From the Guidelines
Foods high in potassium that can exacerbate hyperkalemia include bananas, oranges, potatoes, tomato products, legumes, lentils, yogurt, and chocolate. According to the kdoqi clinical practice guideline for nutrition in children with ckd: 2008 update 1, these foods are considered high in potassium and should be limited in children with CKD stages 2 to 5 and 5D who have or are at risk of hyperkalemia.
Key Points to Consider
- The nutrition facts panel on food labels can provide potassium content, with foods containing 200 to 250 mg or greater than 6% DV considered high in potassium 1.
- Breast milk has a lower potassium content compared to standard commercial cow’s milk-based infant formulas, with 546 mg/L (14 mmol/L) in mature breast milk 1.
- Volumes of infant formula of 165 mL/kg or greater can exceed 120 mg (3 mmol) K/kg and may aggravate hyperkalemia 1.
Potassium Restriction
To manage hyperkalemia, suggested dietary management limits intake to less than 2,000 to 3,000 mg (50 to 75 mmol/d) of K daily for adults, which is equivalent to less than 30 to 40 mg/kg/d (0.8 to 1 mmol/kg/d) for a 70-kg standard adult 1. For infants and young children, 40 to 120 mg (1 to 3 mmol/kg/d) of K may be a reasonable place to start 1.
Foods to Limit
Some examples of high-potassium foods that should be limited in patients with hyperkalemia include:
- Bananas
- Oranges
- Potatoes and potato chips
- Tomato products
- Legumes and lentils
- Yogurt
- Chocolate It is essential to consult with a healthcare provider to determine the best course of action for managing hyperkalemia and restricting potassium intake 1.
From the FDA Drug Label
Patients who receive spironolactone should be advised to avoid potassium supplements and foods containing high levels of potassium, including salt substitutes. The answer is:
- Foods containing high levels of potassium are to be avoided, but the label does not specify which foods are high in potassium. 2
From the Research
Foods High in Potassium
Foods that are high in potassium include:
- Fruits
- Vegetables
- Nuts
- Potatoes, which are the highest source of dietary potassium 3
- White vegetables, which are associated with a decreased risk of stroke, possibly due to their high potassium content 3
Importance of Potassium Intake
Increasing potassium intake has been associated with significant reductions in both systolic and diastolic blood pressure, particularly in patients with hypertension and those with a high sodium intake 4 A high potassium intake may also reduce the risk of stroke by approximately 25% 4 However, high potassium intake may be risky in hypertensive patients with chronic kidney disease (CKD) stages 3-5, particularly diabetics 4
Hyperkalemia Risk
Severe hyperkalemia from oral potassium is extremely rare if kidney function is normal, but can occur in patients with renal impairment or those taking certain medications such as potassium-sparing diuretics, angiotensin receptor blockers, or angiotensin-converting enzyme inhibitors 5 Life-threatening hyperkalemia can also occur from nutritional supplements containing potassium, particularly in patients who take excessive quantities 5 Hemodialysis patients are often advised to limit their intake of high-potassium foods to help manage hyperkalemia, although the benefits of this practice are not supported by rigorous randomized controlled trials 6