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Slippery Elm Bark


Flower Essences


Heel Products



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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 (SEB) for gastric hyperacidity 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 Medicine (TCM). The American Holistic Veterinary Medical Association (AHVMA) 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. The AHVMA has members in the USA offering a variety of holistic treatments.


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



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.


National Center for Complementary and Integrative Health 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 a 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.


American Botanical Council has 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


What Is Slippery Elm Bark?

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 bark. A potential nutritional prophylactic for the reduction of feline hairball symptoms (2004) Dann JR, Adler MA, Duffy KL & 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).


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


Little Big Cat Hofve J is an article about slippery elm bark.



Gastrafate is a product available in the USA. It used to contain sucralfate but according to Expedited management of canine and feline vomiting and diarrhea: observational study in 3952 dogs and 2248 cats using sucralfate-like potency-enhanced polyanionic phyto-saccharide elm mucilage (2013) McCullough RW Open Journal of Veterinary Medicine 3 pp228-234, it now contains a patented ingredient referred to as "magnesium chelated elm mucilage" or "polyanionic phyto-saccharide of elm mucilage (PEPPS)...The resultant potency-enhanced phyto-saccharide (PEPPS) is muco-specific and capable of attaining augmented surface concentration of slippery elm."


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.


Drugs mentions that Gastrafate contains calcium carbonate and calcium sulfate (slippery elm bark also contains calcium), so it is probably better not to use it if your cat has hypercalcaemia.


Marshmallow Root

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.


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. Try to ensure the capsules contain only pure slippery elm bark, no fillers, because it can be virtually impossible to make the syrup recipe from capsules containing anything other than slippery elm bark (it will not thicken).


Unfortunately it is difficult 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 safe for cats but may affect the thickening of the syrup, though some people have been able to make it successfully from such capsules. There is one US supplier below selling capsules containing slippery elm bark only.



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.

Most cats are given slippery elm bark daily, but some cats do not need it every day, so experiment and see what works best for your cat.


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 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.


If you are using slippery elm bark decanted from capsules, you need pure slippery elm bark with no fillers, otherwise the syrup will usually not thicken properly.


Stovetop Method

  • Take a stainless steel or heat-proof glass pan (not an aluminium or non-stick one).

  • Put one cup of cold water in the pan.

  • Sprinkle 1 to 1.5 tsp of slippery elm bark powder on to the water.

  • Let it sit until the powder is damp (this should not take too long), then bring to the boil stirring constantly.

  • 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 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 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.

Slippery Elm Bark: Where to Buy



San Francisco Herb Co sells loose slippery elm bark powder at the best price I've found, US$22.20 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. You can also find Frontier products on Amazon.


Mountain Rose Herbs sell 4 oz of slippery elm bark powder for US$9.75.


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


Vitacost sells 4 oz of the NOW brand for US$9.00.


Iherb sells 4 oz of the NOW brand of slippery elm bark powder for US$8.99.


Iherb also sells 100 Christopher's Original Formula 400mg capsules without any fillers. 


Vitamin Shoppe sells slippery elm bark capsules.


Swanson Vitamins sells its own brand 400mg slippery elm bark capsules for US$3.49 for 60.



Unfortunately, EU regulations for herbal products were introduced in Europe in 2011. The Human Medicine Regulations 2012 has a list of affected herbs, which includes slippery elm bark as a restricted ingredient.


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.


Some 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.

Neal's Yard sells 50g of slippery elm bark powder for £9.


Holland and Barrett sells 100 370mg capsules for £10.49. These are the ones I use.



Amazon Canada sells a 1 lb bag of Starwest Botanicals organic slippery elm bark powder for CAN$59.99.


Slippery Elm Bark: Cautions

PennState Hershey states that slippery elm bark can inhibit the absorption of other medications or supplements. 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.




D-mannose is a simple sugar which is used for cats suffering from urinary tract infections. Please see Pyelonephritis and UTIs for more information.


Flower Essences

What Are Flower Essences

Flower essences or remedies are made by either placing 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 described below.


The best known flower essences are the Bach Flower Remedies. 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 Review 12(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.


The impact of the Bach flower remedies on stress among emergency and health service workers: a pilot study (2015) Balgobin SH found that the remedies seemed to have a positive effect on the recipients, though pointed out this might be in part because of the relationship formed with the practitioner who prescribed the remedies.


