Effect of Dietary Potassium Restriction on Serum Potassium, Disease Progression, and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Morris, Andrew; Krishnan, Nithya; Kimani, Peter K.; Lycett, Deborah

doi:10.1053/j.jrn.2019.09.009

Cited by 34 publications

(24 citation statements)

References 31 publications

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“…Another frequently stated concern is the perceived risk of hyperkalemia. We are not aware of scientific evidence to support the cultural dogma that dietary potassium restriction in CKD improves outcomes [84]. Evidence suggests that dietary potassium, particularly from whole, plant-based foods, does not correlate closely with serum potassium variability [85,86].…”

Section: Safety and Adequacy Of A Plant-dominant Low-protein Dietmentioning

confidence: 98%

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

et al. 2020

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Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

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Section: Safety and Adequacy Of A Plant-dominant Low-protein Dietmentioning

confidence: 98%

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

et al. 2020

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“…A recent meta-analysis indicated that restriction of dietary potassium significantly reduces serum potassium levels in patients with CKD; however, this effect was driven by the results of 1 randomized trial, in which dietary potassium intake was strictly controlled with the sole source of nutrition provided by a manufactured liquid diet, which may not be attainable under normal dietary conditions. 24 …”

Section: Influence Of Dietary Potassium Intake On Serum Potassiummentioning

confidence: 99%

Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet

2020

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In patients with advanced-stage chronic kidney disease (CKD), progressive kidney function decline leads to increased risk for hyperkalemia (serum potassium > 5.0 or >5.5 mEq/L). Medications such as renin-angiotensin-aldosterone system inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks for cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal renin-angiotensin-aldosterone system inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk for hyperkalemia, although further studies are needed.

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“…Current expert opinions [27, 32, 38, 39] recommend dietary K restriction in advanced CKD due to higher risk of acute hyperkalemia. However, evidence suggesting a robust relationship between dietary K intake and plasma K concentration is weak and needs to be further explored [32, 40]. Notwithstanding the potential that lower K intake could contribute to the maintenance of stable K levels over time in patients with progressive loss of kidney function, the extent to which dietary interventions are a necessary intervention in the broader CKD population remains unclear.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Potassium Trajectories prior to Dialysis and Mortality following Dialysis Initiation in Patients with Advanced CKD

Dashputre

Sumida

Potukuchi

et al. 2021

Nephron

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Introduction: Patients with advanced non-dialysis-dependent CKD (NDD-CKD) have a reduced ability for maintaining plasma potassium (K) in normal range. Deviation from normal plasma K ranges is associated with increased mortality; however, the average trajectory of plasma K over time in patients with advanced NDD-CKD and the outcomes associated with plasma K trajectory are unknown. Methods: We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 2007 and March 2015 with at least 1 K measurement each year over a 3-year period prior to dialysis transition (3-year prelude). The K trajectory defined as the change in K (slope) per year over the entire 3-year prelude was estimated using linear mixed-effects models. The association between unadjusted (crude) K slope (categorized as stable [−0.09 to 0.09 mEq/L/year], decreasing [≤−0.10 mEq/L/year], and increasing [≥0.10 mEq/L/year]) and time to all-cause and cardiovascular mortality during the 6 months following dialysis initiation was assessed using multivariable-adjusted survival models. Results: The crude and multivariable-adjusted K slopes (mean, 95% CI) over the 3-year prelude were 0.008 (0.0059, 0.0110) and −0.15 mEq/L/year (−0.19, −0.11), respectively. Decreasing K slope was associated with higher multivariable-adjusted risk of all-cause mortality (adjusted hazard ratio [95% CI] vs. stable K slope: 1.08 [1.00–1.17]). No association was observed between K slope and cardiovascular mortality. Discussion/Conclusion: The average intraindividual plasma K trajectory is remarkably stable in patients with advanced NDD-CKD. A decreasing K slope is associated with higher all-cause mortality risk.

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Effect of Dietary Potassium Restriction on Serum Potassium, Disease Progression, and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Cited by 34 publications

References 31 publications

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet

Potassium Trajectories prior to Dialysis and Mortality following Dialysis Initiation in Patients with Advanced CKD

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