you will love the idea of holistic treatments. Others will be extremely sceptical about them.
I'm more of an allopathic (conventional) medicine
person myself, but some of the
methods discussed below worked for Thomas and for many other cats on
Tanya's CKD Support Group
so I think it is important to discuss them.
Even if you try nothing else, I strongly
recommend the herbal remedy, Slippery Elm Bark (for excess stomach acid and
constipation), if appropriate.
Unfortunately holistic medicine is
an area which can attract charlatans and others aiming to make money from the
stressed and the vulnerable. I know you want to help your
cat, but there is no miracle cure for CKD (if there were, I
wouldn't need to run this site), so please don't fall for
the hype (or the testimonials).
Even if you are a devotee of holistic medicine, please be
prepared to use allopathic medicine as well when appropriate. I am not
aware of any holistic treatments that could substitute for phosphorus
binders, for example.
Holistic and Homeopathic Medicine
Holistic medicine aims to treat the whole cat rather
than just symptoms. Holistic medicine consists of a variety of modalities,
including homeopathy, herbal medicine, acupuncture and Traditional Chinese
The American Holistic Veterinary Medical Association has a good
overview of holistic medicine and how homeopathic treatment forms a part of
If at all possible, please try to visit an holistic vet.
works on the principle of treating like with like, but unlike allopathic
treatments, homeopathic remedies are extremely diluted (though in
homeopathic terms, this is thought to make them more effective). There are two types of homeopathy,
classical and complex. Classical homeopathy only uses one treatment at a time.
In contrast, complex homeopathy uses several treatments at a time.
Homeopathic remedies do not work
the way regular medication does - you cannot take a remedy when you feel
sick and expect it to work like an aspirin would. Usually you give a
homeopathic remedy once, then maybe not again for days, weeks or even a
Ideally you should seek advice from a homeopathic vet, though these are
not always easy to find.
If you are using herbal medicine, it is important not to overdose. Herbal
remedies are just like any other drug and may have side effects. Too high
can actually end up causing the very thing you are trying to treat - for
example if you give too much of a treatment for diarrhoea, it can actually
make the diarrhoea worse. So only give the suggested dose and remember
that, as with all medicines, more is not always better.
Herbal remedies can be very potent, so I would not recommend giving herbs
other than slippery elm bark without input from a qualified professional;
and do ask your vet about slippery elm bark or any other products you plan
Health Library has information on herbs and supplements and possible interactions with
- links to summaries of research papers, including benefits, harmful
effects and safety testing of herbal medications (primarily relates to
The natural remedy most commonly
used for CKD cats is slippery elm bark powder (ulmus rubra or
ulmus fulva). Slippery elm
bark is a herbal remedy used for most kinds of digestive or intestinal problems - it can
be used for nausea, vomiting, diarrhoea or constipation. As a side effect
it can also improve coat dryness and dandruff.
Slippery elm bark is a demulcent, which means it soothes the stomach lining and
intestinal walls and reduces irritation. This can be particularly useful in
combating the nausea and excess stomach acid which many CKD cats experience. You
will usually see an improvement within a day or two of starting slippery elm
A potential nutritional prophylactic for the reduction
of feline hairball symptoms (2004) Dann JR, Adler MA, Duffy KL and
Giffard CJ The Journal of Nutrition 134(8) pp2124S-2125S found
that it also appears to help with hairballs.
You can use slippery elm bark in addition to
famotidine (Pepcid AC) if necessary (though
with luck the slippery elm bark alone will suffice), but do not give these
treatments at the same time (see
The study states that "with PEPPS the concentration of elm USP administered is less than 8%
the slippery elm dose
recommended by holistic veterinarians...Administration of PEPPS was in
accordance to weight. On average dogs or cats weighing less than 25 lbs
received daily doses upwards of 72 mg." The study indicates that the product
was effective but you need a prescription from your vet in order to purchase
it, so buying slippery elm bark over the counter is probably
easier and cheaper.
I am occasionally asked about marshmallow root. This shares some similarities
with slippery elm bark and some people use it instead of slippery elm bark,
but slippery elm bark is used most often on the CKD support groups, so I am
more familiar with it.
Ideally, you want organic or wild-crafted slippery elm bark powder from most
good health food shops. See below for sources.
If you cannot find loose slippery elm bark, you can usually find capsules
in a 350-400mg size, but try to make sure the capsules contain only pure
slippery elm bark, no fillers.
It is hard to find capsules that don't contain magnesium stearate because it
is a glidant used in the manufacturing process (it helps the powder flow when
the capsules are being filled). Magnesium stearate is not a problem, but I
would try to avoid capsules containing other ingredients. You cannot always
syrup recipe from
capsules containing anything other than slippery elm bark.
I would avoid tinctures because they often contain other ingredients,
especially alcohol, though some members of my support group in the USA have
managed to find one brand without alcohol.
Slippery Elm Bark Dosage
The usual dosage is:
1/8 to 1/4 (0.125 - 0.25) of a teaspoon of the organic or
wild-crafted slippery elm bark powder once or twice a day; or
one 350-400mg capsule a day. You can give these whole or open them and
sprinkle on the cat's food once or twice a day.
Some cats do not need it every day, so experiment and see what works best for
I open the capsules and sprinkle the slippery elm bark into my cat's food and mix it up, but
slippery elm bark has a
bittersweet flavour which some cats do not like. In that case, try giving
it in a capsule, either the one it came in (though these may well be too big
for the average cat) or, if you are using loose slippery
elm bark, purchase
separately for this purpose.
Some people have found their cat will eat slippery elm bark if it is mixed in
baby food (make sure the baby food does not contain any onion).
You can also
make slippery elm bark into a syrup that is used for digestive problems or
for mouth sores or ulcers. It has the same soothing and healing effects in
the mouth - try dabbing in your cat's mouth ulcers if required. The syrup
is weaker than the straight powder, so you can give a little more of it.
