Nick, Dr. Conor Brady, and Dr. Brendan Clark discuss diagnosing and managing kidney disease in dogs, emphasizing fasting blood tests and urine analysis. Raw-fed dogs often show 30-50% higher kidney markers than kibble-fed dogs without actual disease. They critique the IDEXX SDMA test for lacking independent validation and flag dehydration, infections, and dental disease as common mimics.
Chapters
Did. It's the scene where they're riding around on a bicycle.
Yeah.
And it's Catherine somebody. I utterly fell in love with her at the age of about 8.
Oh yeah. Good taste.
No, it's good. If nobody's seen Butch Cassidy and the Sundance Kid, it is an amazing—
Are we live?
Really?
We are live.
Did you not know?
I love the scene. Where, where he, uh, I think it's, um, Redford, um, and, and this old guy chucks a, chucks a coin like 10 yards away and says, can you hit that? And he says, can I move? And Robert Redford just, uh, and the guy goes, no, just shoot the goddamn coin, or something. And he, and he aims and he tries to hit it when he misses, and he misses again. And then he says to the guy, can I move? And then he jumps sideways, twists, and as he's moving, he shoots the coin up and up and up and up. And then he goes, yeah, I'm better, I'm better when I move.
He doesn't like standing still shooting. I love when they're on the side of the cliff. It's the best buddy movie ever. It's the best man.
It is.
But, uh, do you remember they're on the side of the cliff and they're getting hunted by, um, what's his name, the sheriff. Oh, he's a relentless dude. And, uh, they kept— and he's at the side of a cliff and they're caught. There's no way out. And there's an enormous jump down to a really tiny gorge.
Yeah.
And, uh, and, you know, Butch is saying, come on, you gotta jump. And Sundance is saying, I'm not jumping, I'm not jumping.
Why?
He goes, I can't swim. And Butch spends about 20 seconds laughing at him. He goes, are you crazy? He goes, the fall will kill you.
Yes.
And it's his idea to make him jump.
And they, and they both hold the belt.
Yeah, that's right.
As they go over, remember, there's the belt between them and And, uh, and, um, Brendan and I have just been to the island with Anna Heim-Björkman, just off Helsinki. And we thought of you because we went swimming. But when Conor and I went swimming, we, on the very first morning, we'd never— we haven't even put a toe in the water, and we just thought, right, we're gonna do it. So we reenacted Butch Cassidy and the Sundance Kids. So we held hands in a macho kind of way, obviously, and we just We just jumped into the water, not knowing whether it was going to be bollock freezing or whether it was going to be bollocking warm. It wasn't that deep. No, no, no.
It was perfect.
It was deep.
Yeah.
How was the island, guys? Did you have fun?
It was great. The good thing is I went out on the first morning and I found the sunny side of the island. And I thought, this is absolutely great. And I just sort of like, I Slowly went in. I said, my God, compared to what you guys had talked about, this was absolutely balmy warm. It was like somebody had peed in the water.
It was that warm.
It was Nick around the other side of the island. So literally I came out, dried off on the rock, you know, had my thing, walked back over, and Nick was coming out of the water. He was on the other side of the island. Yeah, you can't get in the warm water.
So you picked yourself a nice sheltered little bay where the water doesn't turn over. That's what you want.
So he was freezing. I was really warm. And look, guys, I've also got to apologize for the massive error on film. Yeah, we started talking about films. I was almost embarrassed by the Gene Hackman versus Gene Wilder sort of faux pas in your film review last week.
Who made that mistake?
Me?
Yeah.
Gene Hackman. Okay, let me think. Gene Hackman.
Gene Hackman.
Gene Wilder.
Gene Hackman's in Charlie and the Chocolate Factory.
Gene Wilder is Charlie and the Chocolate Factory.
Yeah. Gene Hackman was in a 1970s cop. He's like, oh, he's in everything, but his French Connection was one of his best movies.
Anyway, sorry guys, we really do apologize.
I highly recommend checking out the French Connection and the French Connection 2. Oh, so good. True.
Amazing car chase.
Yeah, that's right. Yeah, it's awesome. That's Gene Hackman. Do you know? There you go. No, I can't remember.
I'm thinking Bullet with, uh, with Steve McQueen.
That's a handsome man.
Have you ever seen that?
Oh man, yes, I have. Absolutely love Steve McQueen. Um, yeah, it's cool. He died in a car crash actually, didn't he? He loved fast cars.
No, uh, no, didn't he die of, um, he died of mesothelioma because as a kid he blew out brake pads and they had asbestos because they used to use asbestos.
Yeah.
As brake liners, yeah, to slow the cars because it was a perfect material apart from the fact it killed people. And so he used to blow these things out and so for a summer he was breathing in asbestos and that's what killed him. He died at what, 40?
Steve McQueen?
Okay, you're thinking of Mark Bolan.
I'm going to call this to order. We have got so much to cover.
Are we going to talk about kidneys?
We are, by the way.
Loads of people saying I'm so pleased to be here to learn about kidney disease, not about blowing out asbestos brakes.
