Holistic and Homeopathic Medicine

Slippery Elm Bark

Flower Essences


Heel Products

Rehmannia 8



Cautions: Vitamins, Cranberry, Garlic, Noni Juice, Dandelion and Nettle Seed, Colloidal Silver, Essential Oils, Flax Seed (Linseed) Oil, Kidney Support Gold

Save Your Money:

RenAvast, Standard Process



Tanya's CKD Support Group Today



Site Overview

What You Need to Know First

Alphabetical Index


Research Participation Opportunities

Search This Site



What Happens in CKD

Causes of CKD

How Bad is It?

Is There Any Hope?

Acute Kidney Injury



Nausea, Vomiting, Appetite Loss and Excess Stomach Acid

Maintaining Hydration

The Importance of Phosphorus Control

All About Hypertension

All About Anaemia

All About Constipation

Potassium Imbalances

Metabolic Acidosis

Kidney Stones



Coping with CKD

Tanya's Support Group

Success Stories



Alphabetical List of Symptoms and Treatments

Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)

Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)

Phosphorus and Calcium Imbalances

Miscellaneous Symptoms (Pain, Hiding Etc.)



Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)

Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism

Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection

Urinalysis (Urine Tests)

Other Tests: Ultrasound, Biopsy, X-rays etc.

Renomegaly (Enlarged Kidneys)

Which Tests to Have and Frequency of Testing

Factors that Affect Test Results

Normal Ranges

International and US Measuring Systems



Which Treatments are Essential

Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)

Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)

Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)

Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)

Antibiotics and Painkillers

Holistic Treatments (Including Slippery Elm Bark)

ESAs (Aranesp, Epogen etc.) for Severe Anaemia

General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations

Tips on Medicating Your Cat

Obtaining Supplies Cheaply in the UK, USA and Canada

Working with Your Vet and Recordkeeping



Nutritional Requirements of CKD Cats

The B Vitamins (Including Methylcobalamin)

What to Feed (and What to Avoid)

Persuading Your Cat to Eat

Food Data Tables

USA Canned Food Data

USA Dry Food Data

USA Cat Food Manufacturers

UK Canned Food Data

UK Dry Food Data

UK Cat Food Manufacturers

2007 Food Recall USA



Intravenous Fluids

Subcutaneous Fluids

Tips on Giving Subcutaneous Fluids

How to Give Subcutaneous Fluids with a Giving Set

How to Give Subcutaneous Fluids with a Syringe

Subcutaneous Fluids - Winning Your Vet's Support




Heart Problems



Polycystic Kidney Disease (PKD)


Dental Problems









The Final Hours

Other People's Losses

Coping with Your Loss



Early Detection



Canine Kidney Disease

Other Illnesses (Cancer, Liver) and Behavioural Problems

Diese Webseite auf Deutsch



My Three CKD Cats: Tanya, Thomas and Ollie

My Multi Ailment Cat, Harpsie

Find Me on Facebook

Follow Me on Twitter

Contact Me

Home > Treatments > Holistic Treatments



  • Some of 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                                                              Back to Page Index


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 Medicine (TCM). The American Holistic Veterinary Medical Association has a good overview of holistic medicine and how homeopathic treatment forms a part of holistic medicine. If at all possible, please try to visit an holistic vet.


Alt Vet Med - lots of information and links but being remodelled as at April 2012.

East meets west: integrative veterinary medicine (2007) Silver RJ is a detailed paper about holistic treatments. Not all of these treatments will be appropriate for CKD cats.

American Holistic Veterinary Medical Association has members in the USA offering a variety of holistic treatments.



Homeopathy 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 month.


Ideally you should seek advice from a homeopathic vet, though these are not always easy to find. 

The National Center for Complementary and Alternative Medicine has a helpful overview of homeopathy.

Academy of Veterinary Homeopathy has a list of homeopathic vets in the USA and Canada.

The British Association of Homeopathic Veterinary Surgeons can help you find an homeopathic vet in the UK


Herbal Medicine

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 a dose 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 to use.


