PDD | TAKING THE KALE OUT OF HYPERKALEMIA: PLANT FOODS AND SERUM POTASSIUM IN PATIENTS WITH KIDNEY DISEASE
J Ren Nutr (2022)
ABSTRACT | Traditionally, diets for kidney disease were low in potassium. This recommendation was based on outdated research and often wrong assumptions that do not reflect current evidence. In fact, studies conducted over the past decades show patients with CKD, including kidney failure, do not benefit from the restriction of plant foods relative to control. Generally, dietary potassium does not correlate with serum potassium, and we posit that this is due to the effects of fiber on colonic potassium absorption, the alkalinizing effect of fruits and vegetables on metabolic acidosis, and the bioavailability of dietary potassium in plant foods. Also, consumption of plant foods may provide pleiotropic benefits to patients with CKD. Emerging dietary recommendations for kidney health should be devoid of dietary potassium restrictions from plant foods so that patient-centered kidney recipes can be encouraged and promoted.
CONCLUSION | Hyperkalemia is a common electrolyte abnormality in those with kidney disease. Because of the dangers associated with this condition, previous consensus and guidelines have cautioned the addition of potassium-rich plant foods in the diets of those with CKD and kidney failure. Based on the evidence from numerous studies of patients with CKD and kidney failure, we believe that the correlation between dietary potassium and sK is small to nonexistent, and that whole, unprocessed plant foods should not be restricted to the extent that they have been in the ‘‘renal diet.’’ These foods likely possess factors that mitigate a potential rise in sK like their high fiber content, alkalinizing potential, and reduced bioavailability of potassium. Last, there are many well documented benefits of plant-based diets and the pleiotropic benefits of plant foods that reduce mortality, symptoms, and comorbidities in CKD and kidney failure patients. Indeed, there are dietary interventions such as the patient-centered plant-dominant low-protein (PLADO) diet and other plant-centered diets that may improve CKD outcomes and prevent or delay renal replacement therapy. We suggest a reconsideration of the previous low potassium guideline that restricts some fruits and vegetables since evidence for this is weak. The current evidence of the benefits of a healthy dietary pattern that centers on plant foods should be cautiously encouraged.