Don't blow out asbestos brakes from your brake pads, guys. And that is a very important health lesson, actually. Um, we are the Raw Pet Medics, and, and this here is Dr. Conor Brady, and this here is my good friend, uh, Dr. Brendan Clark. And we do this every week at 7 PM, and we are on Patreon. And we're going to do another 10 minutes after this at 7:45 if I can rein the boys in. Uh, I'm going to do 10 minutes because we love our Patreon people and we like to give them a little extra on the side. And we are also on, uh, all sorts of podcasts. Every podcast you can think of, we are there. We can come with you when you walk the dogs or paint the walls or cut the grass. Um, we can be there with you, and that's rather a comforting way to think about things, I'm sure. Yeah, absolutely. Take us when you walk the dogs, please. Yeah, and then we will whisper softly in your ears.
Dulcet tones in your ears. Indeed, indeed.
So boys, kidney disease, what do you reckon?
Bummer. What you got?
It's a bit of a downer, isn't it? You get that horrible diagnosis and they just say, yeah, it's downhill from here. Well, let's just stop right there. Hold your horses. Don't panic is the first thing, because I think we've got to start talking about first things first. Too many people go based on this, okay? And, you know, we've talked about blood tests in the past, and I think, you know, yes, blood tests are really important when it comes to the actual diagnosis, but if there's one thing I'll say to you all please make sure it's a starved sample. That's no food for 12 hours before you get the sample taken. If they've taken it and they've come back to you and they said, oh my God, they're all up through the roof, we've got a problem here, just take the time, say, okay, I fed my dog, sorry, maybe I need to starve my dog before we take the next test. Okay. That's really important. So that's rule number 1.
Every single time you do it, so it's consistent.
Yeah, the same time in the morning, maybe it's like 10:00 to 4:00 in the afternoon. Would that make much of a difference if you're repeating the tests?
Yeah, so absolutely. Standardization was morning sample. Okay, so when we do this normal distribution curve, we've talked about this if you look back at our blood test one, but let's do it briefly. Normal distribution curves like a bell-shaped curve. But it's based on some main factors that you've got to think about. Starved sample taken in the morning, okay, for that particular species, and it will generally be for kibble-fed dogs, okay, because that's when it was all founded and they looked at all of those standardizations. So just be careful. There are breed differences, there are feeding differences over time. Gene Dodds did a great little study on looking at the urea and creatinine levels in raw-fed dogs, made some slightly off-the-cuff issues around that that might be worse.
Do you want to go into that just now, Brendon? Because most people watching this are going to be feeding raw and they'll be going, oh, my vet keeps on saying my dog's got kidney failure, but in fact they've got an increase in urea.
When I've collated the raw samples after all of that, looking back, I've gone, okay, so if I've got raw-fed dogs, even if they're starved, Yes, they do seem to have a level of up to a third higher, so 50% higher, okay, okay, from the total levels. It seems to be acceptable without there being any evidence of disease, chronic deterioration, other markers that you would expect like the calcium phosphorus to be out, or looking at the SDMA we'll talk about in a moment because Conor's got a A little bee in his bonnet about that one. So any of the other markers that we'd look at, what's going on with the red cells, you know, are we getting anaemias, what's going on as far as electrolyte balance, what's going on as urine protein creatinine ratio. We'll talk about urine in a second as well. All of those stay normal, but we can have up to a third high. So instead of it being 10 as the upper marker, we can see up to 15 and still be seemingly okay ongoing for urea. So that's blood urea nitrogen. So when you're taking the waste nitrogen, okay, and it's bound up in ammonia, which is then bound together to create urea, okay, that floats around in the blood to be excreted by the kidneys. Now, when they're raw fed, my experience has been it can be up to that level.
And then blood urea nitrogen, sometimes called urea on the blood test, can be higher, So that's about it. And the creatinine can be a wee bit higher as well because the kidneys are working a wee bit harder, but they're happy. Okay, so what we're saying is the normal raw-fed dog can have slightly elevated renal figures, creatinine, BUN, relative to the poor dogs feeding kibble. It's as simple as that. Okay, so if you are feeding a raw a raw diet and your dog is otherwise well, then I think having a little chat with, with a raw feeding vet is a good idea, or even just question with your, with your vet to say, my dog's on raw, I've heard something about they may have slightly higher figures and be perfectly healthy. So that's, I think that's really important.
I think we should share the GeneDODS. I'm going to find it now and I'll share it on the Facebook page so people have it, because I think most conventional vets won't be ready for this conversation. They won't have heard this before. They'll see the 30% increase in creatinine and bone, and they'll go, hmm, it looks like your dog is approaching early-stage kidney disease. So that's tricky because all raw feeders need to be prepared for the kind of bit where you say, hang on there a second, their dog's fed ultra-low protein dry food, which is hard to absorb. These are dogs fed lots of protein, so they have a bit more protein in their blood, which is a simplistic way of saying it. So do they have to go in with this little sheet, or because most vets aren't aware of this, you know. I'll share it now to the page.