Health library has information on herbs and supplements and possible interactions with allopathic medicines.

Herbmed - links to summaries of research papers, including benefits, harmful effects and safety testing of herbal medications (primarily relates to human use).



The Distant Healing Network offers free distance healing for pets. 


Slippery Elm Bark                                                                                                   Back to Page Index


What Is Slippery Elm Bark?

The natural remedy most commonly used in the treatment of CKD 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 stomach acid which many CKD cats experience. You will usually see an improvement within a day or two of starting slippery elm bark. 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 cautions).

Slippery Elm Bark Formulations


Loose Powder

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 make the syrup recipe from capsules containing anything other than slippery elm bark.


I would avoid tinctures because they often contain other ingredients, especially 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.

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 or, if you are using loose slippery elm bark, purchase gelcaps separately for this purpose.

Some people have found their cat will eat slippery elm bark if it is mixed in a little baby food (make sure the baby food does not contain any onion).

Syrup Recipe

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:


Stovetop Method

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 whites.


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.


Microwave Method

For the non-cooks among us, one of my support group members came up with this method.


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 again.


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.


Frontier Natural Products Co-op sells loose slippery elm bark, in both organic and standard forms.


Affordable Natural Supplements sells the Now brand of slippery elm bark in both powder and capsule form - type slippery elm in the search facility.


Whole Foods Market sells slippery elm bark in bulk in its stores in USA and Canada.


Iherb sells 4 oz of the NOW brand of slippery elm bark powder for US$8.28.


Drugstore sells 100 370mg Nature's Way slippery elm bark capsules for US$5.99.


Vitamin Shoppe sells two brands of slippery elm bark capsules.


Swanson Vitamins sells its own brand 400mg slippery elm bark capsules for US$3.49 for 100.



Unfortunately, as part of the new EU regulations for herbal products, slippery elm bark was banned in Europe from 1 May 2011. From that date herbal medicines can only be sold in Europe if they have either a traditional herbal registration (which slippery elm bark does not) or a product licence.

UK suppliers (including those mentioned below) will be allowed to sell slippery elm bark until their stocks are exhausted. Thereafter slippery elm bark products will only be available in Europe if they are licensed, but since obtaining a licence can cost as much as £300,000 per product, not every manufacturer will continue to sell slippery elm bark, though apparently Holland and Barrett hopes to do so, as does Neal's Yard. However, there is no guarantee that pure slippery elm bark products will be available; it is entirely possible that manufacturers will instead produce products containing slippery elm bark mixed with other ingredients which may not necessarily be suitable for cats.


Some manufacturers are arguing that slippery elm bark is a foodstuff, which would make it exempt from these regulations. I am waiting to see how this argument pans out. However, if you live in Europe, I recommend stocking up on slippery elm bark with as long a shelf life as possible. If you visit the USA, I would also stock up there.


Medicines and Healthcare Products Regulatory Agency has more information on the new regulations.


Amazon sells 100g of slippery elm bark powder for £10.59.

The Superfood Company sells 50g of slippery elm bark powder for £5.49.

Neal's Yard sells 50g of slippery elm bark powder for £7.15.

Green Life Direct sells  loose slippery elm bark for £5.11 for 50g.


Holland and Barrett sells 100 370mg capsules for £6.99. These are the ones I use (and have stocked up on myself).



Body Energy Club sells 100 capsules (400g each) of slippery elm bark for CAN$7.35 plus tax. Shipping is included in the price.


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 hypercalcaemia.

Slippery Elm Bark More Information

Southwest School of Botanical Medicine has a breakdown of the components of slippery elm bark.

University of Maryland Medical Center also has information on slippery elm bark.

Little Big Cat has an article about slippery elm bark by Jean Hofve DVM.

1001 Herbs has more information on slippery elm bark.


Flower Essences                                                                                                  Back to Page Index

What Are Flower Essences

Flower essences or remedies are made by boiling flowers. 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. 


