Updating the Approach to Potassium Management in Nephrology Care

Potassium management is critical in nephrology care due to the risk of cardiac arrhythmias caused by imbalanced potassium levels. Traditionally, a renal diet with potassium restriction was recommended for those with chronic kidney disease (CKD). However, recent evidence suggests a need for more personalized and liberal recommendations.

The KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines updated their guidance on potassium management in 2020, recommending:

1. Adjusting dietary intake to keep serum potassium in the normal range.
2. Individualizing dietary or supplemental potassium intake based on patient needs and clinician judgment for adults with hyperkalemia or hypokalemia.

This shift in potassium recommendations recognizes that modifying a diet may not always influence serum potassium levels in CKD patients and that multiple factors can affect serum potassium levels, such as medications, gastrointestinal problems, acid-base balance, glycemic control, and catabolic state. High potassium levels should be seen as a signal that something else needs to be addressed.

Additionally, a more liberal potassium diet has several benefits for those with CKD, such as improved cardiovascular health, metabolic acidosis control, reduced inflammation and fibrosis, gut health, reduced production of uremic toxins, decreased risk of kidney stones, and improved quality of life. A survey of dialysis patients showed that adhering to the renal diet can be difficult due to complexity, conflicting dietary recommendations, and social issues.

For implementing these more liberal and individualized potassium recommendations, nephrology providers should consider the root cause of high potassium levels, follow guidelines for potassium intake based on stage and serum level, recognize that most potassium in diets comes from various foods, clarify follow-up with patients and staff, and refer patients to a renal dietitian for support.

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Related Articles

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Potassium and the Renal Hemodialysis Diet

Study Links Dietary Potassium Intake With Blood Potassium Concentration in CKD Patients

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References

Updated Guidelines Challenge Current Standard for Potassium Intake in CKD

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update

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‍About the Author

Rich Foreman brings over 30 years of technology leadership to his role of CEO and Co-Founder of KidneySoft.  As founding CTO, Rich led the team that developed the CordicoShield / CordicoFire Wellness App. Cordico was honored with the Sacramento Innovation Award in 2021. After achieving a 7 digit ARR, Cordico was acquired by Lexipol in 2020. Rich has a BS in Industrial Engineering from the University of Washington, an MPA from Troy State University and was an officer in the U.S. Navy. Rich co-authored his book, "Tap into the Mobile Economy." Rich's blog was listed in Top 20 Marketing Mobile Blogs of 2014. He has been featured on KCRA3, NEWS10, 1170 Tech AM PowerDrive, Business Radio Money 105.5, SiliconIndia, the Sacramento Business Journal, and the Sacramento Bee. Rich is also the Founding Director of the Sacramento Chapter of Startup Grind and served a term as Utility Commissioner for the City of Folsom. Rich is a regular contributor to TechWire.net and StartupSac. Rich was the Co-founder of Apptology which was named Small Business of the Year in 2014 by the Sacramento Asian Pacific Chamber. He was also the Founding Chief Technology Officer at Cordico. Cordico was acquired by Lexipol in 2020.  Rich also served 4 years as a Naval Officer in the Civil Engineer Corps.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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