First things first, most vets don't seem to make sure that owners are aware of starving their dogs. So, you know, I sort of accept that to some degree as an owner. If you go back in and just say, look, there's some things I want to double-check here before we go headlong into changing diets and doing all of the supplements and everything else, let's make sure that my dog truly has this kidney problem. So look, There are other markers out there that can be looked at, but really we want to talk also about urine testing. So when you start to stage these levels of renal disease, we also want to look at, well, what could be the cause? Because in dogs there are a few things that can cause acute renal crisis. So most people will go, oh my God, this is it, that's the end, it's on downward spiral because they've got kidney disease, because they think of chronic kidney disease, CKD, and they're thinking that they're already in those end stages. Well, actually, there are lots of stages before that, and one of the most critical bits is whether they've picked up a kidney infection and that's impairing the issue, or whether they've got, you know, therefore dental disease that needs to be addressed. And then all of a sudden the vets are saying, well, we're not going to operate, your dog's got kidney disease, we're not going to deal anything with the teeth. But actually, once you deal with the teeth and get rid of the infection, the kidneys suddenly make a miraculous recovery. So that's, you know, cutting down inflammation. So think about that. And the other things are around blood pressure. So check, you know, what's going on with their other diseases that could cause high blood pressure, etc. And that leads us onto a load of hormonal problems. Let's not mistake things like problems with Cushing's disease, that's an excess of body steroid alongside then even getting into some of the other immune-mediated diseases like thyroid problems with the liver, et cetera. Okay, so look, it gets complex. Let's simplify again.
Let's simplify it. Caroline Crosby very, very wisely says, What are the symptoms? Okay, so I'm going to jump in the shallow end before we swim out to the deep end. And symptoms of chronic kidney disease is various things, but I would say mainly it's like, hmm, dog not quite right and increased thirst. Now, if dog is drinking outside and you don't notice they're drinking more, what you may notice is they're peeing more because if you drink more, you're going to pee more. Okay, so those would be two of the big ones. You may find you've got somebody who you can't really see, they're just going off their food a little bit. So a general profile to look at liver and kidney health, and they haven't got anemia or infection or anything like that, is very, very useful. But as you say, Caroline, increased drinking, increased peeing would be the number one. Increased peeing could be that they've got cystitis and what have you. So if you take a sample to the vet for analysis, that's a very, very good idea. So there you go. That's where we start with this stuff, and then we move on to a urine test and then maybe a blood test, and then we go further from there.
I think there's lots of low-hanging fruit. I think that like a single blood test is like a moment in time in these dogs' lives, and anything could have happened in the 24-48 hours, you know, before that blood test was taken. So like, what of the dog that ate something funny, took a worming tablet, didn't have a drink of water in the, in the 12 hours before the test. I mean, you know, a lot of things can throw that test out. I'm assuming that a second test— one test is a good marker to see if there's any smoke alarms, and a second test to verify. What can throw the kidney readings out that is relatively benign?
Dehydration.
Yeah, dehydration. High blood pressure, you know, consuming something that's taken up their blood pressure and it's impaired their kidney function. So, you know, if they've managed to snaffle somebody's medication, you know, something along those lines, just be aware of all of those things that could happen. But I think to be fair, the point is that you— the blood markers are a warning, but then you should be looking at the rest of the biochemistry, as I alluded to, with the calcium phosphorus. Ratio, looking at, you know, is that 2:1? Is there what's going on with the electrolyte balance? You know, what's happening with the sodium potassium levels? You know, all of this comes into understanding what's happening. It's, you know, you can even look at bicarbonate levels and look at is there an acidosis or alkalosis that will give you indicators if the kidneys are functioning or not. But then, so a simpler option is to say, well, okay, if this truly is kidney disease, what's going on with the urine? And we alluded to there is a test for looking at the protein within the urine. It's more specifically, the papers show that actually that should be microalbumin tested, which is looking at specific protein. But most of the strips, and I, I've already seen that Caroline has some strips at home like this, okay, with little colors on.
Yeah.
And they are strictly timed. Okay. So there is a timing in seconds below each of the markers. So in seconds as to when you should read it and you literally don't ask your dog to pee on the stick. Okay. Literally, please, because they won't collect it, collect it in a ladle or something like that.
And then you have a dog and squeeze them.
Don't do this at home.
Don't do that.
Are they human test strips? Bren?
So this is the really interesting bit. So there are human ones, okay? And I grabbed this out of the drawer just to show people.
These are human ones you've got in your hand?
Yeah. All right. So these can be bought off Amazon. This is what somebody politely returned to me, okay?
£8 last time I looked.
There are veterinary ones, okay, that say that they are specific for veterinary. And then obviously they'll go— so don't accidentally buy the ones which are for vet machines. Which you can get on Amazon, but all of a sudden you need the machine to read them because there's absolutely no—
which will cost you 50 grand.
Yeah, well, not quite 50 grand, but, you know, a couple of thousand.
Okay, okay, okay.
So look, so look at the urine. If there's urine, uh, shows that there's blood, that there's protein through the roof, that it's really, you know, uh, quite strong concentrated urine, it's far less likely that's a renal disease and far more likely that all of the symptoms you've been seeing are down to a kidney infection. Okay, and you've got consequences of the kidneys not functioning correctly because you've got a urinary tract infection going on. So be aware of that. And then there's loads of other different tests that need looking at. So in dogs, I would say one of the key things that causes renal impairment is kidney or urinary tract infection first and foremost.