Recommended Essences

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 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


You can of course also use the essences for yourself.


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. Some remedies are available alcohol-free and may be labelled as safe for animals, including Rescue Remedy for Pets, 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 pets according to the manufacturer, presumably 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



Bach Remedies lists some US stockists.


Vitamin Shoppe sells Rescue Remedy (20 ml) for US$24.99 plus shipping. 



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


Chemist Direct sells Rescue Remedy.


Boots sells Rescue Remedy for £10. Some Boots stores and some other pharmacies also stock the remedies.


Flower Essences Links

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.


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


PetCoach briefly mentions flower remedies.


"Bach Flower Remedies for Animals" (2005) Ball S & Howard J The C W Daniel Company Ltd, is available from Amazon and from Amazon UK.




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

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

What is Heel Complex?

Heel is a German company that produces a number of homeopathic remedies. Members of the German Feline CKD support group, 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)

It is sometimes referred to as SUC, based on the first letter of each remedy.


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 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 subcutaneously, as preferred by the cat's caregiver. 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 caregivers 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 total.



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 press release.


United Remedies in the UK sells Heel products and will ship worldwide.


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 in late 2014 to last her a year, and including shipping it cost her around US$450.


Bio Pathica is the UK supplier. It will only supply to fully qualified practitioners but may be able to put you in touch with such a person in your area.




Chinese rhubarb extract has been used to treat kidney problems in humans for many years in China. Rhubarb leaves are toxic for cats but the root is safe. Rubenal is made from Rheum officinale (Chinese rhubarb extract). In TCM (traditional Chinese medicine),  rheum is commonly used in combination with other herbs, but Rubenal appears to contain Rheum only.


I first heard about Rubenal in April 2008 from a lady who was participating in trials of a new CKD treatment made by Vetoquinol (who also make Ipakitine (Epakitin) and Azodyl) 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).


In 2011 Rubenal became the subject of a label review by the FDA in the USA, which prevents the manufacturer from producing or advertising Rubenal within the USA, so it appears Vetoquinol have stopped producing it. US suppliers no longer have any stock and it is not known when or if the FDA will permit it to be sold again (one Canadian supplier sells it for a high price on the US Amazon). It is still available in some other countries.


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.


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.


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.


Drugs explains more about Rubenal.


Rheum officinale ( a traditional Chinese medicine) for chronic kidney disease (2012) Wang H, Song H, Yue J, Li J, Hou YB & Deng JL Cochrane Database of Systematic Reviews 11(7) examined nine trials into the use of Rheum officinale in 682 human patients. The study concludes "Currently available evidence concerning the efficacy of Rheum officinale to improve SCr and BUN levels in patients with CKD is both scant and low quality. Although Rheum officinale does not appear to be associated with serious adverse events among patients with CKD, there is no current evidence to support any recommendation for its use."


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.




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 (Liu Wei Di Huang Wan), 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. 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.


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.


Rehmannia eight formula and its veterinary formulations: treating aging animals (2010) Dharmananda S has more information about its composition and uses.




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 "natural" things can be very dangerous, such as belladonna.


I am pretty open to the idea of holistic treatments such as some of 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.


A new member of Tanya's CKD Support Group said it perfectly: "we are willing to try just about anything." So many holistic producers know that and frankly prey on you. Please, always consider your sources. If they are using scare tactics, back away. If it's recommended by a friend of a friend's dog's uncle on social media, back away. If they swear it's safe and they get five star ratings but no negative ones, back away. If it's available at a "very reasonable price" (which adds up to US$300 a year), or uses emotional blackmail ("yes, our product is not cheap, but how can you put a price on your cat's health?"), back away.


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 (actually, some of them probably are because people fall for the hype) and this website would be redundant. There is no such miracle cure, so please don't fall for their marketing tactics.


Remember, I'm not trying to sell you anything here. I have no axe to grind about any particular CKD treatment. If it were good, I'd have it on here. I recommend what I have seen work for my own and other cats (and I have "seen" thousands over the last twenty years). If I don't rate something, I tell you why.


Below are some of the 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.


For a cat who is prone to urinary tract infections, I would talk to your vet about using d-Mannose instead.


Renate is a supplement for CKD cats that contains cranberry and turmeric. There is more information about it here.


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.