Many people are sceptical about flower essences, failing to see how they work or believing that using them simply results in the placebo effect. Although I was sceptical, 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.

In order to help your cat, you need to identify which is the most appropriate remedy. Some essences are for personality traits, and others are for moods or emotions. It is best to try to find the remedy suitable for the animal's personality type as well as for its current mood. Thomas, for example, who was a stoical, low-key kind of cat, responded well to Oak as his personality type essence.


Recommended Essences

These are the remedies which I think may help a CKD cat, although others may be helpful too:


Crab apple               the cleansing essence

Gorse                        hopelessness, pessimism

Olive                          exhaustion

Rock rose terror,     panic (perhaps for vet visits)

Star of Bethlehem    shock

Rescue Remedy      for emergencies and crisis situations


Flower Essences Dosage 

There 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.

There is a new 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.

Method One

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 bottle.

Method Two

Alternatively, 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 ears.


Where to Buy Flower Essences


USA Sources

Nelsons 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.

Vitamin Shoppe sells Rescue Remedy (20 ml) for US$10.87 plus shipping. 


UK Sources

Ainsworth's Homeopathic Pharmacy in London sells the Bach remedies by mail order. 

Boots the Chemist in UK sells the remedies for £6.65 each (Rescue Remedy is a little more expensive) - search for Bach. You can also buy the remedies in Boots stores and some other pharmacies. 


Flower Essences Links

The Special Needs Website has more information about flower essences.

The Bach Centre is the home of the Bach Flower Remedies and provides information and links for obtaining the remedies throughout the world.

Bach Calm has information on how to choose a remedy.

Nelson Bach has information on the use of Flower Essences in companion animals.

Pet Synergy - this site has information on many different types of flower essence and links to ordering information.

Pet Education briefly discusses flower remedies.

"Bach Flower Remedies for Animals" by Stefan Ball and Judy Howard, is published by The C W Daniel Company Ltd, price £8.44 from Amazon UK  and US$16.06 from Amazon.


Acupuncture                                                                                                           Back to Page Index


Acupuncture is 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 run smoothly. 


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 Harpsie's arthritis.  


Washington 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. 


Acupuncture Links

Introduction to Veterinary Acupuncture (2001) is an article by Phil Rogers, an Irish vet, presented to the World Small Animal Veterinary Association Congress 2001

International Veterinary Acupuncture Society enables you to search for a veterinary acupuncturist near you.

American Academy of Veterinary Acupuncture can help you find an acupuncturist in the USA.

The Association of British Veterinary Acupuncturists mentions that acupuncture can be helpful for CKD, and allows you to search for a UK veterinary acupuncturist.


Heel Complex                                                                                                          Back to Page Index

What is Heel Complex?

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 using them.


Normally a combination of three remedies is used:

  • Solidago compositum ad us.vet (goldenrod)

  • Ubichinon compositum (CoQ10)

  • Coenzyme compositum ad us.vet (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 at the moment. 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.


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.



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



iHerb sells two of the Heel products in liquid form as follows:

Bank's Chiropractic in the USA sells Heel products online, with orders over US$100 shipping for free within the USA. It will ship internationally for a flat fee of US$29.95 (less for Canada).

Heel USA is the American website. It contains links to retailers - I believe many of these only sell commercial human remedies but they may be able to order the remedies you require.



Heel Canada is the Canadian website. It contains links to retailers - I believe many of these only sell commercial human remedies but they may be able to order the remedies you require.



Biopathica 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.



Ergebnisse zur chronischen Niereninsuffizienz der Katze bei biologischer Behandlung (Results of treating CKD in cats with biological means) (2006) Eichentopf A, Eichentopf F Biologische Tiermedizin 2 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 sub-cutaneously, 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 the treatment.