If you— so my take on that would be if you do a urine strip, yeah, and you repeat it a couple of times just to make sure that you got it right, and there's anything that you don't like the look of, I think get along to the vet.
Yeah, that's the idea of them. It's a smoke alarm. It's like, hmm, this doesn't look good. High glucose. Well, that must be a very telling one. I mean, that's a—
yeah, for sure. So another really good thing to have Okay, this is for whether you've got crystals in your dog's urine or cat's urine, or you've got, you know, risk of infections going on, or you've got kidney disease, is to buy one of these. You can buy these online as well now. So refractometers used to look at the concentration of solutions, so you can look at alcohol levels in your brewing stuff, but all the way through to testing your pet's urine. So this will look at how concentrated the urine is.
Hey, Brent, how much?
So these are currently anywhere between, depends on who produces them, anywhere between £15 and £30.
Okay, on Amazon or something.
On Amazon, okay, okay, so readily available, not that expensive, easy to get hold of.
Okay, easy to use. Do you want to give us a little rundown?
Yeah, and in fact, I think Conor, you might even have a link to people to be able to get hold of one of these alongside strips.
I don't, I have the strips actually on mine. I've got 14 tests on mine. We'll talk about that in a second, So don't buy them from Amazon, buy them from Dogs First. But I don't have this actual device, so I'm interested in this.
Okay, so this is literally what you do is you take a drop of the urine, so you can just spot it onto this little sheet here. You click this down and literally you look through this end. Okay, and there's a— I don't think the camera will pick it up. Oh yes, it does.
Does it?
Does it?
Does it?
Oh.
Can you see a little blue line?
It's like a picture of somebody on holidays.
Yeah, anyway, so the point is there is a blue-white line drawn across and you can read off the concentration of that urine. And anything above 1.018, we're not really going to be too worried. They can concentrate their urine, there shouldn't be an issue with that. And certainly most dogs will be certainly about probably around about the 1.030 mark if they're concentrating their urine really well. So anything like that, we're not worried that they're suddenly losing loads of water through their kidneys without control. When you get down below 1.010, so a bit of a gap, there's a grey area, okay, then obviously then we're looking, can they actually concentrate their urine? A couple of things. If they're drinking loads, okay, because of flavour of the food or something like that that's driven them on to want to drink more and they get dilute urine and they're drinking excessive amounts, maybe on a hot day, something like that, then of course their urine concentration can go down. It's just like you going out for a few too many pints, Conor, you know, might drive you into a bit of diuresis. So do be aware there are other things. So look at it as a whole picture, a whole landscape. Don't just see the one point of this is urine concentration, the other point of that there's a little bit of protein in the urine. Okay, look at it as the whole picture alongside that blood test.
Yeah, it's taking a little control, isn't it? It's like, you know, nobody's saying this is going to replace having a chat with your vet. Obviously you're seeing these symptoms and you get any— but what it is is a handy early warning sign because, you know, the idea of waiting for a blood test to let you know you've got early-stage kidney disease, as you know, we'll talk about STMA in a while, but like 50% of your kidney function needs to be gone for bun and creatinine to start rising in your blood, they say. So you're well along the ladder. And so I'm sure there's plenty of little small warning signs that we can look out for. And, you know, perhaps those strips give you an early warning. So I like taking that bit of control. I'd like, certainly for glucose, you know, that would be an easy one. And there's an interesting thing on the GeneDotties Gene Dodd's piece, packed cell volume was 10% higher in raw-fed dogs as well. So more red blood cells in the blood. Is that just an effect of eating lots of heme iron and you're just like making the good stuff? And but that would not give you a higher specific gravity reading as a result.
We've also got to look at another number of other factors because I don't think in that paper there was a note made of hydration level. So, you know, that's really important because actually all of those figures, even though it's more than one dog, you know, as soon as you start to get into that, what were the circumstances for those dogs for the average to be that high? Was this a test that was taken in the summertime and they drew blood on all of those? Were those dogs restricted from not just food but also water prior to those tests? For 12 hours, because you have to look at if any of those parameters are high across the board. So when you look at the albumin level within the blood, if that's also high, that's unusual for a renal patient. It's more significant that you've got a dehydration, and then you've got to factor all of the other chemicals in the blood that may be high because of dehydration. Including the cell counts.
Okay, so talk to your vet. If in doubt, talk to your vet. Yeah, don't try this at home, guys.
Yeah, absolutely.
Yeah, for sure. Great.
What's the microalbumin? What's wrong with the total protein bit and the microalbumin? Can you talk to me about that? What's the difference in those two protein readings?
Okay, so protein is found in all of your cells Okay, but actually also all bacteria as well. So if you've got blood into the urine, if you've got cell debris because you've got cystitis going on, even if you've got a free catch sample and that dog has passed urine through past the prostate and down the urethra for a male dog, or actually through the urethra and bypassing the vagina, and there's mucus production going on in that vagina then all of that can add to overall protein levels alongside bacteria. So a total protein by free catch sample can be misleading, and this is where your vet may end up passing a catheter to get a catheterised sample, or even using a fine needle to aspirate the bladder to get a urine sample direct from the bladder.