Some people have told me they find it hard to place the syrup on their cat's
mouth ulcers if they are in hard-to-reach areas of the mouth. In such cases,
you may wish to use a syringe to aim the syrup at the ulcers.
Here is the
recipe for the syrup:
Sprinkle 1 to 1.5 tsp of
slippery elm bark powder onto one cup of cold water.
If you are using slippery elm bark from capsules, you need pure slippery elm
bark with no fillers, otherwise the syrup will usually not thicken properly.
Let it sit until the powder is damp, then bring to the boil stirring
constantly. Use a stainless steel or heat-proof glass pan, not an aluminium or
non-stick one. Reduce the heat and simmer, still stirring constantly, until it
thickens, about 3 minutes or so. It will be the consistency of watery egg
Allow to cool and give ¼ - ½ (0.25 to 0.5) teaspoon up to 4 times a day. This will
keep at room temperature for a day or in the fridge for up to five days.
For the non-cooks among us, one of my support group members came up with this
method but it may not work with powdered slippery elm bark.
Take a glass container which holds two cups. Put one cup of water in the cup.
Add 1 to 1.5 tsp of slippery elm bark powder.
Heat in the microwave on high for about 1.5 minutes. Remove from the microwave
and stir, then put it back in for about another 30 seconds. Keep an eye on it
because you do not want it to boil over. Remove from the microwave and stir
Allow to cool and give
¼ - ½ (0.25 to 0.5) teaspoon up to 4 times a day. This will keep at room
temperature for a day or in the fridge for up to five days.
Where to Buy Slippery Elm Bark
San Francisco Herb Co
sells loose slippery elm bark powder at the best price I've found, US$16.10
per pound plus exact shipping cost, but their minimum order is for US$30. They
will waive this on request and charge a US$7 small order fee instead;
alternatively you could stock up on other products such as catnip.
sells its own brand 400mg slippery elm bark capsules for US$3.49 for
Unfortunately, EU regulations for herbal products were introduced in Europe in
The Human Medicine Regulations 2012
has a list of affected herbs, which includes slippery elm bark as a
Banned or restricted herbal ingredients
on the UK government website states that "Manufacturers,
wholesalers and sellers must ensure any herbal products they place on the
market do not contain banned ingredients. They must also ensure that
restricted ingredients are used legally." It states that as far as
restricted ingredients (such as slippery elm bark) are concerned, the
legislation "Prohibits the sale or supply (including general retail or
following a one-to-one consultation with a practitioner) of herbal
medicines in the UK, if it contains one or more of the listed plants,
except where sold in premises which are registered pharmacies and by or
under the supervision of a pharmacist." This makes me laugh. I wonder
whether the average pharmacist, skilled though s/he may be, has even heard
of slippery elm bark.
I understand that herbal
medicines can still be sold in Europe if they have either a traditional herbal
registration (which slippery elm bark does not) or a product licence.
Obtaining a licence can cost as much as £300,000 per
product, though apparently for herbs it may cost "only" £50,000.
manufacturers are arguing that slippery elm bark is a foodstuff, which would
make it exempt from these regulations, and are continuing to sell it. You
can also import it from outside the EU, though in theory it might be
confiscated by customs.
Overall though, my original fears about this new law have not come to pass
and you should still be able to buy slippery elm bark, though it may not
be as easy to find as it was previously.
Amazon UK has a number of sellers, including
Alchemists Apothecary which sells 100g in
powdered form for £7.95. It also sells the
organic brand at £52 for 1 lb.
Another seller sells 100g of slippery elm bark
powder for £10.59.
Body Energy Club sells 100 capsules (400g
each) of slippery elm bark for CAN$7.35 plus tax. Shipping is included in the
Slippery Elm Bark Cautions
Do not give slippery elm bark at the same time as any other
medications or supplements - as
University of Maryland Medical Center
explains, it can inhibit the absorption of the
medications. It is therefore best to give it 1-2 hours before or after any other
medications (especially antibiotics), and ideally on an empty stomach,
although it is safe to sprinkle it on food if you wish.
Slippery elm bark also contains calcium, so it is probably safer not to use it
if your cat has
D-mannose is a simple sugar, in fact it is actually the active ingredient in
cranberry but without the downsides associated with
cranberry. It is used for cats suffering from urinary tract infections.
A human study at the Washington University in St Louis School of
Establishment of a persistent Escherichia coli
reservoir during the acute phase of a bladder infection
(2001) Mulvey MA, Schilling JD & Hultgren SJ Infection and Immunity69(7) pp 4572-9, found that in some cases the bacteria that cause
urinary tract infections can burrow so deep into the bladder lining that
they cannot be detected in the usual tests. If your CKD cat is prone to persistent, ongoing or repeated UTIs, speak to your vet about using D-mannose,
which appears to be very helpful when dealing
with infections where the bacteria have burrowed into the bladder wall.
It does not kill the bacteria as an antibiotic does; rather, it works by
attracting the bacteria to bind with itself rather than with the bladder
wall; the bacteria can then be passed out of the body via urination.
D-mannose will only work for
urinary tract infections caused by E coli and possibly
Klebsiella infections are rare, but E coli accounts for 90% of all
urinary tract infections in humans, and is commonly the cause of
feline urinary tract infections too.
have heard from a number of people who have tried this treatment on their
cat, and all of them thought it was effective.
Although D-mannose is a type of sugar, it does not get absorbed by the digestive tract.
Therefore it should be
safe for diabetic cats, but check with your vet before using if your cat
D-mannose appears to be effective, it seems to work best for cats with a
recurring UTI. D-mannose is not intended to take the place of antibiotics. If your vet prescribes
antibiotics, you must use them, because untreated urinary tract infections
can rise into the kidneys and cause permanent damage, which is the last
thing a CKD cat needs. See
Treatments for more information on treating urinary tract infections.
