Hannah Zulueta What Your Vet Prescribed, and What It Asks of the Bowl
Benazepril, telmisartan, and calcitriol, explained in plain language for the person filling the prescription.
You came home from the vet with a new bottle and a name you can barely pronounce. Here is what each of these three drugs is doing inside your dog, and what each one changes about the food you cook.
Do my dog’s kidney medications change what I should cook?
Yes. Benazepril and telmisartan can raise potassium, so the recipe’s potassium has to be watched. Calcitriol raises how much calcium your dog absorbs, so every calcium source has to be counted. I don’t prescribe medication or change doses. That is your vet’s work. My work is making sure the food and the medicine pull in the same direction.
- On benazepril or telmisartan: no salt substitutes, and go easy on high-potassium extras.
- On calcitriol: phosphorus under control first, every calcium source counted, and no extra vitamin D.
- With any new drug: tell whoever formulates the recipe, and change one thing at a time.
What are these three drugs actually for?
Two of them protect the filters. One protects the bones and the balance of minerals in the blood.
Lowers the pressure inside the kidney’s filters so less protein leaks into the urine. Also lowers blood pressure a little.
Same goal as benazepril, reached through a different step in the same hormone chain. Often chosen when protein loss is heavier.
Replaces the vitamin D the kidney can no longer switch on. Keeps the parathyroid gland from pulling calcium out of bone.
None of them repairs a kidney. Each one slows a specific kind of damage, and each one has a food conversation attached to it.
Why does protein in the urine lead to a blood pressure drug?
Picture a coffee filter. Pour slowly and only coffee comes through. Pour hard and fast, and grounds start pushing through the paper.
Each kidney holds thousands of tiny filters called glomeruli. When some of them are lost to disease, the ones left behind carry the extra load. The pressure inside them climbs. Protein starts pushing through, the way the grounds did.
Your vet measures that leak with a test called the UPC, the urine protein-to-creatinine ratio. In a dog with kidney disease, a UPC above 0.5 counts as proteinuria under IRIS guidelines. Leaked protein also irritates the tubules downstream and speeds the disease along.
Benazepril and telmisartan work on a hormone called angiotensin II. Angiotensin II squeezes the small vessel that drains each filter, which holds the pressure inside high. Both drugs loosen that squeeze.
That small creatinine rise after starting one of these drugs is expected. Your vet decides how much of a rise is acceptable for your dog.
Benazepril or telmisartan: why would my vet pick one over the other?
Benazepril has the longer track record in dogs. It is the older of the two and usually the first one reached for.
Telmisartan blocks angiotensin II at the receptor, one step further down the chain. In a 2020 randomized trial in dogs with persistent kidney protein loss, telmisartan lowered the UPC more than enalapril, a close relative of benazepril (Lourenço et al., 2020).
Some dogs end up on both. That choice sits entirely with your vet, because using the two together raises the chance of the side effect below.
The side effect that reaches the kitchen: potassium.
Both drugs make the kidney hold on to potassium. In most dogs this stays small. In some it climbs high enough that the drug has to be lowered or stopped. What you feed can push that number up or help hold it steady.
Not every high potassium comes from the drugs. Addison’s disease can look like kidney disease on bloodwork, with high potassium and low sodium. If the medications don’t explain your dog’s potassium, ask your vet whether Addison’s has been ruled out.
What changes in the bowl on benazepril or telmisartan?
- Tell whoever formulates your dog’s food about the drug. Potassium targets in the recipe depend on it.
- Never use a salt substitute. Products sold as lite salt or no-salt seasoning are usually potassium chloride. On these drugs, that is the fastest way to push potassium too high.
- Know the high-potassium foods. Sweet potato, spinach, banana, tomato, and liver all carry a lot. They are fine in a measured recipe, and risky as generous extras.
- Boil and drain when potassium is creeping up. Potassium dissolves into cooking water. Boiling vegetables and pouring off the water pulls a real share of it out.
