I researched the disease and alternative options, and I considered making home cooked food. Back when the melamine scare hit the pet food industry, I home cooked for a brief period until I felt I could "trust" commercial food again. It was a close call with my pets, because the pet food brand I was using was recalled. Some of their products were contaminated resulting in pet deaths. Luckily, the particular product I was using from that company was not involved with the melamine additive. When CRF or chronic renal failure became more problematic for Haley, turning to home cooking was not intimidating. I had already done it for a short while.
I found several internet sites that were especially helpful in educating me about home cooking for my dog. I learned about the important things to do to keep meals nutritious and balanced. Key for a "kidney" dog, is to reduce the phosphorus load on the kidneys and use as high a quality protein as possible. Not all protein is equally bioavailable to the dog's metabolism. (Keep this in mind when reading dog food labels, just because it lists proteins, not all are equally utilized by your dog.) The amount of phosphorus in protein sources is important to know, as you have precious few milligrams of phosphorus allotment to work with.
I home cooked for Haley for 3 years based on the knowledge I learned reading books, signing up for newsletters, and joining canine CRF forums. I used glutinous rice as a source for additional calories (it's very low in phosphorus), egg whites (one of the most biologically available proteins that has a low phosphorus load), chicken, turkey or beef and low phosphorus vegetables. There are also suggested supplements to help balance the diet and mitigate the problems that renal failure causes. Those supplements are further discussed in depth on the website Iisted below. Most importantly, I learned to balance all meals so that calcium and phosphorus amounts are equalized. Sometimes, calcium amounts should be even higher than phosphorus. I used a nutrition calculating website called NutritionData to build my recipes and balance ingredients.
Haley thrived for her final 3 years of life, and it was only in her last 3 months, that she started to have other health issues that seriously compromised her health. She loved her food. Feeding prescription food can often be a problem, because the low protein, low phosphorus ingredients aren't very appealing to many pets. Also, CRF related nausea can negatively impactt their appetite. Haley thrived, maintaining her weight and most of her muscle mass until the end. Over time, many CRF dogs get very thin and experience muscle wasting from poor appetite and reduction in protein intake. Her coat was still full and shiny. She did not look like a sickly dog, just a senior dog.
Home cooking pet food requires extra effort and some time commitment. I don't regret the time I invested educating myself and making her food. With Haley being a small dog, I didn't have to make large batches. I would freeze servings in ice cube trays, pop them out and store them in freezer bags. I just pulled out what I needed for a meal, microwave and serve. I think doing this gave her 3 quality years in spite of advancing renal disease. Cooking for larger dogs is a bigger project, but pet owners on canine CRF forums have great ideas and hints to make the task easier.
My vet accepted and supported my decision to home cook. We worked together to make sure Haley did well. Not all vets are comfortable with feeding home prepared food exclusively and it might take some effort to get your vet to agree. If he/she doesn't support a home prepared diet, it might be time to shop around, as there are other vets that do. Haley's vet became a believer over time. He even commented that he had other CRF patients that could benefit if their owners could commit to making home prepared diets. He always remarked that Haley looked so good, even though her test results indicated she should look much sicker.
I hope you and your pet never have to face the challenge of renal disease. But if you do, there is so much support available. (forum members know a great deal and are extremely supportive of each other) There is considerable information online to help you. Just be sure to use reliable sources. The forum groups listed have files and links to help guide your research. If the home cooking option is right for you, I hope your pet thrives and lives a quality life despite having renal disease.