Correction of hyperkalemia in dogs with chronic kidney disease consuming commercial renal therapeutic diets by a potassium-reduced home-prepared diet

Background: Hyperkalemia occurs in dogs with chronic kidney disease (CKD). Objectives: (1) To determine the incidence of hyperkalemia in dogs with CKD, (2) to determine the proportion of hyperkalemic dogs that required modification of dietary potassium intake, (3) to evaluate the response to dietary modification. Methods: The hospital database was reviewed retrospectively to identify dogs with CKD and persistent (>5.3 mmol/L on at least 3 occasions) or severe (K ≥ 6.5 mmol/L) hyperkalemia while consuming a therapeutic renal diet. Records of dogs with hyperkalemia that were prescribed a home-prepared, potassium-reduced diet were evaluated further. Response was evaluated by changes in body weight, BCS, and serum potassium concentration. Results: One hundred and fifty-two dogs were diagnosed with CKD, of which 47% had ≥1 documented episode of hyperkalemia, 25% had ≥3 episodes of hyperkalemia, and 16% had ≥1 episodes of severe hyperkalemia (K > 6.5 mmol/L). Twenty-six dogs (17.2%) with CKD and hyperkalemia were prescribed a potassium-reduced, home-prepared diet. The potassium concentration of all hyperkalemic dogs on therapeutic diets (potassium content, 1.6 ± 0.23 g/1,000 kcal of metabolizable energy [ME]) was 6.5 ± 0.5 mmol/L but decreased significantly to 5.1 ± 0.5 mmol/L in 18 dogs available for follow-up in response to the dietary modification (0.91 ± 0.14 g/1,000 kcal of ME, P < 001). Potassium concentration normalized in all but 1 dog. Conclusions and Clinical Importance: Hyperkalemia is a potential complication of CKD. In a subset of CKD dogs, hyperkalemia can be associated with commercial renal diets and could restrict use of these diets. Appropriately formulated, potassium-reduced, diets are an effective alternative to correct hyperkalemia.