Okay.
So the differential then is actually if you can find microalbumin, so looking at just the albumin on its own and no other types of protein, that differentiates that that's coming from the glomeruli, the filtration beds in the kidneys, down to the urine that's in the bladder rather than it coming from other sources.
Cool, I like that. What about microalbumin? So why is that more effective?
So it generally looks at this if you've got a protein-losing nephropathy. So the microalbumin is really just albumin, okay, is looking at just that protein loss through the albumin levels.
Okay, cool.
Now, Conor, you were looking at SDMA, which is a test that came out maybe 4 years ago.
Yeah, I haven't had a deep dive on this, so I'm looking to speak anything except off the notes of what this lady posted. I put it up on the Facebook page there. I'll also put up Gene Dodds as well, the last two posts. So that's up on the Facebook page. But this vet is on— it's on VetSpace, and they were just highlighting a couple of issues with this test, this SDMA test. It's a new addition to the whole blood parameters, and what I never realized was that some of these tests are patented. So that was interesting, that was new to me. I kind of just thought all labs could perform whatever test if they had the bits and pieces and the doodads and the doohickeys, which is, uh, but, uh, technical. Yeah, but, um, but it turns out no. If you are doing an SDMA test, which is always on the blood readings now, uh, that is a test that is owned by IDEXX, um, a big, big US company that do a lot of veterinary stuff. IDEXX Labs, isn't it? Laboratories. I mean, they do, they do, um They do lots of stuff. They do the software, they do all sorts of things.
Yeah, hardware within the practices. They also do a lot of tests. So the majority of stuff was based around originally their external laboratory testing areas across America, across the UK, across Europe now. So pretty much—
I want to see how much they're earning. I'm going to check that later. So this vet had some good points to make and they just said, you know, what's the story with the SDMA test? Like, what's the science behind it? And as soon as somebody asks that question, you always feel a bit silly because you're gonna go, I should have asked that ages ago. You know, not that I listen, I don't know anything about SDMA tests. I'm just looking at assuming it's useful. And as soon as somebody asks that, you kind of know that they've already had a look and they haven't found much. And in this case, they say that the whole point of the SDMA test is early detection because you need to have lost quite a chunk of your kidney function before the bloods will start to pick it up on creatinine. So you need to— there needs to be a big traffic jam there before, before the bloods will show it. And so they want something a little bit earlier to detect it. Would be handy because, you know, you want to avoid it as early as possible. Early detection of cancer is better than, you know, shit, that's a little bit on. So that was their main selling point. But this key line here, but no independent research has ever confirmed it. I was like, ooh. So that was a telling claim. They claim that this is about a year. They claim that they can detect kidney disease in your dog about a year before standard tests, bone and creatinine and urine microalbumin. So they reckon they can do it a year before those, but there is no test in no study in support of that. They quote a great many studies that they alone are now in partnership with Hill's Pet Food, a provider of kidney diets. Funded to back up their claims. IDEX marketing department knew that they needed to convince veterinarians to use the SDMA test. One of their veterinary reviews mentions 41 scientific articles, but none of them were very illuminating because none were structured in a scientific laboratory. And then they say they've got 2 studies, okay, supporting them. Only one was looking at SDMA's value. It said the only independent 2020 article that examined SDMA as a valuable way of measuring bloods was in the cheetah, not even a cat. And cheetahs are apparently more likely to develop kidney disease than your standard cats, domestic cats, which is surprising. But in that 2020 independent study, BUN and creatinine levels were found to be more accurate, the standard stuff we're talking about here in bloods, than actually using SDMA. So the only study that they were using to say how great SDMA tests are actually verified the fact that actually bone and creatinine are more useful. The only other test that's available for SDMA that I can find so far, it pairs it up with something else. And so, you know, that it rises, you know, that this measure can be used is okay, that's interesting, but is it more effective than what we're using at the moment? There's a kind of a thing in pharmacology when you're bringing out a drug, it has to be— I can't remember the term, I nearly had it— It needs to be as equally effective as the drugs that are on the market. So it can't be worse than that. It must be equally effective, and then you can market the hell out of it. So, um, the test needs to be at least as good as— let's say you would hope with tests it would be as good as bone and creatinine, because we already have that. And so otherwise you wouldn't need this patented test. So every time you do a blood panel, that SDMA test is there. That's a patented test. You've paid for it. But is it actually any more useful than bone and creatinine? This vet is saying well, there's no evidence to say it is. So that's interesting. I just thought, ooh, I didn't even know you could patent tests. So it just goes to show, when you look at this blood panel, you just pay for everything. It's part of this whole kit that the vet sends off the blood and you pay for it and it comes back. But I don't think you can actually say, I won't have the SDMA tanks. It's kind of like saying picking and choosing your vaccines, it's not easy to do, you know. So, um, that's really interesting there, Conor.
We've got Mary Burke here who's in the States by the look of things who says, I'm a long-term med tech, a medical technician, and she says she puts no stock in the SDMA. It's not kidney specific, says she.
That article, the article does go into that actually and says ADMA and SDMA and the confusion between the two and it not being so. Mary knows what she's talking about. There you go, Mary for president.