A commonly used dose is 250-500mg twice a day. With most (but not all)
brands, a ¼ of a teaspoon of the powder is 500mg, so this would mean
giving ⅛-¼ teaspoon twice a day, but check with your vet. Some people find
it works better if they divide the total amount over 3-4 doses a day. Keep
giving it for a week after the symptoms have disappeared.
Since it is a type of sugar, D-Mannose has a pleasant taste. It can be
easily mixed with wet food or mixed with water and syringed into the cat's
Where to Buy D-mannose
D-mannose is widely available from health food shops such as Vitamin
Shoppe and Wholefoods (it is often in the
women's health section). You want pure D-mannose. It can also be bought
Amazon sells the Now brand at US$17.33
for 3 oz. Some people are reporting (April 2016) a possible problem with
one batch with an expiry date of 11 2018.
Flower essences or remedies are made by either leaving flowers in a
glass bowl filled with spring water which is left in bright sunlight for
three hours, or by boiling flowering twigs in a pan of spring water for
half an hour. The resulting liquid is then mixed with brandy and used as
The best known
flower essences are
the Bach Flower Remedies (details of this and other makes are
below). These are thirty-eight individual essences which are designed to
address a specific state of mind or personality trait. These remedies can be
mixed together; in fact, the best known remedy, Rescue Remedy, is a
combination of five different essences.
Flower Essences Research
Many people are sceptical about flower essences, failing to see how they
work or believing that using them simply results in the placebo effect.
Healing with Bach flower essences: testing a
complementary therapy (2007)
Halberstein R, DeSantis L, Sirkin A, Padron-Fajardo V & Ojeda-Vaz M
Complementary Health Practice Review12(1) pp3-14 was a
double blind placebo-controlled study at the University of Miami which
looked at the impact of flower remedies on anxiety in humans, and found that
they appeared to be more effective than the placebo for acute
situational stress for those with high levels of anxiety.
Although I was sceptical, failing to see how they
could work, my own experiences of using
such essences with my cats have been favourable, and since they are
reasonably priced and are unlikely to do any harm, you may wish to give them a
try as appropriate.
These are the remedies which
I think may help a CKD cat, although others may be helpful
Crab apple the cleansing essence
Gorse hopelessness, pessimism
terror, panic (perhaps for vet visits)
Rescue Remedy for emergencies and crisis
You can of
course also use the essences for yourself.
Flower Essences Dosage
are two main ways to give your cat the remedies, and you can give more than one
remedy at a time. However, do not use more than six or
seven remedies in one go or results may be disappointing, because mixing
too many remedies together can make some of the essences ineffective.
Although flower remedies contain alcohol, this is not normally a problem since
they are diluted so much before using. Some remedies are available
alcohol-free and may be labelled as safe for animals, so you may want to look
for these, though I used the remedies containing alcohol with no problems.
There is a pastille form of Rescue Remedy but this should not be used for
cats according to the
manufacturer because it contains xylitol.
Although this is toxic to dogs, there is currently no
evidence that it is toxic to cats. However, some people prefer to avoid
products containing it.
Add two to
four drops of each remedy to a 30ml bottle of bottled spring water (do not
use tap water for flower essences). Take four drops at a time from this bottle at least four times a
day, and use a dropper to place the remedies in your cat's mouth. Make
sure you thoroughly rinse the dropper before putting it back into the
place two to eight drops of each remedy in your cat's bowl of drinking
water. As long as your cat drinks four times a day - and most CKD
cats do, of course - he/she will be receiving the correct dose.
Incidentally, it does not matter if you have other cats who share the
water bowl, they will not be affected by the remedies.
I have also heard from one reader who at times of crisis has put a couple of
drops of the remedies on her fingers, and then rubbed the drops into her cat's
Where to Buy Flower Essences
sells Bach essences online in the USA at US$17.55 for 20ml.
My Vitanet sells Bach essences online for US$9.69 - US$10.19.
Boots in UK sells the remedies for £7.35 each (Rescue
Remedy is a little more expensive) - search for Bach. It only seems to
stock Olive and Rescue Remedy online but you can may be able to buy the
in Boots stores and some other pharmacies.
the home of the Bach Flower Remedies and provides information and links
for obtaining the remedies throughout the world.
has information on
how to choose a remedy.
Bach has information on the use of Flower Essences in companion
Synergy - this site has information on many different types of flower
essence and links to ordering information.
"Bach Flower Remedies for Animals" by Stefan Ball and
Judy Howard, is published by The C W Daniel Company Ltd, price
Amazon UK and US$16.06 from
based on the idea that the body has channels along which energy passes.
Imbalances or blockages may arise in these channels, leading to health
problems, but acupuncture can clear the blockages so that the energy can
To the Western
mind, this can sound strange. However, acupuncture for humans is covered
by many private health care schemes in the UK, because of its proven
benefits. I admit that I myself am a big fan
of acupuncture. It has
worked wonders for me personally, finally getting rid of pain that nothing
else could shift, and had astonishing results on
State University College of Veterinary Medicine mentions that acupuncture may be of use for
pain management and diseases of the kidneys and the liver, and some people
have had very good results using acupuncture for CKD cats, either by
improving the cat's wellbeing (less vomiting, generally perkier) or
occasionally even through an improvement in bloodwork. It can also help
with appetite. Of course, I have
also heard of a couple of people whose cats did not react particularly
well to acupuncture; but when it is performed by a trained professional
with sterile needles, acupuncture is unlikely to have bad side effects even if
you don't notice an actual improvement, so you may wish to try it and see
how you get on.
Heel is a German company that produces a number of homeopathic remedies.
Members of the German Feline CKD list,
Nierenkranke Katze, have used these products for many years and speak
highly of them, in many cases finding that BUN and creatinine reduce after
Normally a combination of three remedies is used:
Ubichinon compositum (CoQ10)
Using the remedies in this way is complex homeopathy rather than classical homeopathy, which would
require that a treatment plan be tailored to the individual's needs and
symptoms. However, it can be
hard to find a classically trained homeopathic vet.
