Dietary Approach to Recurrent or Chronic Hyperkalaemia in Patients with Decreased Kidney Function

Abstract

Whereas the adequate intake of potassium is relatively high in healthy adults, i.e., 4.7 g per day, a dietary potassium restriction of usually less than 3 g per day is recommended in the management of patients with reduced kidney function, especially those who tend to develop hyperkalaemia including patients who are treated with angiotensin pathway modulators. Most potassium-rich foods are considered heart-healthy nutrients with high fibre, high anti-oxidant vitamins and high alkali content such as fresh fruits and vegetables; hence, the main challenge of dietary potassium management is to maintain high fibre intake and a low net fixed-acid load, because constipation and metabolic acidosis are per se major risk factors for hyperkalaemia. To achieve a careful reduction of dietary potassium load without a decrease in alkali or fibre intake, we recommend the implementation of certain pragmatic dietary interventions as follows: Improving knowledge and education about the type of foods with excess potassium (per serving or per unit of weight); identifying foods that are needed for healthy nutrition in renal patients; classification of foods based on their potassium content normalized per unit of dietary fibre; education about the use of cooking procedures (such as boiling) in order to achieve effective potassium reduction before eating; and attention to hidden sources of potassium, in particular additives in preserved foods and low-sodium salt substitutes. The present paper aims to review dietary potassium handling and gives information about practical approaches to limit potassium load in chronic kidney disease patients at risk of hyperkalaemia.

Constipation in CKD

“…Given the high prevalence of hyperkalemia and its significant association with increased mortality in patients with CKD, it is important to recognize the potential impact of constipation on hyperkalemia management in this population. 91 Dietary potassium is absorbed mostly in the duodenum and jejunum and the net intestinal potassium absorption is approximately 90%. Under physiologic circumstances, intestinal potassium excretion is quite constant at approximately 10 mmol/d, with a maximum level of 15 to 20 mmol/d 91 ; however, when the kidneys are unable to excrete the dietary potassium load (i.e., oliguria/anuria), the gut becomes especially important for maintaining potassium balance.…”

“…91 Dietary potassium is absorbed mostly in the duodenum and jejunum and the net intestinal potassium absorption is approximately 90%. Under physiologic circumstances, intestinal potassium excretion is quite constant at approximately 10 mmol/d, with a maximum level of 15 to 20 mmol/d 91 ; however, when the kidneys are unable to excrete the dietary potassium load (i.e., oliguria/anuria), the gut becomes especially important for maintaining potassium balance. 92 A series of potassium balance studies have demonstrated that potassium excretion in stool was 3 times higher in HD patients compared with healthy controls, reaching approximately 80% of dietary potassium (up to 3000 mg/d) for some HD patients.…”

Potassium Binders for Hyperkalemia in Chronic Kidney Disease—Diet, Renin-Angiotensin-Aldosterone System Inhibitor Therapy, and Hemodialysis

“…15,19,40 This section discusses the clinical implications of addressing the effects of hyperkalemia management on diet, RAAS inhibitor therapy, and hemodialysis and reviews research with new K þ -binding agents that may 41,42 However, in patients at risk for hyperkalemiadsuch as those who have late stages of CKDdhigh dietary K þ presents a clinical challenge. 19,42 Dietary K þ restriction (<3 g/d) is recommended in patients at risk for hyperkalemia but should be individualized because it can lead to patients not receiving the benefits of a heart-healthy diet [43][44][45] (Table 3). 44,46,47 Appropriate dietary counseling is important in patients with CKD with or at risk of hyperkalemia but can be challenging in clinical practice without dedicated resources.…”

Case of Chronic Cough Caused by Accidental Inhalation of Lanthanum Carbonate Granules

“…Furthermore, greater dietary potassium intake was associated with higher mortality even after adjustment for serum potassium level in dialysis patients (8). Thus, dialysis patients should consume fruit and vegetables following cautious dietary advice (9). Healthy dietary patterns but not fruit and vegetables should be tested in dialysis patients.…”