Noni Juice


This product has high levels of potassium, which can be dangerous for cats with advanced CKD. 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 give dandelion root or nettles to 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.


PennState Hershey says that dandelion may increase levels of stomach acid, and may reduce blood sugar levels.


PennState Hershey 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 antibiotic. However, The National Center for Complementary and Integrative Health 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.


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 intolerant person.


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


The Lavender Cat has a detailed brochure about the risks of using essential oils and hydrosols in cats.


Pot pourri hazards in cats Richardson JA ASPCA/National Poison Control Center is an article by a veterinary poison specialist about pot pourri, which also discusses essential oils (which are commonly used in pot pourri).


Essential oils, diffusers and candles pose a potential risk to cats (2018) International Cat Care reports on the potential risks of essential oils when used around cats.


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 Association 244(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."


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 reports on documented poisoning cases in cats.

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 is applied in high doses.


Omega 6 Oils: Flax Seed Oil (Linseed Oil) and Coconut Oil


Essential fatty acids (EFAs) are polyunsaturated fats (sometimes abbreviated as PUFA). They are essential in the sense that the cat's body cannot synthesise them in sufficient amounts, so they have to be obtained through food.


The two main types of EFAs are omega 3 and omega 6. Commercial diets tend to contain far more omega 6, partly because omega 6 EFAs are cheaper and more stable, but excessive amounts of omega 6 fatty acids may create a potentially harmful imbalance. The correct balance is not yet known, though some believe it is probably around 5:1 (omega 6:omega 3).


There are two omega 6 essential fatty acids for cats, linoleic and arachidonic. Even if you give your cat linoleic 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.


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, so if you want to give your cat an essential fatty acids oil, consider a fish-based oil instead. See Nutritional Requirements for more information on essential fatty acids for CKD cats. Information about Astro's Oil can be found here.


Flax Seed Oil (Linseed Oil)

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.


There have been recent reports that flaxseed may contain cyanide. Ground flaxseed — how safe is it for companion animals and for us (2019) Lindiger M Veterinary Science Research 1(1) pp35-40 reports on safe levels for humans but states that the safe level for cats is unknown.


Since flax seed oil is of limited value to cats anyway, because their bodies cannot metabolise it properly (flax seed oil contains around 13% linoleic acid but no arachidonic acid), so I would not bother with it.


Coconut Oil

There is a real trend for using coconut oil in humans, and I use it myself, but it is also not the best choice for cats. It contains only around 2% linoleic acid, even worse than flax seed oil.


Adding medium chain triglycerides to a cat's diet (2017) Fascetti A Winn Feline Foundation blog advises against using coconut oil in cats, saying that it contains triglycerides, which can reduce palatability for cats, not a good idea for most CKD cats.


Coconut oil and cats (2015) Hofve J also advises against coconut oil for cats. She mentions that it contains triglycerides, which can reduce palatability for cats, not a good idea for most CKD cats.


Coconut oil: the overhyped superfood for pets (2015) Tudor K also advises against coconut oil for cats.


Curcumin (Turmeric)


Curcumin (diferuloylmethane) is one of the components of the spice, turmeric. It is thought to have an antioxidant and anti-inflammatory effect and may have cancer-fighting properties in humans. Therapeutic roles of curcumin: lessons learned from clinical trials (2013) Gupta SC, Patchva S & Aggarwal BB American Association of Pharmaceutical Sciences Journal 15(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 Biology 1(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.


Curcumin is 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 & Medicine 4(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 kidney stones, which are difficult to treat. It may interact with medications such as famotidine.


Ground turmeric as a source of lead exposure in the United States (2017) Cowell W, Ireland T, Vorhees D & Heiger-Bernays W Public Health Reports 132(3) pp289–293 reports on "a growing body of evidence indicating that turmeric containing excessive concentrations of lead is available for purchase in US grocery stores and that childhood lead-poisoning cases attributable to consumption of contaminated turmeric have occurred in the United States. We hypothesize that turmeric is being intentionally adulterated with lead to enhance its weight, color, or both."


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.


Renate is a supplement for CKD cats that contains cranberry and turmeric. There is more information about it here.


PennState Hershey has an overview of turmeric.


Web MD has some information on turmeric.


Kidney Support Gold


Judging by the number of people who join Tanya's CKD Support Group who are already using this product, its manufacturer is very good at marketing, particularly on social media, though it is not particularly popular with longer-serving group members.


