Calcium and phosphorus in diet therapy of uremia

Significant advances have been made in understanding the pathogenesis of renal osteodystrophy. Several factors play a role in the development of uremic bone disease, such as secondary hyperparathyroidism, PTH resistance at the level of bone, abnormalities in vitamin D metabolism, and factors contributing to extraosseous calcification. Through a better understanding of the pathogenetic mechanisms, a more rational approach to the dietary management of patients with chronic renal failure has been possible. In view of present knowledge, the following preventive and therapeutic interventions can be recommended: provision of liberal calcium intake in the diet, appropriate restriction of phosphorus intake, provision of potent vitamin D analogs, and close attention to the calcium-phosphorus product. With careful attention to these recommendations, the bone lesions of secondary hyperparathyroidism and osteomalacia may be minimized and even prevented.