed the diet containing the fermentable fiber blend had increased fecal nitrogen excretion (34% increase; p &lt; 0.05) and decreased urinary nitrogen excretion. Therefore, it appears the body increased nitrogenous waste product excretion via a nonrenal mechanism; this mechanism could be used to potentially increase dietary protein intake in dogs with CKD, without increasing buildup of uremic toxins.<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-9057 aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-498x1024.png\" alt=\"010214 NN enc pts\" width=\"498\" height=\"1024\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-498x1024.png 498w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-146x300.png 146w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-768x1578.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-748x1536.png 748w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts-997x2048.png 997w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-enc-pts.png 1068w\" sizes=\"(max-width: 498px) 100vw, 498px\" \/><\/a><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>IN SUMMARY<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">The mainstay of therapy for CKD\u2014in both dogs and cats\u2014is dietary management. Research has shown that:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Veterinary therapeutic renal diets are superior to conventional maintenance diets for management of CKD. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Diets containing omega-3 PUFAs in the <\/span><span class=\"s1\">form of fish oil and rich in EPA are beneficial for both dogs and cats. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Renal diets supplemented with appropriate amounts of antioxidants are beneficial for dogs. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Most recently, dietary protein restriction in dogs with CKD may be unnecessary as long as the diet fed is phosphorus restricted and supplemented with prebiotic fiber to promote enteric dialysis.<\/span><span class=\"s4\"><sup>5<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">It is important to keep in mind, though, that commercial therapeutic renal diets vary in their nutritional composition.<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-9058 aligncenter\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-1021x1024.png\" alt=\"010214 NN food table copy\" width=\"650\" height=\"652\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-1021x1024.png 1021w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-300x300.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-150x150.png 150w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-768x771.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-1531x1536.png 1531w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/010214-NN-food-table-copy-2041x2048.png 2041w\" sizes=\"(max-width: 650px) 100vw, 650px\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\">AA = arachidonic acid; AAFCO = Association of American Feed Control Officials; ALA = alpha-linolenic acid; CKD = chronic kidney disease; DMB = dry matter basis; EPA = eicosapentaenoic acid; FOS = fructooligosaccharide; GCP = glomerular capillary pressure; GFR = glomerular filtration rate; H = high; L = low; LA = linoleic acid; PUFA = polyunsaturated fatty acid; ROS = reactive oxygen species; SCFA = short-chain fatty acid<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":1081,"footnotes":""},"categories":[364],"tags":[],"class_list":["post-4963","post","type-post","status-publish","format-standard","hentry","category-january-february-2014","clinical_topics-nutrition","clinical_topics-urology-renal-medicine"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Nutritional Management of Renal Disease: An Evidence-Based Approach | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"description\" content=\"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nutritional Management of Renal Disease: An Evidence-Based Approach\" \/>\n<meta property=\"og:description\" content=\"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/\" \/>\n<meta property=\"og:site_name\" content=\"Today&#039;s Veterinary Practice\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/todaysveterinarypractice\" \/>\n<meta property=\"article:published_time\" content=\"2014-01-01T21:10:27+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-03-24T10:22:39+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Nutritional Management of Renal Disease: An Evidence-Based Approach\",\"datePublished\":\"2014-01-01T21:10:27+00:00\",\"dateModified\":\"2022-03-24T10:22:39+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/\"},\"wordCount\":2036,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/01\\\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\",\"articleSection\":[\"January\\\/February 2014\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#respond\"]}]},{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/\",\"name\":\"Nutritional Management of Renal Disease: An Evidence-Based Approach | Today&#039;s Veterinary Practice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/01\\\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\",\"datePublished\":\"2014-01-01T21:10:27+00:00\",\"dateModified\":\"2022-03-24T10:22:39+00:00\",\"description\":\"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#primaryimage\",\"url\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/01\\\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\",\"contentUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/01\\\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/nutrition\\\/nutritional-management-of-renal-disease-an-evidence-based-approach\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Nutritional Management of Renal Disease: An Evidence-Based Approach\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"name\":\"Today's Veterinary Practice\",\"description\":\"Peer-Reviewed Veterinary Journal\",\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\",\"name\":\"Today's Veterinary Practice\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"contentUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"width\":179,\"height\":89,\"caption\":\"Today's Veterinary Practice\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/todaysveterinarypractice\",\"https:\\\/\\\/www.youtube.com\\\/thenavc\"],\"email\":\"info@navc.com\"},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Nutritional Management of Renal Disease: An Evidence-Based Approach | Today&#039;s Veterinary Practice","description":"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Nutritional Management of Renal Disease: An Evidence-Based Approach","og_description":"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.","og_url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/","og_site_name":"Today&#039;s Veterinary Practice","article_publisher":"https:\/\/www.facebook.com\/todaysveterinarypractice","article_published_time":"2014-01-01T21:10:27+00:00","article_modified_time":"2022-03-24T10:22:39+00:00","og_image":[{"url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"10 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#article","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/"},"author":{"name":"","@id":""},"headline":"Nutritional Management of Renal Disease: An Evidence-Based Approach","datePublished":"2014-01-01T21:10:27+00:00","dateModified":"2022-03-24T10:22:39+00:00","mainEntityOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/"},"wordCount":2036,"commentCount":0,"publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#primaryimage"},"thumbnailUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png","articleSection":["January\/February 2014"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#respond"]}]},{"@type":["WebPage","MedicalWebPage"],"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/","name":"Nutritional Management of Renal Disease: An Evidence-Based Approach | Today&#039;s Veterinary Practice","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#primaryimage"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#primaryimage"},"thumbnailUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png","datePublished":"2014-01-01T21:10:27+00:00","dateModified":"2022-03-24T10:22:39+00:00","description":"Successful treatment of CKD in dogs and cats involves a multimodal approach, including implementation of veterinary therapeutic renal diets.","breadcrumb":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#primaryimage","url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png","contentUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/01\/Screen-Shot-2015-06-18-at-4.33.56-PM-e1456237992312.png"},{"@type":"BreadcrumbList","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/nutritional-management-of-renal-disease-an-evidence-based-approach\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/"},{"@type":"ListItem","position":2,"name":"Nutritional Management of Renal Disease: An Evidence-Based Approach"}]},{"@type":"WebSite","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","name":"Today's Veterinary Practice","description":"Peer-Reviewed Veterinary Journal","publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization","name":"Today's Veterinary Practice","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/","url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","contentUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","width":179,"height":89,"caption":"Today's Veterinary Practice"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/todaysveterinarypractice","https:\/\/www.youtube.com\/thenavc"],"email":"info@navc.com"},{"@type":"Person","@id":"","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/4963","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/comments?post=4963"}],"version-history":[{"count":4,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/4963\/revisions"}],"predecessor-version":[{"id":29533,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/4963\/revisions\/29533"}],"wp:attachment":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media?parent=4963"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/categories?post=4963"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/tags?post=4963"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}