Effect of dietary phosphate restriction on renal secondary hyperparathyroidism in the cat

Twenty-three cats with stable chronic renal failure (CRF) were examined in a prospective study of the effects of feeding a veterinary diet restricted in phosphorus and protein with or without an intestinal phosphate binding agent (aluminium hydroxide) on plasma phosphate and parathyroid hormone (PTH) concentrations. Fifteen cats accepted the veterinary diet; compliance was not achieved in the remaining eight (due to limited intake by the cats or owner resistance to diet change). Feeding the veterinary diet was associated with a significant fall in plasma phosphate and PTH concentrations by five months, with only two cats requiring aluminium hydroxide therapy. The maximum decrease in plasma PTH concentration was not associated with a significant change in plasma 1,25 dihydroxycholecalciferol concentration. Euparathyroidism was achieved in eight cats. Conversely, in cats with CRF fed proprietary diets over the same time period, mean plasma PTH concentrations did not change significantly; indeed, in seven of the eight cats, PTH concentrations increased. Dietary therapy alone or in combination with intestinal phosphate binders does reduce PTH concentrations in cats with CRF and, when effective control of phosphate intake is achieved, plasma PTH can be normalised.