The words "ad
us.vet" mean it is a special
veterinary formula but this is only available in German-speaking countries. If you live elsewhere, you will
have to use the human products, which were used by the German support
group before the veterinary products became available.
The Heel Veterinary Guide has information
about these remedies on pages 82 (Coenzyme compositum), 115 (Solidago
compositum) and 121 (Ubichinon compositum).
Luca's Story tells
(in German) the
story of Luca, who had borderline high kidney values before he was even
one year old. By the time he was three, his creatinine level was 7.4
mg/dl. He was treated with Heel Complex, and his creatinine level fell to
3.3 mg/dl. Luca lived to the age of seven despite having CKD, and died of
cancer, not of CKD.
Ergebnisse zur chronischen Niereninsuffizienz der Katze bei biologischer
Behandlung (Results of treating CKD in cats with biological means) (2006) Eichentopf A, Eichentopf F Biologische Tiermedizin2 pp31-34
discusses the results of a study which used the above remedies plus
another one called Hepar compositum to treat 24 CKD cats aged from 7-17
for eight weeks. On the first two days, the cats were given the basic
three remedies subcutaneously, along with sodium chloride fluids. On days
3-7 the cats were only given the Heel remedies once daily, with dosage
thereafter reducing to once every other day and eventually to once or
twice a week. After the first week the treatments were given orally or
subcutaneously, as preferred by the cat's owners. The Hepar compositum
was given once a week between the third and eighth weeks. The study found
that all the cats improved in terms of behaviour (appetite etc.) and most
of the cats had measurably better bloodwork within the first 1-2 weeks,
although results were much less dramatic for those cats in end stage renal
disease. 80% of the owners involved in the
study were very satisfied with
Biologische Behandlung bei Katzen mit chronischer
Niereninsuffizienz (CNI) (Biological treatment of cats with
CKD) (2002) Ulf U Wissenschaftliches Veterinär-Symposionder
Firma Heel involved giving the Heel Complex to fifty cats with medium
stage to advanced CKD. Forty cats showed improvement within one week. Ten
cats did not respond so their treatment was discontinued. Five of the
treated cats died but 75% were still alive after 3-6 months, and 50% were
still alive after 7-12 months, often with much improved bloodwork results.
Some of the cats were treated for three years in all.
The usual starting dose is 1 ml of each, three times a week (they can be
mixed together in a syringe). After a few weeks, if the cat seems to be
improving, dosage can be reduced to twice or occasionally once a week.
Where to Buy
Heel products are no longer available in the USA or Canada since Heel
pulled out of the North American market on 31 August 2014 because of class
action lawsuits, according to this
is the UK supplier. They will only supply to fully qualified practitioners
but may be able to put you in touch with such a person in your area.
Apparently the branch of
Metropolitan Pharmacy located at Frankfurt airport
will ship Heel products internationally. You can e-mail them in English to
ask for current prices. One member of Tanya's Support Group in the USA
ordered sufficient to last her a year, and including shipping it cost her
I first heard about Rubenal in April 2008 from a lady who was participating in
trials of a new CKD treatment made by Vetoquinol at Kansas State University. Rubenal was launched in Europe in
2008, in the UK in January 2009, and in the USA in July 2009. The trial
results were published in 2011 (see below).
Rubenal is made from
Rheum officinale (Chinese rhubarb extract) and produced by Vetoquinol, who
also make Ipakitine (Epakitin) and Azodyl. In TCM (traditional Chinese
medicine), Chinese rhubarb extract has been used to treat kidney problems in
humans for many years. Rhubarb leaves are toxic for cats but the root is
In TCM rheum is commonly used in combination with other herbs. Vetoquinol
appear to have produced a product that only contains Rheum.
available in two sizes, 300mg and 75mg. The recommended dose is 25mg per kg
(2.2lbs) of body weight twice a day, so a 3kg (6.6lb) cat would need two 75mg
tablets a day. In the UK they cost around £9-10 for 60 tablets.
Vet UK is a UK online supplier which sells 60
75mg Rubenal tablets for 9.81. Rubenal is also available in the UK
from vets or Amazon.
I have heard from a number of
people in German-speaking countries who have used Rubenal. The majority of
them seem to think it has helped their cats, although one person said the capsules are too
big for a cat to swallow easily, a problem which commonly arises with another Vetoquinol product,
Rhubarb extract may affect
electrolytes. In particular, it may lower potassium levels, so I would
recommend monitoring your cat's potassium levels and other electrolytes
if you use Rubenal.
In early 2011 Rubenal became the subject of a label review by the FDA in the
USA. Whilst this is going on, the manufacturer is not allowed to produce or
within the USA, so most US suppliers no longer have any stock and it is not
known when or if the FDA will permit it to be sold again. You might be able to
obtain it from UK suppliers on eBay or at
Clinical effects of rheum and captopril on preventing
progression of chronic renal failure (1990) Zhang JH, Li LS, Zhang
M Chinese Medical Journal103(10) pp788-93 investigated the
effects of rhubarb extract and captopril (an ACE inhibitor) on people with CKD.
The three groups tested received either rheum, captopril or both together. The
people who received both together did best but it was concluded that
"long-term low-dose Rheum E taken orally is beneficial to CKD. Its effect is
better than that of Captopril."
Effects of rhubarb tannins on uraemic toxins
(1991) Yokozawa T, Fujioka K, Oura H, Nonaka G & Nishioka I Nephron58(2) pp155-60 found that certain components of rhubarb reduced BUN
and creatinine levels in the rats in the study, though another tannin
found in rhubarb actually increased BUN levels.
Rehmannia 8 (Jin Gui Shen Qi Wan or Ba Wei Di Huang Wan) is a traditional Chinese medicine treatment which is supposed
to strengthen kidney function. Some sites also recommend it for helping
with infection or inflammation.