Biologische Behandlung bei Katzen mit chronischer Niereninsuffizienz (CNI) (Biological treatment of cats with CKD) (2002) Ulf U Wissenschaftliches Veterinär-Symposion der 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 Heel Veterinary Guide has information about these remedies on pages 82 (Coenzyme compositum), 115 (Solidago compositum) and 121 (Ubichinon compositum).


Rehmannia (Jin Gui Shen Qi Wan or Ba Wei Di Huang Wan)                        Back to Page Index


Rehmannia 8 is a traditional Chinese medicine treatment which is supposed to strengthen kidney function. Some sites also recommend it for helping with infection or inflammation. A few members of Tanya's CKD Support Group use it and find it helpful. It is unlikely to do any harm and may be helpful, but do check with your vet before using.


Herbs 2000 mentions that Rehmannia may have a diuretic effect, which is not good for a CKD cat. It also states that Rehmannia should not be used in cats with acute infections.

The Institute for Traditional Medicine has some information about Rehmannia 8.

TCM Assistant also discusses how this works.


Rubenal                                                                                                                   Back to Page Index


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 safe.


In TCM rheum is commonly used in combination with other herbs. Vetoquinol appear to have produced a product that only contains Rheum.


Rubenal is 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, Azodyl.


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 advertise Rubenal 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 Amazon UK.


Drugs explains more about Rubenal.

Rheum officinale, fibrosis and chronic kidney disease (2007) Cosnier A State of the Art in Renal Disease in Dogs and Cats Proceedings, Vetoquinol Academia, reports on Rubenal (go to page 36).

The effects of Rheum officinale on the progression of feline chronic kidney disease (2011) Hanzlicek AS Thesis submitted to Kansas State University College of Veterinary Medicine states "Based on easily measured clinical parameters, this study failed to detect a significant difference in cats administered a Chinese rhubarb supplement, benazepril, or both."

Clinical effects of rheum and captopril on preventing progression of chronic renal failure (1990) Zhang JH, Li LS, Zhang M Chinese Medical Journal 103(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 Nephron 58(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.

Rheum officinale: A new lead in preventing progression of chronic renal failure (record only) (1996) Leishi, L. Chinese Medical Journal 109(1) pp21-69 is an early study into the use of rhubarb extract in CKD.

Memorial Sloan-Kettering Cancer Center has some information about Rheum officinale.


D-Mannose                                                                                                           Back to Page Index


A human study at the Washington University in St Louis School of Medicine, Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection (2001) Mulvey MA, Schilling JD & Hultgren SJ Infection and Immunity 69(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 is supposed to be very helpful when dealing with infections where the bacteria have burrowed into the bladder wall.


D-Mannose is a simple sugar, in fact it is actually the active ingredient in cranberry but without the downsides associated with cranberry. 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 with urination. D-Mannose will only work for urinary tract infections caused by E coli, but this accounts for 90% of all urinary tract infections in humans, and is commonly the cause of feline urinary tract infections too.


I have heard from a number of people who have tried this treatment on their cat, and all of them thought it was effective. 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 mouth.


Since D-Mannose does not get absorbed by the digestive tract, it should be safe for diabetic cats, but check with your vet before using if your cat has diabetes


Although D-Mannose appears to be effective, it seems to work best for cats with a recurring UTI. 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.


D-Mannose is widely available from health food shops (it is often in the women's health section). You want pure D-Mannose. It can also be bought online:


Amazon sells the Now brand at US$17.33 for 3 oz.

Iherb sells the Now brand. 3 oz cost US$20.38

Vitacost sells 2.5 oz of the Kal brand for US$27.33. This brand is stronger than some others so the dosages mentioned above need to be amended accordingly.


Amazon UK sells the Now brand at £20.37 for 3 oz.

D-Mannose UK sells 50g for £17.50. This company will ship to other countries.


The British Medical Journal has information about a human study which showed that lactulose (which is normally used for constipation) may help prevent urinary tract infections in humans.

Cautions                                                                                                               Back to Page Index


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. Below are some of the unsuitable products I have seen recommended for CKD cats, and an explanation as to why they may be inappropriate.  