So I'm just going to put, this is just the wonderful thing about science, and that is So just to point out, so the one on the left is looking at creatinine level, I believe, and the one in the middle— so the left one is normal, the right one is in kidney disease, CKD, in dogs. This is specifically in dogs, and this is a 2020 study, so, you know, this is one that's maybe not been spotted. So this is in the Veterinary Journal of Science, I think it was something like that. And so the middle one is SDMA. So the one on the left, the black line, is normal. The one on the right is in CKD. You can see that there's a slightly higher— so that block is higher than the normal. The one on the very right, they were comparing another one, which is cysteine C compound, which is again another marker that is not currently used in looking, but again, differentiated CKD from normal patients. A little bit less able to see the rise in the block that's there above normal. So that's why they possibly used SDMA. So it's interesting when you start to search all of these studies, you listen to what's put out there on social media, and that there's only limited studies, and some of them aren't specific, etc. There is always more science out there to be looking at. And it's really hard to gather every little jot.
With those, those, those bars that we're looking at there, let's see the little line at the top, and it looks like a T sticking off the bar chart. Yes, standard, standard errors, standard error bars. So they're very wide. So if you were to compare across those three, you would say there's a hell of a lot of overlap there because the standard error bars are so wide.
And so if you look at the normals, if you look at the normal standard error bars, they're not that wide at all.
Yeah, the normals are okay.
If you look at the diseased ones, yes, you could come down into normal with an SDMA, but generally they do go up quite high. Yeah, for those.
Yeah, be interested to see when was this article written, just to see if the—
yeah, that was 2020, June 2020.
Yeah, this lady wrote this in 2023, so I'm going to find— look, this is an enormous article, so I just picked off the top half of it and I'll read down to it. That's interesting. Yeah, but you would—
Do you know how many dogs were in that study, Bren? Did it say? And were they randomized to the healthy and the CKD side of things? I'm really suspicious of trials.
Me too. Yeah, I'm going to pull this apart.
Well, this is just looking at patients that are sick and patients that aren't. Okay, I'm guessing in 49 dogs in the study.
Yeah, but how they parcel them out then is— yeah, look, it's interesting. I think like, you know, I do hope that there's more studies on it. And I do hope this is something to it. But even if there's just like one trial or two, I'm kind of thinking, oh, that's not a whole lot really. Like, I want, I want a lot.
It's like, where do I hope that Idexx did a hell of a lot more than that?
Yeah. The thing is, they've got access to the laboratories. On all the bloods of all the dogs in the world. And if I was bringing out a patented drug and I was Idexx, I would use 10,000 dogs in my test and go check it out. This is what it says. You don't need to limit yourself to small RCTs, randomized controlled trials, which this isn't. You wouldn't, you wouldn't like, you would just, you would have such access like dry pet food companies. Mars owns, you know, 50,000 veterinary health professionals. They can just churn out a study on dry-fed dogs. Look how healthy they are when we feed them this product. It's no problem. They own Antech, they own all the laboratories. So I think when a company like Idexx is bringing out something, the onus is on them to produce just an enormous, you know, plethora of data that you go, "Phew, that's convincing, hard to argue with that." But then when you come out and you go, "Well, we tested 7 dogs," what they could have done is tested 7 dogs 20 times and then they produced the most valuable study and they published that one, you know. So it's— I want more. I want it to be so solid that you look at the study and go, "Oh, that's so cool, you know, especially if it's a huge company. Like, if RPM come out with a study, forgive us if we only use 10 dogs because every dog's costing you 10 grand to house for 3 months. So, like, you know, it's different. The onus is more when you're a big, huge multinational making billions, you know. So who knows, who knows, a bit of smoke there, but hopefully it's useful.
It's very interesting. Vicky has come on. Vicky is an epidemiologist who actually I think we should come we should get to come on. We should absolutely get her on. Vicki, please come on and talk about, um, anything.
Point, external, maximus.
What looks like a good study. Yeah, give us some examples of good studies and, and maybe some, some bad studies, because my confidence in many studies is, is sorely shaken. So Vicki Adams, if you would like to come on and talk to us about the quality of studies in veterinary medicine, that'd be a really, really good show, methinks.
Vicky just corrected me there. She says they're not actually standard error box on a box and whisker plot. I don't know what a box and whisker plot is. I'm just nodding politely and hoping this passes.
I think they are. Yeah. So she's talking about the points are potential outliers.
Yeah.
Okay.
Yeah. Cool. Vicky's actually running the study. We're doing a study at the moment. I say we, Vicky's doing it. But I definitely helped raise the money for it and we're looking at kind of retrospectively looking back in a veterinary clinic and we're looking back to see why these vets, it's not a secret, and we're looking back to see what is the implication of feeding dry and raw to dogs over a year or two, you know, on many ways you can look at that so it's very interesting so Vicki is doing that, she'd be great to come on for talking about dirty science. I like her saying, we were sitting around the table the other night and she said She, this is a classic example of what the abstract doth bestow, the methods and results doth take away. In other words, abstracts can really say, look what we found, it's this amazing thing, it's a lion. And then you look at the methods and results, it's like meow, little kitten. It's like, no, that's bullshit, isn't it? It's not very, it doesn't say that at all. You didn't find, but they can make the abstract sound amazing because often most people just read the abstract. I'm as guilty as everybody else. You kind of fall for it. But when you tease through the methods and results, only certain people can do that. People like Vicky, they love that, that wags her tail. Gotta bring Vicky on, she'd be very good for that. Yeah.
