Manufacturer’s dog supplement description: “Epakitin by Vetoquinol is a nutritional supplement designed to help slow the progression of chronic kidney disease in dogs and cats. This supplement features Chitosan, a natural product derived from shellfish that helps support healthy kidney function. In addition, the supplement also features lactose and calcium carbonate, designed to improve an animal’s overall health. Epakitin for dogs and cats is also considered safe to use in conjunction with most veterinary recommended renal care diets and diets designed to be low in phosphorus.”[tabs][tab title =”Overview”]Epakitin, made by Vetoquinol, is a licensed food additive for use in cases of chronic renal failure (CRF), in which the kidneys aren’t able to properly filter waste products and unwanted minerals out of a dog’s bloodstream.[/tab] [tab title =”How It Works”]Epakitin is a phosphate binding agent in powder form. It binds to the phosphate in food, and prevents it passing into the animal’s body.[/tab] [tab title=”Uses”]Research has clearly indicated that using phosphate binders are effective in decreasing the level of phosphate in the blood, when the kidneys are unable to do this (as they would in a healthy animal). Keeping levels of phosphate in the blood lower can delay the onset of serious symptoms associated with chronic kidney disease.[/tab] [tab title =”Side Effects”]Epakitin is made from the shells of crustaceans, so any animals with an allergy to shellfish must avoid this product. Very occasionally, using a phosphate binder such as Epakitin will leave the animal with high blood calcium levels (hypercalcaemia).[/tab] [tab title =”Dosage”]Epakitin is a powder which should be added to the animal’s food, 1g per 5kg of bodyweight.[/tab][/tabs]
Vetoquinol Epakitin for Dogs
One of the substances that the healthy kidney maintains within tight levels is phosphate. The diseased kidney is progressively less able to remove phosphate from the blood, leading to elevated levels. These raised levels cause further damage to the kidneys and also decrease the functioning of other organs.
Lowering the amount of phosphorus in the diet of an animal suffering from chronic kidney disease (CKD) has a positive effect on progression of disease. By adding a phosphate binder to the food as a supplement, the amount of phosphorus available is decreased, thereby lowering its levels in the food.
Several studies [1, 2] have shown that giving Epakitin with food is effective in lowering serum phosphate levels because it prevents the phosphate being absorbed out of the gut and into the bloodstream in the first place. The idea of using phosphate binders is widely accepted within the veterinary community.
However, it should be noted that the studies showing Epakitin to be effective were small scale and some of them were part funded by Vetoquinol, though the results were sufficiently compelling to be able to conclude that Epakitin is effective in lowering serum phosphate levels in cases of chronic renal failure in cats. The mechanism of action is the same in dogs, and so phosphate binders will have the same effect but the median survival for dogs suffering from chronic kidney disease tends to be lower than that of cats.
Epakitin gets extremely positive reviews from just about all pet owners who use this dog supplement. It is generally used following the advice of the vet as part of a package of management measures to maintain phosphate levels in dogs and cats suffering from CKD.
Epakitin has 80mg of Chitosan and 100mg of calcium carbonate per gram of product. It acts in combination with dietary phosphate, producing insoluble, non-absorbable, phosphate compounds which trap phosphorus in the gut of the dog and are then excreted in feces. This process prevents the phosphate passing into the bloodstream.
Levels of serum phosphorus are a good prognostic indicator for the animal, and restricting dietary phosphorus is known to have a protective effect on the remaining, undamaged kidneys and slow the progression of the renal failure . This is the premise behind specially formulated “renal support” diets which have specific formulations that lower dietary phosphorus and other minerals, and also decrease protein intake.
Unfortunately, anecdotally they also appear to be much less palatable to the dog or cat with chronic kidney failure, sometimes preventing this route being available to the owner , and increasing the importance of a binder that can be added to regular dog food in the management of chronic kidney disease.
Occasionally, dogs and cats being treated with Epakitin supplement will end up hypercalcaemic as a result of adding calcium carbonate to the diet.
It’s important to note that because chitosan is a polysaccharide derived from the chitin found in the shells of crustaceans , Epakitin probably should not be given to dogs that have allergies or intolerance to shellfish.
Epakitin against Hyperphosphataemia in dogs with CKD
In cases of chronic kidney disease, kidneys will stop functioning properly. Therefore, minerals and the products of metabolic processes that would normally be removed from the bloodstream are instead left to circulate and build up, until they become a risk to the animal’s health.
One of said minerals – phosphorus – is normally filtered out of the bloodstream by the nephrons in the kidney to maintain circulating phosphorus levels within tight parameters. As kidneys begin to fail, initially, the body is able to respond by increasing levels of Parathyroid Hormone, which signals to the kidneys to increase their efforts to filter phosphates out of the bloodstream. For this reason, phosphorus levels can sometimes still register as normal in the early stages of renal failure while parathyroid hormone levels are raised.
However, once enough of the kidney has been damaged that it is no longer able to respond to the parathyroid hormone, levels of phosphates in the blood begin to go up. High levels of phosphorus can further damage the kidney, leading to reduced function in the remainder. In addition, high levels of parathyroid hormone can also cause health issues both in kidneys and elsewhere, leading to calcium deposits in the kidney and other tissues in dogs. It can also cause demineralisation of bone with pain in limb bones and sometimes increased prevalence of fractures, but kidney signs are predominant in dogs with high levels of parathyroid hormone.
- Wagner E, Schwendenwein I, Zentek J. Effects of a dietary chitosan and calcium supplement on Ca and P metabolism in cats. Berl Munch Tierarztl Wochenschr. 2004 Jul-Aug;117(7-8):310-5 [study]
- Brown S, et al. Effects of an Intestinal Phosphorus Binder on Serum Phosphorus and Parathyroid Hormone Concentration in Cats With Reduced Renal Function. [pdf]
- Elliott J, Rawlings JM, Markwell PJ, Barber PJ. Survival of cats with naturally occurring chronic renal failure: effect of dietary management. J Small Anim Pract. 2000 Jun;41(6):235-42 [study]
- Illum L. Chitosan and its use as a pharmaceutical excipient. Pharm Res. 1998 Sep;15(9):1326-31 [study]
Disclaimer: The purported effects of the supplements or ingredients discussed in this article may, or may not, have been subject to rigorous scientific investigation. This article is an introductory document for educational purposes only which is not intended to be a scientific review either endorsing or refuting the claimed effects of the supplements or ingredients. The information is NOT to be used for diagnosis or treatment of your pet. You should always consult your own veterinarian for specific advice concerning the treatment of your pet. The supplement has not been tested or tried by the author(s) of the content/review, and are not endorsed or recommended in any way.