Kidney Support Gold contains astragalus root, cordyceps sinesis, rehmannia and Dong Quai root:

  • rehmannia is covered above.

  • astragalus root is thought to be an antioxidant. It seems relatively safe though apparently it 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. Cordyceps 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 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, but it is not cheap and not proven, so personally I wouldn't 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.




I used to receive regular enquiries about a product called Tripsy. Tripsy is apparently still going, though I never get asked about it any more.


Tripsy is designed for "kidney, renal and urinary disorders" (love the tautology). I think they are being rather modest. Tripsy seems to be a panacea for whatever ails your cat. It can simultaneously help treat Feline Lower Urinary Tract Disease, kidney stones and kidney disease. As a bonus, it also helps the liver and pancreas.


Of course, none of this would be necessary if you hadn't made the mistakes you did. Apparently you caused your cat's problems by your choice of food for your cat. If only it were that simple, we would all feed the "correct" food and CKD would disappear and I could have a life.


Unfortunately one of Tripsy's primary goals seems to be to increase urinary flow so it contain a lot of diuretics, which is not a good idea for CKD cats, who tend to urinate a lot and become easily dehydrated anyway. One person told me they contacted the manufacturer about this and were told that the other herbs in the product "help balance the diuretic effect." I find this rather confusing. Why give a diuretic but combine it with something that stops it being a diuretic?


One of the herbs in Tripsy is hydrangea, which is apparently "A pain reliever that increases the flow of urine and eliminates swelling and fluid retention." Unfortunately hydrangea is toxic for cats, according to the ASPCA, and can cause vomiting, lethargy and diarrhoea.


Some people do like Tripsy according to the reviews on their website, but it is not cheap and not proven, so personally I wouldn't use it when more proven treatments are available, which do not erroneously blame you for causing your cat's illness. I would not use it without talking to your vet first, and ideally to an holistic vet.


Hemp-Based Products and Cannabidiol (CBD)


There is increasing interest in using cannabis-based products for a variety of ailments in humans, and some people are also interested in using these products in their cats.


Mammals have an endocannabinoid system in their bodies. This system consists of a number of receptors in the brain and throughout the body. Humans have CB1 and CB2 receptors. Cats definitely have CB1 receptors, but it is not known if they have CB2 receptors.


CB receptors regulate many physiological processes, including pain and appetite. It is thought that cannabis-based products may affect the endocannabinoid system in a positive manner, helping, amongst other benefits, to control pain and improve appetite.


Difference Between Marijuana (THC) and Cannabidiol (CBD)

The cannabis plant contains more than eighty biologically active compounds known as cannabinoids. The two usually of primary concern when discussing cannabis are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).


Marijuana and industrial hemp are both derived from the cannabis plant and therefore both contain a number of cannabinoids but — and this is key — in different ratios. Marijuana, when processed, contains 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.


Despite the name, some (but not all) forms of medical marijuana are based on hemp.


Marijuana (THC) and Cannabidiol (CBD) Regulation



Marijuana is a Schedule 1 drug in the USA. Some US states permit marijuana (THC)  to be used in humans for medical reasons, and in 2012 two states (Washington and Colorado) also legalised marijuana for recreational use. Nevertheless, under federal law the DEA still considered a product derived from the cannabis plant to be a controlled substance.


However, in 2018 the Agriculture Improvement Act of 2018 removed hemp (defined as cannabis or derivatives of cannabis with a THC content below 0.3% on a dry matter analysis basis) from the Controlled Substance Act's definition of marijuana. Therefore hemp is no longer a controlled substance under federal law.


In 2019 the US Food and Drug Administration held a public hearing into the legal status of certain cannabis-based products and has set up a working group to look into the matter further.


The US Food and Drug Administration explains more about its role in regulating cannabis-related products, including CBD.



Medicinal cannabis was legalised for humans in the UK in late 2018, but it is only very rarely prescribed, and only for very  specific conditions such as rare seizure disorders, nausea and vomiting caused by chemotherapy, or muscle spasms and stiffness caused by multiple sclerosis. It can only be prescribed by hospital consultants, not by GPs.



Cannabis was legalised in Canada for humans in 2018. According to the Canadian Veterinary Medical Association, vets in Canada are not legally allowed to prescribe cannabis products to companion animals, though the law is due for review in 2021, so this may change.


