Nutrient Non-equivalence: Does Restricting High-Potassium Plant Foods Help to Prevent Hyperkalemia in Hemodialysis Patients?

Abstract

Hemodialysis patients are often advised to limit their intake of high-potassium foods to help manage hyperkalemia. However, the benefits of this practice are entirely theoretical and not supported by rigorous randomized controlled trials. The hypothesis that potassium restriction is useful is based on the assumption that different sources of dietary potassium are therapeutically equivalent. In fact, animal and plant sources of potassium may differ in their potential to contribute to hyperkalemia. In this commentary, we summarize the historical research basis for limiting high-potassium foods. Ultimately, we conclude that this approach is not evidence-based and may actually present harm to patients. However, given the uncertainty arising from the paucity of conclusive data, we agree that until the appropriate intervention studies are conducted, practitioners should continue to advise restriction of high-potassium foods.

Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Associations of reported dietary potassium intake with serum potassium concentration in hemodialysis patients from the Nutritional and Inflammatory Evaluation in Dialysis (NIED) study (n=224) Regression line (solid line) and 95% confidence interval (shaded area) are shown for the linear regression analysis. Reproduced with permission from Noori et al., Am J Kidney Dis 2010;56(2):338–347.

Figure 2

Associations of reported dietary potassium intake with serum potassium in hemodialysis patients from the BalanceWise Study (n=140) a. Potassium Intake; r=0.06, p=0.50 b. Potassium Density; r=−0.003, p=0.97

Figure 2

Associations of reported dietary potassium intake with serum potassium in hemodialysis patients from the BalanceWise Study (n=140) a. Potassium Intake; r=0.06, p=0.50 b. Potassium Density; r=−0.003, p=0.97