Vitamin Supplements

CKD 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.



Garlic 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.



You should avoid giving cranberry or food containing cranberry to CKD cats - it is too acidic for CKD cats, who tend towards acidosis anyway. Cranberries also contain benzoic acid, which cats lack the pathways to metabolise. The active ingredient in cranberries is D-Mannose, so you could consider giving D-Mannose to a cat who is prone to urinary tract infections.


Nutrient Requirements of Cats, a 1986 publication from the US Board of Agriculture, explains why benzoic acid is not good for cats.

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.

A market analysis of the US pet food industry to determine new opportunities for the cranberry industry (2005) from the Center for Business Research may help explain why cranberries are suddenly a popular choice as a cat food ingredient.


Noni Juice

This 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. 


Noni juice (Morinda citrifola): hidden potential for hyperkalaemia? (2000) Mueller BA, Scott MK, Sowinski KM & Prag KA American Journal of Kidney Disease 35 pp310-12) reports on a human male who developed hyperkalaemia (high potassium) after drinking noni juice several times a day.

Acupuncture Today has more information on this study and others. 


Dandelion and Nettles

I sometimes hear from people who want to use dandelion root or nettles on their CKD cat 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 CKD cat.


The University of Maryland Medical Center 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 pressure medication.


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.


Colloidal Silver

Some people use colloidal silver as a type of natural antibiotics. However, The 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.


Essential Oils

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 this.


Essentially, essential oils should never be used on cats, and some sources also question whether hydrosols are safe.


Pot pourri hazards in cats is an ASPCA article by a vet about pot pourri, which also discusses essential oils (which are commonly used in pot pourri).

Australian tea tree (Melaleuca alternifolia) oil poisoning in three purebred cats (1998) Bischoff K, Guale F Journal of Veterinary Diagnostic Investigation 10(2) pp208-10.

Toxicity of melaleuca oil and related essential oils applied topically on dogs and cats (1994) Villar D, Knight MJ, Hansen SR & Buck WB Veterinary and human toxicology 36(2) pp 139-142 mentions that in most - but not all - cases, the oil was applied in high doses.


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 Nutritional Requirements for more information on essential fatty acids for CKD cats. Astro's CRF Oil can be found here.


Kidney Support Gold (Tripsy)

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 astralagus root, cordyceps sinesis, rehmannia and Dong Quai root:

  • rehmannia is covered above.

  • astralagus is thought to be an antioxidant but Holisticat states that astralagus should only be used short term in cats.

  • 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. It is a natural blood thinner. It may increase the effectiveness of 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 astralagus 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.


Save Your Money                                                                                                                      Back to Page Index


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 using. 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).

Standard Process Products

Standard Process is a company which manufactures supplements containing kidney glandulars. They make three products which some people use for CKD:

The reasoning 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 Group members 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.


The shady history of Royal Lee and Standard Process products is a report by Quackwatch. Although this is a recent article, the information to which it refers is rather old.



RenAvast was 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."


Amino acids are the components of protein. Peptides are the molecules formed when two or more amino acids are joined together. 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. Taurine 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 amino acids.


RenAvast is marketed as a dietary supplement. Dietary supplements do not need US Food and Drug Administration approval but the manufacturers make 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." The 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 this.


RenAvast is being widely promoted online. The marketing literature for RenAvast focuses 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 for years.


An unrelated study, 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 Research 60(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 RenAvast is the miracle cure it claims to be.


Still, some members of my support group have tried RenAvast and like it, whereas others think it has either not helped or in a couple of cases has even made their cats worse. What do I think? My feeling is that RenAvast might be a good product, it might not, but it is unlikely to be as effective as its manufacturers claim, and it is certainly not cheap at over US$30 a month. Personally, I would save my money  and put it towards more proven treatments than RenAvast.


Back to Page Index

This page last updated: 05 December 2013

Links on this page last checked: 27 April 2012