There is also a version called Rehmannia 6 (Min-Tong-Liu-Wei-Huang),
which as you might guess, contains two fewer ingredients. Chinese members
of Tanya's CKD Support Group tend to prefer Rehmannia 6 because one of the
additional ingredients in Rehmannia 8 is aconite, which can be toxic in
Web MD has some information on aconite.
A few members of
Tanya's CKD Support Group
use Rehmannia and find it helpful, but do check with your vet before
using. Ideally you should consult a vet with TCM training if you do use
it. Give no more than one eighth to one tenth of the human dose, and give
it with food but separately from other medications. Do not use if your cat
is suffering from diarrhoea.
The word "holistic" can be strangely reassuring, but it must not be forgotten
that "natural" does not necessarily mean something is safe, in fact some of
the most dangerous things in the world are "natural", such as belladonna.
I am pretty open to the idea of holistic treatments such as those I mention above.
However, over the years I have become increasingly worried - and not a
little sceptical - to see some of the treatments that are recommended
in the holistic world.
So many of these practitioners do not seem to understand the first thing
about kidney problems in cats! They offer products with diuretic properties (a real strain on sick
kidneys), or offer products which are intended for the lower urinary tract
when in fact the kidneys are the upper urinary tract - many products labelled "for urinary
tract health" are intended to treat feline lower urinary tract disease
(FLUTD), and are often contraindicated for kidney problems. Of course, some of
these sellers get around this problem by not even stating what their product contains!
I would never give such a product to my cats, you need to know what you are
Even if these practitioners understand about kidney problems, they
offer blanket treatments for cats and dogs, clearly not understanding that cats
have unique physiological needs.
So please, always consider your sources. If something
sounds too good to be true, it probably is. If that great miracle cure
were such a miracle, we would all be using it, they would be millionaires and
this website would be redundant. There is no such miracle cure, so please
don't fall for the hype or for testimonials. Remember, I'm not trying to sell
you anything here, so I have no axe to grind about any particular CKD
treatment, I just recommend what I have seen work for my own and other cats
(and I have "seen" thousands over the last sixteen years).
Below are some of the products I have seen recommended for CKD
cats, and an explanation as to why they may be inappropriate.
cats usually benefit from Vitamin B supplements, but many other Vitamins,
such as Vitamins A and D, can be a problem for CKD cats. Please see
Nutritional Requirements for more information.
is often promoted as possessing many health benefits. Whilst this appears
to be true for humans, garlic belongs to the same family as onion, and
onion can cause a particular type of anaemia in cats called Heinz body
anaemia. I would therefore not recommend risking garlic supplements,
particularly in CKD cats, who are already sick. The
Which Foods to Feed
page has more information.
should avoid giving cranberry or food containing cranberry to CKD cats -
it is too acidic for CKD cats, who tend towards
Cranberries also contain benzoic acid, which cats lack the pathways to metabolise.
The International Programme on Chemical Safety
reports on a case from 1971 when 28 cats were fed meat containing 2.39%
benzoic acid. Seventeen of the cats died. Toxicity may develop with quantities
greater than 0.45 g/kg given in single doses or 0.2 g/kg when the item is fed
on an ongoing basis.
The Boston Globe reports on the recent trend
of adding cranberries to cat food, and has a comment from a vet at Tuft's
University School of Veterinary Medicine that there is no evidence that
cranberries have the same benefits for cats as they appear to have for humans.
product has high levels of potassium, which can be dangerous for cats in
end stage renal failure. It is not appropriate to use as a potassium
supplement, because it is not possible to tailor an accurate dose.
I sometimes hear from people who want to use dandelion root or nettles on their
because they have read that it is good for kidney function. However, these are actually diuretics, so
are not usually suitable for CKD cats, who are usually urinating excessively.
There is one study I am aware of,
Urtica semen reduces serum creatinine levels
(2003) Treasure J Journal of the American Herbalists Guild
4(2) pp22-25, where nettle seed extract appeared to
lower creatinine levels in two human patients. However, one of these
two patients had cancer, and the other had lupus and a crisis as a kidney
transplant recipient. Obviously these scenarios do not apply to your typical
says that stinging nettles may lower blood pressure and blood sugar levels, so
I would be reluctant to use these in a cat with diabetes or a cat on blood
Dandelion is occasionally used
in CKD cats who are also suffering from heart problems, but this should only
be done with your vet's input. The
Heart Problems page has more information on diuretics as used for heart disease.
Some people use colloidal silver as a type of natural antibiotics. However,
National Center for Complementary and Alternative Medicine
states that side effects "may include neurologic problems (such as
seizures), kidney damage, stomach distress, headaches, fatigue, and skin
irritation." Since CKD cats are prone to many of these problems anyway, I
would not use colloidal silver in a CKD cat.
It never ceases to amaze me how many feline products contain essential oils.
Cats lack the metabolic pathways to process essential oils, so these oils can
be extremely toxic for them, but unfortunately even some vets are not aware of
Some people claim that it is the quality of the oils that matters, and that
high grade oils are safe to use with cats. This is nonsense. If your body
lacks the pathways to metabolise something, it does not matter what the
quality is. It is like saying a lactose intolerant person would be able to
tolerate organic milk even if they can't tolerate ordinary milk. Both types of
milk contain lactose and will therefore have the same effect on the lactose
Essentially, essential oils should never be used on
cats, and some sources also question whether hydrosols are
The Lavender Cat has a detailed brochure
about the risks of using essential oils and hydrosols in cats.
Pot pourri hazards in cats is an ASPCA article by a veterinary
poison specialist about pot
pourri, which also discusses essential oils (which are commonly used in pot
Concentrated tea tree oil toxicosis in dogs and cats: 443 cases (2002-2012)
(2014) Khan SA, McLean MK & Slater MR Journal of the American Veterinary
Medical Association244(1) pp95-9 concludes "Intentional or
accidental use of 100% TTO in dogs or cats caused serious signs of CNS
depression, paresis, ataxia, or tremors within hours after exposure and
lasting up to 3 days. Younger cats and those with lighter body weight were at
greater risk of developing major illness."