CBD-Based Products for Cats

There is increasing interest in using these products for pain such as arthritic pain, anxiety and occasionally for inappetence. A number of companies in the USA 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 (although Australia has recently legalised medical marijuana for humans). However, see below.


Veterinary Marijuana? (2013) Nolen RS JAVMA News discusses the use of marijuana in pets.


I have not had much feedback about CBD-based products yet, but several members of my support group have tried one of these products on their cats. After about a week, most of them did see an increase in appetite.


Personally, I would want veterinary input, and ideally more research, before using CBD-based products in my cat.


CBD-Based Products: Research

Colorado State University College of Veterinary Medicine is looking into the use of CBD for epilepsy and arthritis in dogs, and Cornell University College of Veterinary Medicine is also investigating the use of CBD in dogs. Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs (2018) Gamble L-J, Boesch JM, Frye CW, Schwark WS, Mann S, Wolfe L, Brown H, Berthelsen ES & Wakshlag JJ Frontiers in Veterinary Science epub found that CBD may be helpful for dogs with osteoarthritis


Consumers' perceptions on hemp products for animals (2016) Kogan LR, Hellyer PW & Robinson NG American Holistic Veterinary Medical Association Journal 42 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.


An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies (2017) Iffland K & Grotenhermen F Cannabis and Cannabinoid Research 2(1) pp139–154 looked at research into the use of these products but no research in cats is mentioned.


Single-dose phamacokinetics and preliminary safety assessment with use of CBD-rich hemp nutraceutical in healthy dogs and cats (2019) Deabold KA, Schwark WS, Wolf L & Wakshlag JJ Animals (Basel) 9(10) p832 gave CBD oil to healthy dogs and cats. The study states "Based on these and other recent data, CBD-rich hemp nutraceuticals appear to be safe in healthy adult dogs, while more work in cats is needed to fully understand utility and absorption." The study adds that liver enzymes should be monitored in cats receiving CBD.


In 2019 the American Veterinary Medical Association submitted comments to the FDA regarding the use of CBD in companion animals which state "Although we are encouraged by some of the information obtained from therapeutic investigations into the use of cannabis for treatment of epilepsy and osteoarthritis, few well-controlled studies have been published and results thus far are inconsistent...much of what we know regarding the use of these products in veterinary patients is anecdotal. It is not our intent to suggest that benefits may not exist. To the contrary, there appears to be real potential for cannabis-derived products in the veterinary medical space. However, the path to market must support pursuit of the research necessary to produce safe and efficacious products with valid label claims."


As far as CBD for CKD goes, A review of cannabis in chronic kidney disease symptom management (2019) Ho C, Martinusen F & Lo C Canadian Journal of Kidney Health and Disease 6 pp1-14 looked at the use of marijuana (including both CBD and THC) in human CKD patients. The study states "Until further studies are conducted, the role of nonsynthetic cannabinoids for symptom management in patients with CKD should be limited to the treatment of chronic neuropathic pain."


Safety and tolerability of escalating cannabinoid doses in healthy cats (2021) Kulpa JE, Paulionis LJ, Eglit GML & Vaughn DM Journal of Feline Medicine and Surgery 23(12) pp1162-1175 gave cats increasing doses of CBD, THC and a mixture of both. Adverse events were more common in cats given either THC or THC and CBD together, but cats given increasing  doses of CBD did experience some adverse events, including drooling and wobbliness.The study concludes "Our findings support continuing research on the potential therapeutic uses of orally delivered CBD in cats, and for its consideration as a safe treatment optionin veterinary medicine." All the study authors are current or former employees of the supplier of the product used in the study.


CBD-Based Products: Issues

Some brands make bold marketing claims. In 2015 the FDA 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.


One major problem with many hemp-based products is that they may not contain much, or even any, CBD. 2015 warning letter 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."


Five years later, this continues to be a problem. Cannabinoid, terpene and heavy metal analysis of 29 over the counter commercial veterinary hemp supplements (2020) Wakshlag JJ, Cital S, Eaton SJ, Prussin R & Hudalla C Veterinary Medicine Research and Reports 11 pp45-55 examined 29 products and found that they all contained less than 0.3% CBD, though some contained none. The study concludes "The products analyzed had highly variable concentrations of CBD or total cannabinoids with only 18 of 29 being appropriately labeled according to current FDA non-medication, non-dietary supplement or non-food guidelines. Owners and veterinarians wanting to utilize CBD-rich Cannabis sativa products should be aware of low-concentration products and should obtain a COA enabling them to fully discuss the implications of use and calculated dosing before administering to pets."


