Azodyl is a patented formulation of naturally-occurring beneficial bacteria (Kibow Biotics®) that metabolize and flush out uremic toxins that have diffused into the bowel. It is the first veterinary product that specifically focuseson the reduction of toxin buildup in the blood of dogs and cats with azotemia.Renal care supplement for pets. Shipped in thermal envelope with an ice pack, or upgrade your packaging for more protection.Please consider the day of the week you order cold shipping products. We can hold your order until the following Monday, and will do so at your request only. This will help reduce exposure to heat until delivery. We do not guarantee cold delivery and will not issue any refunds or exchanged for cold shipping items.Want it shipped Cold? Click Here for More Options.