Flax Seed Oil (Linseed Oil) and Other Omega 6 Oils
Flax seed oil is commonly used in cat foods, and may also be recommended as an
essential fatty acid supplement. I don't object to flaxseed oil per se, I use it myself. The problem
is it is of limited value to cats whose bodies cannot metabolise it properly.
There are two
Omega 6 essential fatty acids for cats, linoleic and arachidonic. These fatty acids are essential in the sense that a cat cannot
produce them within the body, so must obtain them through diet.
Flax seed oil
contains around 13% linoleic acid but no arachidonic acid. Cats do not have
the pathways to convert linoleic acid into arachidonic acid, so another source
of arachidonic acid is necessary. Cats can only obtain arachidonic acid from
animal products, so if you want to give your cat an essential fatty acids oil,
consider a fish-based oil instead.
Skin and coat in cats (1999) is an article from the Waltham Course
on Dog and Cat Nutrition which states that "cats require a dietary source of
both linoleic and arachidonic acids."
Unfortunately, excessive amounts of Omega 6 fatty
acids may cause inflammation of the kidneys and therefore may not be a good
thing for CKD cats. See
Requirements for more information on essential fatty acids for
CKD cats. Astro's CRF Oil can be found
is one of the components of the spice, turmeric. It is thought to have an
anti-inflammatory effect and may have cancer-fighting properties in
Therapeutic roles of curcumin: lessons learned from
clinical trials (2013) Gupta SC, Patchva S & Aggarwal BB American Association of
Pharmaceutical Sciences Journal15(1) pp195-218 has an
overview of the use of curcumin in humans.
In 2010, the
Morris Animal Foundation reported on
research at Colorado State University into the use of a derivative of
curcumin called FLL32 for the treatment of a form of cancer called
osteosarcoma in dogs.
Renoprotective effect of the antioxidant curcumin:
recent findings (2013)
Trujillo J, Chirino YI, Molina-Jijón E, Andérica-Romero AC, Tapia
E & Pedraza-Chaverrí J Redox Biology1(1) pp448-456
states that curcumin is a "promising renoprotective molecule against renal
injury." However, the findings referred to are largely experimental
studies performed on rats to induce acute kidney injury.
not approved for use in humans and I am not aware of
any studies in cats.
Role of curcumin in systemic and oral health: an
overview (2013) Nagpal M & Sood S Journal of Natural
Science, Biology & Medicine4(1) pp3-7 says that curcumin "may
cause gastric irritation, stomach upset, nausea, diarrhoea, allergic skin
reaction, and antithrombosis activity interfering with blood-clot
formation." It may also increase the risk of calcium oxalate
stones, which are difficult to treat. It may interact with medications
Although there are now some forms of curcumin designed for cats, which
some people use for arthritic cats, I would not use it in a CKD cat.
I used to receive regular enquiries about a product called Tripsy. Reading the
seller's description of kidney disease was enough to set alarm bells ringing
for me - they could not even seem to differentiate between CKD and Feline Lower
Urinary Tract Disease, which are not the same condition.
In 2012 Tripsy changed both its name (to Kidney Support Gold) and its
formulation. Tripsy used to contain diuretics such as parsley, but Kidney
Support Gold contains astragalus root, cordyceps sinesis, rehmannia and Dong
astragalus is thought to be an antioxidant but
Holisticat states that astragalus should only be used short term in
cordyceps is a fungus which appears to help boost the immune system. It
has been used in human kidney transplant patients and appears to help reduce
the risks of complications in these patients when used in conjunction with
cyclosporine, an anti-rejection medication commonly used following kidney
transplants. Cordyceps is a natural blood thinner. It may increase the effectiveness
corticosteroids, so I would not use it in a cat who is on steroids.
dong quai (Angelica sinesis) is a herb which appears to help manage female
hormonal imbalances, e.g. around the time of the menopause. Some Chinese
studies indicate that using dong quai and astragalus may help kidney function
in rats with surgically induced kidney disease. It may slow blood clotting.
The US National Library of Medicine says that
taking dong quai in large amounts for a long period of time may be unsafe
because it contains carcinogens (chemicals thought to cause cancer).
Some people do like Kidney Support Gold. I think the new formulation is better than
the old one, but I still don't think I would use it when more proven
treatments are available. I would not use it without talking to your vet first, and
ideally to an holistic vet.
and Cannabidiol (CBD)
Marijuana is derived from the cannabis plant. Some US states permit marijuana
to be used in humans for medical reasons. In 2012 two states (Washington and
Colorado) legalised marijuana for recreational use. However, the DEA still
considers cannabis to be a controlled substance, and it is illegal in the UK.
In both countries it is illegal for vets to prescribe or recommend cannabis,
even in states where cannabis is legalised for human use.
Industrial hemp is also derived from the cannabis plant, and both marijuana
and hemp contain a number of cannabinoids but in different ratios. When
processed, therefore, marijuana develops very high levels of THC (which is
what gives the high) and low levels of CBD (cannabidiol, which affects the
nervous system but does not give a high). Hemp, when processed, contains very
low levels of THC (0.3% on a dry matter basis) and high levels of CBD. It is
this which is the basis of medical marijuana.
A couple of companies in the USA,
Canna Companion and
have developed hemp-based products for animals. These products are not
illegal in the USA and may be imported into Europe (indeed, it is legal to
grow industrial hemp in the EU) but not into Australasia. Whether vets can legally prescribe them is a grey area.
These products are used for pain such as arthritic pain, anxiety and
occasionally for inappetance.