Okay, so we've talked briefly about symptoms, we've talked about thirst, we've talked— oh, did we mention about quantities that dogs— because with raw-fed dogs, we often see dogs go down in their thirst because they're just on a moist food. And actually, it was really interesting for somebody who came into me the other day saying, my dog's really, really thirsty. And I said, well, what do you mean? You know, well, she drinks from the bowl a lot. And I said, okay, so are we talking that she visits the bowl a lot? You know, does— how much do you think she drinks? Oh, she drinks probably about a pint a day. And I said, okay, well, that's not a lot for a 25-kilo dog, um, in the grand scheme of things, you know. But she's raw fed. I said, even if we took 60% of the diet as water and added a pint, so 500ml roughly, just for those people that are in Europe and wondering what a pint is, and you add those together, that's still not, if we're looking 150ml per kilo per day, that becomes a polydipsia polyuria case. And literally standard amounts of good sort of hydration should relate to about 50ml per kilo per day intake. So if you're wondering, is my dog drinking a lot? One, what's the concentration of urine? If it's concentrating really well, it's probably not drinking too much. And if you work out the number of mils that it's drinking per kilo and it's less than that 150ml, it probably isn't diseased to that degree of, you know, renal failure or liver issues or Cushing's or anything on those lines or diabetes. So do have a little look at what the total quantity is. And remember, again, if you weigh the overall amount of food you're giving, roughly allocate 60% of that to water. It's only rough because because there's different meats and things like that will have different proportions, especially if there's lots of bone material in there. But roughly 60% of that to water, you can gauge an overall daily intake of moisture.
And I would say to say also look at change. If you've got a dog who's always not drunk very much and they've always been on raw or they've always been on dry, but they're not a big drinker, and then suddenly they change in their drinking habits, that is very significant. Yeah, so if you get a big drinker who stops drinking, or you get a small drinker who starts drinking for no good reason, then you need to look at that, methinks. Yeah, it's that change thing. Yeah, because it's like some humans drink 20 cups of tea a day. Some, I used to work with a nurse, she would drink one cup of tea all day. That was it.
Yeah.
Yeah. And so everybody has a different kind of metabolic—
we have— we're nearly there at 19:45 here. Okay. So we've got more things that we have to cover and we'll move one of them to Patreon, but we've got diet and we've got supplements like— so we've done our talk on kidney disease before. But if I was to tell you what I would do as a non-vet, if I was to panic, if I saw bloods that were high in protein, for example, that's always a typical one. BUN and creatinine are creeping up and it's like, what do I do? I said, okay, Don't panic.
You know, I would come on Hill Science Diet.
Yeah. You know, there's a bit here where we have to say, you know, you know, don't panic and let's look back over the last 2 or 3 weeks. Is there any low-hanging fruit here? You know, perhaps there's a few bits and pieces might have gone wrong in the last while. But so picking up, how are the teeth? There's a huge connection between rotten teeth and kidney disease. So you can have a fracture or an infection in the gum line. Puts a huge amount of immunodebris on the road, lots of cars on the road, and it clogs up your kidneys. So if your kidneys aren't working well and you've got dirty teeth, that's an accident waiting to happen. So you need to keep the teeth clean. And so that alone can actually help with your situation. So there's a lot of low-hanging fruit that you can think about that you do kind of dose them up with a few bits and pieces and, you know, whatever. So, but in between now, this bad test and the next test, let's say in 2 or 3 weeks, And there's some basic things that you can do. And regarding diet, there is never, in my opinion, kind of zero evidence to say that a dry diet would be effective at this stage. I mean, a dry diet for kidney disease, a diet without water for kidney disease, it is absolutely ridiculous when studies show cats with kidney disease do better with hydrated diets. I mean, as if we needed that study, but it exists. And so dry kidney disease diets for cats should be taken off the shelf immediately because there isn't a study saying dry is actually better than on a wet diet, you know, so why aren't they off anyway? So my advice would be if the protein was climbing up a little bit, I would actually reduce the protein in the food a little bit purely because I want to get a good second reading. So I'm going to get your opinion on this, lads. What I would say is, and if the readings aren't too high, I'm not going mad here, but I'm going to say, you know, instead of raw dog food, which is 80/10/10, all meat, you know, meat and protein and fat, Instead of it being 100% of the diet, I'm going to drop it down to about 75% of the diet, two-thirds of the diet, and I'm going to pop in a little bit of plant filler. Okay, how do you guys feel about that? Popping in a little bit slow to digest carbs, a bit of greens because it's got that B complex, which we know the kidneys are in need. We'll talk about the supplements later. So what about that? Just to have a nice simple, plain hydrated diet to get the dog to a second kidney because I want to see that the readings aren't still going up, which would be more worrying. I want to see them plateau or decrease. Gives the person a bit of confidence, and then we can start building on that and upping the protein again. Where are you on the diet?
