Recommendations on nutritional intake of potassium in CKD: it’s now time to be more flexible!

Restriction of dietary potassium has been traditionally considered a key nutritional intervention in chronic kidney disease (CKD) to limit hyperkalemia onset. Experts suggest to limit potassium intake to less than 3.0 g/d in patients with estimated glomerular filtration rate <30 ml/min per 1.73 m2 and even at earlier stages if hyperkalemia becomes a frequent finding. 1 Cupisti A. Kovesdy C.P. D'Alessandro C. Kalantar-Zadeh K. Dietary approach to recurrent or chronic hyperkalaemia in patients with decreased kidney function. Nutrients. 2018; 10: 261 Crossref PubMed Scopus (100) Google Scholar On the other hand, the latest guidelines on nutrition in CKD do not provide firm recommendations leaving nephrologists with the opinion-level suggestion: “it is reasonable to adjust dietary potassium intake to maintain serum potassium within the normal range.” 2 Ikizler T.A. Burrowes J.D. Byham-Gray L.D. et al. KDOQI Nutrition in CKD Guideline Work Group. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020; 76: S1-S107 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar Although the absence of large randomized trials testing the cause-effect relationship between dietary potassium intake and serum potassium (sK) prevents guideline recommendations, we do believe that it is now time for a mind shift of nephrologists toward a more flexible attitude in most patients with CKD. Three main reasons support our recommendation. Potassium intake in patients with chronic kidney diseaseKidney InternationalVol. 102Issue 4PreviewThe practice of recommending a low-potassium diet to patients with chronic kidney disease (CKD) is widespread despite being mostly opinion-based.1 Several observational studies have shown the usual average potassium consumption to be only weakly associated with serum potassium concentration, even in the presence of severe kidney failure.2–5 Concerns have been raised over the relevance of the practice considering that it often restricts the intake of fruits, vegetables, and other plant-derived compounds of high nutritional value and may substantially impact patients’ quality of life. Full-Text PDF