It is also possible for products stating that they contain CBD to contain some THC, which could be dangerous for cats.


Cannabis-based products contain terpenes, which are the compounds that give plants their colour, smell and taste. Different cannabis plants have different terpenes. Some, for example, may contain lemon- or pine-scented terpenes, which many cats dislike the smell of. You need to see the Certificate of Analysis from an independent laboratory which will state which type of terpenes are in the product.


Deciding how much CBD to give your cats is also problematic, because the correct dose is not known.


CBD-Based Products: Choices

A product called Epidiolex is approved for use in humans with rare seizure disorders, and according to the American Veterinary Medical Association, "is Schedule V and is available to veterinarians for extralabel use in animals under the Animal Medicinal Drug Use Clarification Act (AMDUCA)."


Some people buy OTC products for their cats (and in some countries you may not have any alternative) but there is no guarantee they contain what you think you are buying (see Issues).


CBD-Based Products: Side-Effects and Interactions

CBD may increase the effects of amlodipine (for hypertension). Drugs has more information.


It may also interact with painkillers such as buprenorphine, tramadol or fentanyl.


Aloe Vera


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 misbranded."


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.


Memorial Sloan Kettering Cancer Center has some information about aloe vera.


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.


A small percentage of 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.


Amino Acids: Protein Supplements


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. 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.


One 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 CKD 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 few amino acid supplements marketed for CKD cats as follows.

Astro's Oil Renal Care Protein

The maker of Astro's Oil also offers Astro's Oil Renal Care Protein (previously called Astro's CRF Protein Powder). It was apparently tested on 24 cats and 11 dogs but this study has not been published.


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 little processing 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 egg whites.


The powder is odourless and water soluble. It is usually given about twenty minutes before food - it can be mixed with water and syringed into the mouth 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$35.95 plus shipping costs of US$7.95 for a 60g jar which would last 1-2 months for most cats. 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, though that may have improved with the new packaging) so it does not arrive.


I am not aware of any studies into the use of fish protein hydrolysate in CKD patients but it appears to be helpful with other conditions. Reparative properties of a commercial fish protein hydrolysate preparation (2005) Fitzgerald AJ, Rai PS, Marchbank T, Taylor GW, Ghosh S, Ritz BW, Playford RJ Gut 54 pp775-781 found that fish protein hydrolysate significantly reduced gastric injury in rats and concluded "Fish protein hydrolysate possesses biological activity when analysed in a variety of models of injury and repair and could provide a novel inexpensive approach for the prevention and treatment of the injurious effects of non-steroidal anti-inflammatory drugs and other ulcerative conditions of the bowel." Another study, Fish protein hydrolysate reduces plasma total cholesterol, increases the proportion of HDL cholesterol, and lowers Acyl-CoA:cholesterol in liver of Zucker rats (2004) Wergedahl H, Liaset B, Gudbrandsen OA, Lied E, Espe M, Muna Z, Mørk S and Berge RK Journal of Nutrition 134 pp1320-7, concluded that fish protein hydrolysate "may have a role as a cardioprotective nutrient."


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

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 [sic]." 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 L-carnosine.


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."


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 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 has been approved by the Czech Institute of State Control for Veterinary Biologicals and Medicines as a non-medicinal veterinary product, so you may well to be offered to you if you are in the Czech Republic.


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 therapeutic kidney 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.


Effect of AB070597 on blood-serum creatinine concentration in cats with chronic kidney disease (2015) Archer JD Research Journal for Veterinary Practitioners 3(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 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.


Beaphar NutriSupport Kidney

Beaphar NutriSupport Kidney contains taurine, L-carnitine and yeast. It is unlikely to cause any problems, but I can't see that it brings much to the table either.


Shirley's Wellness Cafe


I sometimes receive distressed e-mails from people who have read about the "seven mistakes in treating pets with chronic renal failure" discussed on Shirley's 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 phosphorus binders. 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 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.


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This page last updated: 08 June 2022

Links on this page last checked: 18 July 2020







I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.


If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.



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