Let's do it in Patreon.
Oh, oh no, no, no, no, we've got to do supplements. We've only had 10 minutes of supplements.
1947.
Supplements to do on Patreon, you can't do it to them. There's going to be—
well, look, I would say for dogs specifically, inflammation is my main enemy. Okay. And any diet that's inflammatory will probably impair the kidneys even more. So I would always say there's lots of work being done that I do not want to starve my patient in the long term. So short term, I understand where you're coming from, but long term, I definitely would not be super low protein diet because I think that just ends up with a cachexic— that means wasting away— patient which is starving to death. That's not where we should be. And I think reducing the inflammation, and we can do that with the various fats, etc., giving them quality protein is actually what the studies show, so they can actually utilize those without breaking off the ammonia end of the protein and then creating more waste. So anything that creates a horrible protein that they can't really assimilate and that they can only use in excess for energy that energy release for protein metabolism is by cutting off the ammonia group. That is increasing the waste that leads to your high BUN.
Well, that's what you get from kibble because it's not good quality protein and it's been ultra processed.
Yeah, but in a raw-fed dog, guys, I should have probably—
in a raw-fed dog, I tend not to. However, if you drop the protein and increase the veggies, you're doing actually two things. So if you get an improvement, you don't know whether that's a kind of prebiotic effect because of the veggies or whether it's a beneficial effect because you've dropped the protein and fat. Okay, so because you're doing the classic two things, it's very difficult in nutrition to change one thing. So I would say I generally don't with stage 1 and stage 2. I might go a wee bit with stage 3, and I would with stage 4, which is where the staging is very useful. But because the staging is sponsored by the companies that produce Forticor and all these drugs for renal disease, I'm very wary of the whole staging.
If you see bone and creatinine climbing in a raw-fed dog, like, what— where does your mind go to that you go, hmm, okay, what's going on here?
Yeah, definitely.
Yeah, what's going on with the inflammation? What's going on with infection?
Yeah.
Is there other causes?
How many cars can you take off the road, really? So I always think about it as like a big 6-lane motorway. So if the kidneys are— if the traffic is piling up, it's like there's so much low-hanging fruit that you can definitely— I agree with that. I kind of thought to help further, I thought I just take an edge off and take some of the protein off as well. But now I suppose you're looking— you're doing 2 or 3 different things at the same time then. So you're kind of hoping that if my steps of reducing inflammation and tweaking all that kind of stuff let's hope that actually fixes it and then your dog can stay on a full natural biologically appropriate diet.
But there are, there are a thousand things that you can do for dogs with kidney disease. I mean, we're talking omega-3 is massively important, B complex is massively important, vitamin E is massive, coenzyme Q10 and vitamin C. Yeah.
Oh, come on now, now, Nick, quick, I'm going to call a halt because we should be doing the supplements over on Patreon. If you want to know about supplements, phosphate binding, all of the rest, let's do that over on Patreon. It's been great to catch loads of you guys that have been interested in this subject. I hope you've enjoyed tonight. If so, please do like and follow us, okay? Just increase those numbers, and do join us over on Patreon.
And yeah, do like us on, on YouTube. Very important. Yeah, smash that like button and follow us on YouTube, please, guys. Really important.
Absolutely. Thanks, guys.
And Ethan, uh, we record it so you haven't missed it.
Yeah, always recorded. You should be able to find us. And new projects coming, we're going to talk about that soon. Okay, so because they'll force Conor to actually make a change in what's happening with our Patreon and Oh yes, the two worst weeks.
It's like, oh please, tonight we'll get him, we'll get him, guys.
Eventually he will be on side, he'll get this project done.
Anyway, okay, I'll do it next one. No, no, guys, we have a spare ticket for Ruby's gig. Oh no, do we have a spare ticket in San Diego? And it's the wrong end of things because, you know, on is, is You know, you shouldn't have to start.
Okay. So this is, it's the Feed Real Summit and it's the first weekend in, I can't see my diary, first weekend in October in San Diego.
I'll post a challenge to Facebook, guys. I'm going to post a challenge to Facebook.
I think the challenge has been the only people that are going to hear this are the people that have stuck with us.
Yes.
We've got the 100 people that have still hung on to your every word.
We'll stick it, we'll pop it up on Facebook and say, guys, we've got a free ticket, and there's gonna be a challenge coming out in whatever hour, and I'm gonna pop up some question. It's the first person to email us in the correct answer with that. That's what it's gonna be. We're just— I mean, I'm so sorry, Ruby, if you're listening. I'm sure you know this.
She's gonna kill you.
And you. It was— surely you all three are in trouble. Don't just leave me on my own. Don't throw me under the bus.
I didn't even know about a question.
We did. We tried to do it beforehand, but we made a mess of it, and nobody got to the bar. Give the thing away. So, uh, anyway, um, okay, well, come on, let's, let's bounce. Go to Patreon and I'll, I'll sort this out. I'll, I'll tidy up your mess, guys.
Okay, wonderful. Take care, everyone. Bye-bye.
See you guys.
