From the Guidelines
For hyperkalemia, a low-potassium diet is recommended, limiting intake to less than 2,000 to 3,000 mg of potassium daily. This is based on the guideline that suggests limiting potassium intake for children with CKD stages 2 to 5 and 5D who have or are at risk of hyperkalemia 1.
Key Principles of a Low-Potassium Diet
- Limit high-potassium foods such as bananas, oranges, potatoes, tomato products, legumes, lentils, yogurt, and chocolate
- Focus on lower-potassium options like apples, berries, grapes, carrots, green beans, and white rice
- Portion control is crucial even with lower-potassium foods
- Cooking techniques like soaking and boiling vegetables in water (then discarding the water) can help reduce potassium content
- Processed foods should be limited as they often contain hidden potassium additives
- Staying well-hydrated with water helps the kidneys excrete excess potassium
Importance of Dietary Management
Dietary management of hyperkalemia is critical to prevent and manage hyperkalemia, especially in patients with chronic kidney disease (CKD) stage 5, as severe hyperkalemia can rapidly lead to death from cardiac arrest or paralysis of muscles that control ventilation 1.
Additional Considerations
- Breast milk has a lower potassium content compared to standard commercial cow’s milk-based infant formulas, which is important for infants and young children with hyperkalemia
- The nutrition facts panel on food labels can provide guidance on potassium content, with foods containing less than 100 mg or less than 3% DV considered low in potassium, and foods containing 200 to 250 mg or greater than 6% DV considered high in potassium 1.
From the Research
Dietary Recommendations for Hyperkalemia
The recommended diet for hyperkalemia (elevated potassium levels) involves careful management of potassium intake, especially in patients with decreased kidney function 2, 3.
- A dietary potassium restriction of usually less than 3 g per day is recommended in the management of patients with reduced kidney function 2.
- Potassium-rich foods, such as fresh fruits and vegetables, are considered heart-healthy nutrients with high fiber, high anti-oxidant vitamins, and high alkali content 2.
- To achieve a careful reduction of dietary potassium load without a decrease in alkali or fiber intake, certain pragmatic dietary interventions are recommended, including:
- Improving knowledge and education about the type of foods with excess potassium 2.
- Identifying foods that are needed for healthy nutrition in renal patients 2.
- Classification of foods based on their potassium content normalized per unit of dietary fiber 2.
- Education about the use of cooking procedures, such as boiling, to achieve effective potassium reduction before eating 2.
- Attention to hidden sources of potassium, in particular additives in preserved foods and low-sodium salt substitutes 2, 3.
Individualized Approach
An individualized and gradual reduction of dietary potassium intake in people at risk of hyperkalemia is recommended 3.
- The current potassium dietary advice in chronic kidney disease needs to be reevaluated, individualized, and gradually introduced 3.
- Before restricting dietary potassium, the patient's intake of potassium should be carefully evaluated, and other potential clinical factors related to serum potassium balance should be considered in the management of hyperkalemia in CKD 4.
Etiology-Based Approach
An etiology-based approach to managing hyperkalemia is proposed, which combines key elements of the low-potassium and plant-rich diets, and adds new features of meal planning to lower the risk of postprandial hyperkalemia 5.
- This approach takes into account the observation that reported dietary potassium intake is not associated with plasma potassium concentrations, but people with CKD have impaired potassium tolerance that may make them susceptible to transient increases in plasma potassium levels from dietary potassium 5.
Importance of Awareness
Hyperkalemia can be induced by dietary intake, not only in patients with chronic kidney disease but also in those with normal kidney function 6.