- Keep fish oil in the plan. In dogs with reduced kidney function, fish oil lowered protein loss and helped preserve filtration (Brown et al., 1998). It works alongside these drugs.
- Change one thing at a time. If a new drug and a new recipe start the same week, nobody can tell which one moved the next set of labs.
What happens when the medicine pushes potassium too high?
One senior dog I worked with had protein-losing kidney disease at IRIS stage 3. Her protein loss was heavy, and telmisartan was part of her treatment.
Her potassium climbed and stayed high. Her specialist stopped the telmisartan and added a potassium binder, a medicine that pulls potassium out through the gut.
That changed my job. I moderated the potassium in her recipe to 0.4 to 0.5% of dry matter. I did not push it to the floor. The binder was already pulling potassium down, and a recipe stripped of potassium on top of it risked swinging her too low.
What is calcitriol, and why is the dose so tiny?
Vitamin D arrives in the body switched off. The liver does the first step of turning it on. The kidney does the final step. Calcitriol is the switched-on form.
A failing kidney makes less calcitriol. The parathyroid gland, a small gland in the neck, notices and releases more parathyroid hormone (PTH). PTH pulls calcium out of bone to keep the blood level steady. Over months, this is called renal secondary hyperparathyroidism, and high PTH is linked to faster kidney decline (de Brito Galvão et al., 2013).
Calcitriol replaces what the kidney can’t make, and PTH settles. The doses are measured in nanograms per kilogram, which is why it usually comes from a compounding pharmacy. In a study presented by Polzin and colleagues (2005), dogs in stages 3 and 4 given calcitriol lived longer than dogs given a placebo.
Phosphorus comes first. Calcitriol raises how much calcium and phosphorus the gut absorbs. Vets start it once blood phosphorus is under control, so the low-phosphorus diet does its job before and during treatment.
Every calcium source counts. Eggshell calcium in the recipe, a calcium-based phosphorus binder, and any supplement all add up. Give your vet the full list.
No extra vitamin D. Cod liver oil is rich in vitamin D. It does not belong in the bowl of a dog on calcitriol unless your vet has approved it.
Know the signs of calcium running high. More thirst, more urination, vomiting, a drop in appetite, and unusual tiredness. Call your vet if you see them.
What other drugs might be on my dog’s list?
Kidney dogs often take several medications. Here is what the common ones do, with the food note for each.
Amlodipine
A calcium channel blocker that relaxes blood vessels and lowers blood pressure. Food note: keep sodium moderate and steady from day to day, so the drug isn’t fighting salty extras.
Phosphorus binders
They grab phosphorus in the gut before it is absorbed, so they only work when mixed into the meal. Food note: the lower the phosphorus in the recipe, the less work the binder has to do. More on phosphorus binders.
Maropitant or ondansetron
Anti-nausea drugs. Food note: a dog who eats better on these is telling you nausea was the reason for the empty bowl, which is useful to pass on to your vet.
Mirtazapine or capromorelin
Appetite stimulants. Food note: have the recipe ready and portioned before the dose takes effect, so the hunger lands on the right food.
Potassium citrate or sodium bicarbonate
Used when the blood turns too acidic, which shows up as a low bicarbonate or total CO2 on the chemistry panel. Food note: potassium citrate adds potassium, so it is a poor fit for a dog whose potassium already runs high on benazepril or telmisartan.
Where does TCM Dietetics sit beside these drugs?
In Traditional Chinese Medicine, the Kidney holds the body’s Yin, its cooling, moistening reserve. Think of the damp soil under a shade tree on a hot afternoon. When that reserve runs low, heat and pressure rise, much the way blood pressure and filter pressure rise in a failing kidney.
The drugs manage the pressure. The food can support the reserve. Cooling, moistening proteins such as pork, duck, and egg white nourish Yin, and all three can be fit inside a kidney dog’s phosphorus budget. Egg white is especially useful for a dog on benazepril or telmisartan: high-quality protein with very little potassium or phosphorus.
What else do owners ask about benazepril, telmisartan, and calcitriol?
