Reduction of Incidence of Renal Osteodystrophy Associated with Low Protein Diet in Early Renal Failure

Abstract

HE INCIDENCE of renal osteodystrophy in chronic renal failure in Israel is small less than 2 per cent of the patients having symptoms, or biochemical or radiological T criteria of osteodystrophy, whereas in Europe and North America it is 5 to 10 per cent (Reubi, 1971; Dossetor and Gault, 1971). Even in patients on regular haemodialysis, only 10 per cent have any radiological evidence of hyperparathyroidism. In the UK and the us the incidence of renal osteodystrophy is sufficiently high in frequency in dialysed patients to create a serious problem. We adduce evidence that the reason for the low incidence of hyperparathyroidism in renal failure in Israel is the normal Israeli diet which is low in phosphorus and normal in calcium, whereas the standard British and us diets contain 40 per cent more phosphorus. In this paper we show that in renal failure in Israel, there is at all stages a significantly lower plasma inorganic phosphorus than in comparable cases in the us and UK. We make the recommendation that anyone developing renal disease should reduce his intakes of meat, eggs and milk to approximately those found in a regular Israeli diet, so as to lessen the phosphate load. This will also reduce subsequent metastatic calcification, red eyes and all the accompanying problems caused by a high plasma calcium phosphorus product. Consequently there is a reduced stimulus to parathyroid secretion in Israeli patients, Reiss et al., (1971) having shown that hyperphosphataemia is associated with increased stimulation of parathyroid secretion.