Consumers' perceptions on hemp products for animals
(2016) Kogan LR, Hellyer PW & Robinson NG American Holistic
Veterinary Medical Association Journal42 Spring pp40-48 reports on
a survey of people who had given hemp-based products to their pets. Of the
just under 12% of people surveyed who were using these products in their cats,
the majority seemed to think they were most effective for pain, inflammation
and to help sleep. The main side effect seen was sedation but the second most
common was an increased appetite. I have not had much feedback about these
products yet, but one member of my support group tried one of these products
on her cat after it was prescribed by her holistic vet. After about a week,
she did see an increase in appetite.
2015 warning letters and test results states
that the FDA tested various products, including those made by Canna Companion
and Canna-Pet, and "in some of them, did not detect any CBD. It is important
to note that these products are not approved by FDA for the diagnosis, cure,
mitigation, treatment, or prevention of any disease, and often they do not
even contain the ingredients found on the label. Consumers should beware
purchasing and using any such products."
In 2015 the
US Food & Drug Administration
also issued a warning letter to Canna-Pet stating that the claims on
its website meant that its products were unapproved new drugs. Canna-Pet
subsequently changed its advertising. Canna Companion received
a similar letter.
There is some evidence that cannabinnoids can be of help for certain conditions;
they are sometimes used, for example, to help people undergoing chemotherapy.
However, in light of the foregoing, particularly the lack of any research into
the use of such products in cats, I would not personally use or recommend
these products at this time.
Aloe vera is a plant with antioxidant and anti-inflammatory properties which
historically has been used in humans for skin conditions and for constipation. Human
studies have indicated that it may have cancer fighting effects, however long
term use may cause cancer according to one study in rats and mice.
The outer part of the plant is toxic to cats but the inner part is safe.
Aloe juice made from the inner leaf contains anthraquinone, a stimulant
laxative. In 2002 the US
Food and Drug Administration
issued a final ruling stating that "the stimulant laxative ingredients
aloe (including aloe extract and aloe flower extract)...in over-the- counter
(OTC) drug products are not generally recognized as safe and effective or are
I consider there are much better, gentler and, bearing in mind the need to
source a product that is definitely not toxic to cats, safer treatments for
constipation and would not give aloe vera juice to my cat.
behind these products is that giving kidney glandulars (extracted from
cows' kidneys) is supposed to strengthen the cat's own kidneys. Renatrophin is pure
kidney extract, while the other two products contain other ingredients.
The process by which these extracts (known as protomorphogen or PMG
extracts) are obtained is patented by Standard Process.
I am concerned to note
that the products contain some or all of phosphorus, calcium and Vitamin
A, which can be a problem for CKD cats. They also contain
flax seed oil, and alfalfa,
which is toxic to cats. Some
Tanya's CKD Support Groupmembers
do like these products. Personally,
though, I'd save my money. If you do decide
to use them, Renatrophin contains magnesium citrate, so should be
given apart from phosphorus binders containing aluminium.
Amino acids are the components of protein. There are 23 amino acids which
cats need, and they can manufacture twelve of these themselves, but the
other eleven must be obtained from food.
is one example of an amino acid which cats must obtain from food.
Virginia-Maryland Regional College of Veterinary
Medicine explains more about cats and
Plasma amino acid profiles in cats with naturally
acquired chronic renal failure (1999)
Goldstein RE, Marks SL, Cowgill LD, Kass PH & Rogers QR American Journal of
Veterinary Research60(1) pp109-13, found that CKD cats in all
stages of the disease had lower levels of amino acids than healthy cats.
However, they concluded "the magnitude of these changes is mild and of little
clinical relevance." This is an older study, and it might eventually be shown
that supplementary amino acids are in fact helpful to CKD cats, but currently
there is no evidence that this is the case.
Nevertheless, there are a couple of amino acid supplements marketed for
CKD cats as follows.
Astro's Protein Powder
The maker of
Astro's CRF Oil also offers Astro's CRF
Protein Powder, though it is not mentioned anywhere on the Astro website.
It was apparently tested on 24 cats and 11 dogs but this study has not
The supplement is 96% amino acids made from wild Pacific deep sea white
fish which is enzymatically pre-digested (fish protein hydrolysate), so the
amino acids supposedly are very low molecular weight and therefore need
by the digestive tract. In other words, the product supposedly creates very
little nitrogenous waste. However, since it is made from amino acids, by
definition it will produce some nitrogenous waste.
Astro's Protein Powder is intended to counteract some of the possible side
effects of reduced protein diets in CKD patients (muscle and weight loss and
malnutrition). It can be used in conjunction with Astro's CRF Oil, or
added to food to supplement protein and calorie intake. The manufacturer
states it does this
without placing extra strain upon the kidneys, in a similar manner to
The powder is odourless and water soluble. It is usually given about twenty minutes before food - it can be mixed with
water and syringed in or offered as is in a bowl (apparently some cats
like the taste and will eat it like this). The recommended dose is a
quarter of a tsp per 10lb (4.5kg) of cat 1-2 times a day.
The product costs US$32.95 plus shipping costs of US$7.95 for a 120g jar
which would last 2-3 months for most cats.
It can be
obtained by going to Astro's CRF Oil and emailing the manufacturer (email@example.com).
You have to tell him what and how much you want to buy and that you want
him to send you a Paypal invoice (you will need to give him your Paypal e-mail address). The shipping cost is
usually the same for up to three items (around US$7 for the USA). The
product is shipped from Canada and tends to take a couple of weeks to
arrive in other countries, though it may take up to five weeks. The seller
does not used tracked
shipping, so it is hard to know if it is on its way, and it is sometimes
intercepted by Customs (probably because it is so poorly labelled) so it
does not arrive.
Although Astro's CRF Oil is widely advertised, the protein powder is still
not mentioned on the Astro website, even though it has been available
since 2008. I have heard from people who
have purchased it that no ingredient details are given on the package.