Can I stop benazepril if my dog’s kidney values go up?
I strongly recommend that you talk to your primary care veterinarian so they can guide you through this. A small creatinine rise after starting benazepril is expected, because the drug lowers filter pressure. Your vet decides whether the rise is acceptable or the dose needs to change.
Does telmisartan cause high potassium in dogs?
It can. Telmisartan and benazepril both make the kidney hold on to potassium. Most dogs see a small change. Some climb high enough that the drug is lowered or stopped. Salt substitutes and generous high-potassium extras make that climb more likely.
Can my dog take calcitriol and a calcium-based phosphorus binder together?
Many dogs do, under a vet’s supervision. Calcitriol raises calcium absorption, and a calcium carbonate binder adds calcium directly. Together they raise the risk of high blood calcium, so your vet needs to know every calcium source in the recipe, including eggshell.
Are salt substitutes safe in homemade food for a dog on benazepril?
No. Most salt substitutes replace sodium with potassium chloride. Benazepril and telmisartan already make the kidney hold on to potassium, and adding potassium chloride on top can push blood potassium high enough to affect the heart. Leave them out entirely.
Should my dog’s homemade recipe change when a new kidney medication starts?
Sometimes. A drug that raises potassium may call for lower-potassium vegetables. Calcitriol calls for a close look at calcium and vitamin D. Tell whoever formulates the recipe about every new drug, and avoid changing food and medication in the same week.
Where do I go next for the rest of my dog’s kidney diet?
This guide explains the medication list. The Kidney Disease hub covers the recipe itself, and the Gut Health hub picks up the nausea and appetite changes that often come along with these drugs.
Want a recipe built around your dog’s medications?
I build TCM Dietetics kidney recipes that account for every drug your dog takes, from potassium on benazepril to calcium on calcitriol.
References
Brown, S. A., Brown, C. A., Crowell, W. A., Barsanti, J. A., Allen, T., Cowell, C., & Finco, D. R. (1998). Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency. Journal of Laboratory and Clinical Medicine, 131(5), 447-455.
Brown, S., Elliott, J., Francey, T., Polzin, D., & Vaden, S. (2013). Consensus recommendations for standard therapy of glomerular disease in dogs. Journal of Veterinary Internal Medicine, 27(S1), S27-S43.
de Brito Galvão, J. F., Nagode, L. A., Schenck, P. A., & Chew, D. J. (2013). Calcitriol, calcidiol, parathyroid hormone, and fibroblast growth factor-23 interactions in chronic kidney disease. Journal of Veterinary Emergency and Critical Care, 23(2), 134-162.
International Renal Interest Society. (2023). IRIS treatment recommendations for CKD in dogs. IRIS Kidney.
Lourenço, B. N., Coleman, A. E., Brown, S. A., Schmiedt, C. W., Parkanzky, M. C., & Creevy, K. E. (2020). Efficacy of telmisartan for the treatment of persistent renal proteinuria in dogs: A double-masked, randomized clinical trial. Journal of Veterinary Internal Medicine, 34(6), 2478-2496.
Polzin, D., Ross, S., Osborne, C., Lulich, J., & Swanson, L. (2005). Clinical benefit of calcitriol in canine chronic kidney disease [Abstract]. Journal of Veterinary Internal Medicine, 19(3), 433.
Hannah Zulueta obtained her Certificate in Canine Nutrition from CASI Institute. She is also studying for her Doctorate in Acupuncture, Traditional Chinese Medicine, and Herbalism from the esteemed Pacific College of Health and Medicine. If you’re as keenly interested in health for yourself, visit her website for human health: Satori Acupuncture and Herbs.
She resides in San Diego with her three dogs, Maggie, Orbit, and Mr. Higgins.
She is available for one on one consultations. She develops evidence-based recipes that meet both NRC and AAFCO nutritional standards while integrating the therapeutic food principles of Traditional Chinese Veterinary Medicine into her formulations.
Additionally, you can find her sharing free content on Instagram.