Some members of Tanya's CKD Support Group are happy with this
product, saying it has increased their cats'
appetites. Other people have told me it didn't seem to harm their cats in
any way, but nor did it help them. The best way for cats to take in the correct balance of amino
acids is normally from eating a complete food designed for cats, but if
you do want to try this product, run it by your vet first.
RenAvast and AminAvast
launched in the USA in summer 2011 and contains something called Avastamine
(AB070597). Avastamine is said to consist of "naturally occurring
biomolecules", which apparently means it is a proprietary mix of six specific
amino acids and one peptide. I suspected one of them would be
l-arginine, but they did not state which ones until August 2013, when it
was announced that RenAvast contained a "Proprietary blend of amino acids and
peptides 300mg: L-Aspartic, L-Carnosine, L-Glutamic Acid, L-Glutamine,
Glycine, L-Arginine, L-Histadine." Apparently each 300mg dose contains
25 mg L-arginine, 50 mg glycine, 50 mg L-glutamine, 25 mg
L-histidine, 50 mg L-aspartic acid, 50 mg L-glutamic acid, and 50 mg
Amino acids are the components of protein. Peptides are the molecules formed
when two or more amino acids are joined together. .
RenAvast was originally marketed as a dietary supplement. Dietary supplements do not need
US Food and Drug Administration approval but the manufacturers made the bold
claims that RenAvast "can halt the progression of chronic renal failure in
cats" and that "unlike other products and drugs, RenAvast does not treat the
symptoms of renal failure, it treats the cause."
FDA states that
"a product sold as a dietary supplement and promoted on its label or in
labeling as a treatment, prevention or cure for a specific disease or
condition would be considered an unapproved - and thus illegal - drug."
On 1 August 2012, the
FDA issued a warning letter to the
manufacturer of RenAvast about their claims for RenAvast. The
manufacturer took no notice, so in July 2015 the
FDA issued an
injunction banning the manufacturer from marketing RenAvast "unless and until
it obtains an approved new animal drug application or meets the requirements
for an investigational new animal drug exemption."
This is obviously unlikely to happen, but according to
JAVMA News, the manufacturer may continue to
market RenAvast abroad and the same product can also be made and sold in the
USA, but only if it is under a different name and with different marketing
which does not make the same medicinal claims. Enter AminAvast.
RenAvast was widely promoted online and the same applies to AminAvast. The marketing literature for RenAvast focused heavily on a study published online by the manufacturers
(rather than in a veterinary journal), AB070597 and its effect on declining renal function in
felines (2007) Archer J, published online. This reports on 19 cats
who were given RenAvast over a two year period. Cats joined and left the study
during this period so it is not known over how long a period the results for
individual cats were measured. No cats in the trial were on sub-Q fluids or a
prescription diet, but it is not known if they were receiving other treatments
such as phosphorus binders or Azodyl. Many of the cats were in early stage CKD
(Stage 2 of IRIS), and it is not uncommon for cats in this stage to survive
Effect of AB070597 on blood-serum creatinine
concentration in cats with chronic kidney disease (2015) Archer JD
Research Journal for Veterinary Practitioners3(3) pp58-68
appears to be an update of the above study. It reports on 27 cats who were
given RenAvast. Control cats were added retrospectively - I'm not at all sure
how that works. The study found that RenAvast appeared to have positive
effects on the creatinine levels of the cats in the study, though again, it is
not known what other treatments the cats were receiving, and they did not have
any concomitant diseases such as hyperthyroidism.
The manufacturer claims over two million doses of RenAvast/AminAvast have been
given without problems. I wonder how they know? Some members of my support group have tried RenAvast/AminAvast and like it,
whereas others think it has either not helped or has
made their cats worse, but they did not report this to the manufacturer.
What do I think? My feeling is that RenAvast/AminAvast might be a good
product, it might not, but it is unlikely to be the miracle cure that its
manufacturer's aggressive marketing claim it to be, and it is certainly not
cheap at over US$30 a month. It also sticks in my craw that the manufacturer
plays on people's vulnerabilities, doesn't play by the rules, and markets the
product really aggressively (if the product is so good, why is that necessary?
To sell two million doses, I guess).
The best way for cats to take in the correct balance of amino acids is
normally from eating a complete food designed for cats, but if you do want to
try this product, run it by your vet first. Personally, I would save my money
and put it towards more proven treatments.
I have started to receive distressed e-mails from people who have read about
the "seven mistakes in treating pets with chronic renal failure" discussed on
this website. Having read the article myself, I'm not surprised people are
upset. Basically, you caused your cat's CKD; but on no account are you to
treat it. In particular, you are not to use the following:
aluminium-, calcium- or lanthanum-based
I notice she does not give alternatives though. Presumably you should just
leave your cat feeling lousy and allow the CKD to progress faster rather than
use those nasty products.
antibiotics, even if your cat has a urinary tract infection. I
discuss D-mannose above, and I'm not a person who believes in the use of
antibiotics willy nilly, but if your cat has a UTI, s/he needs an antibiotic.
erythropoiesis stimulating agents
(ESAs) for severe anaemia. Apparently using these products is pointless:
"The remedy begins to work within a day; but most studies have shown that pets
return to normal blood cell levels after four weeks of consistent therapy."
This is completely untrue but hey, better to let your cat die of treatable
anaemia rather than use another nasty product.
There are many more gems such as these.
The problem with holistic sites like this is that they have an agenda. I
don't. Well, I do, but my agenda is to find what works for CKD cats, not to
push the holistic approach at the expense of everything else. I try to give a
balanced view, of course I do have my own prejudices, we all do, but I try to
be as impartial as I can. I don't care if something is holistic or not. All I
care about is that it works and is safe (i.e. the benefits outweigh risks,
e.g. with ESAs when used appropriately). And I don't sell anything on my site,
so I have no axe to grind, I simply look at every treatment and give my
opinion supported by research where at all possible.
I really do not recommend visiting this website. If you have had the
misfortune to do so before coming here, here is your new mantra: I did
not cause my cat's CKD.