Potassium and the Renal Hemodialysis Diet

When I think about Potassium, an image of bright yellow bananas automatically forms in my mind.  I feel like I am probably not alone and perhaps there are people whose knowledge of potassium is limited to the image of bananas. I hope this will be helpful then to someone who before never thought about potassium, what it is,  why it is important in our diet for overall good health?  And more importantly, why is potassium of concern to individuals receiving dialysis  treatments?

Potassium is a mineral that is found naturally in many of the foods we eat.  It is important for good health because potassium helps to keep our heartbeat regular, and fluid balanced in our bodies, keeping our blood pressure normal. It also helps to keep our muscles working properly.  Healthy kidneys that are doing their job make sure we have the right amount of potassium in our bodies by getting rid of extra potassium we eat in our urine. People with Chronic Kidney Disease (CKD), can no longer do the job they are supposed to. If a person with unhealthy kidneys eats high potassium foods the level of potassium in the blood can reach a dangerous level. High potassium levels can cause a person to feel weakness, numbness, and a tingling sensation.  If the level is dangerously high, it can cause a person to have an irregular heartbeat, or even lead to a heart attack.  

It is important to keep track of your potassium level. Knowing if your level falls in the safe zone, the caution zone, or the danger zone is crucial to your health.  Tracking your potassium level allows your dietician and doctor to recommend changes to your eating patterns and medications to ensure you stay as healthy as possible. You might find it helpful to keep an ongoing log of potassium levels, similar to your food diary. My patients have found it helpful in the past to write down the levels in a notebook.  If you are recording everything you eat and drink in a food diary, and potassium rises or falls, we can look at what foods you were eating during that time period. Perhaps this will help us in making  decisions at the grocery store, or even if we should have a meal in a restaurant, or perhaps limit that to fewer times a month. Discussing all of that with her dietitian  becomes easier once we know what it is we need answers to or help with!  Potassium levels that fall into the Safe Zone are generally 3.5-5.0. The caution zone is levels of 5.1-6.0.  Anything higher than 6.0 is considered to be in the danger zone.  Do you know what zone you are in?  

To keep your potassium level from becoming too high and putting you in that danger zone, you should limit the foods that are high in potassium. Your dietitian can help you in planning your diet so you are getting the right amount of potassium. On the renal diet potassium is limited to less than 2000mg per day. High potassium foods are those that have more than 200mg of potassium per serving. You should be eating a variety of foods, but in moderation. Remember, the serving size is very important. Almost all foods have some potassium. Eating a large amount of a low potassium food can turn it into a high potassium food!

Over the weekend my aunt and I made a trip to our local farmers market. We enjoyed the warm sunny day looking at all the booths selling locally made arts and crafts, and shopping for fruits and vegetables. We came prepared with a list of those that are lower potassium that she can have on a renal diet, and came home with a week worth of delicious, healthy additions to our meals.  Below you can see  the list of low potassium fruits and vegetables. Serving size is ½ cup, unless otherwise noted.

‍Fruits low in Potassium‍

Apple (1 medium), Apple juice, Applesauce, Apricots, Blackberries, Blueberries, Cherries, Cranberries, Fruit Cocktail, Grapes, Grape juice, Grapefruit (½ of whole) Mandarin Oranges, Peaches (fresh 1 small, canned ½ cup), Pears (fresh 1 small canned ½ cup), Pineapple, Pineapple juice, Plums, Raspberries, Strawberries, Tangerine, Watermelon (limit to 1 cup).

‍Vegetables low in Potassium‍

Alfalfa Sprouts, Asparagus (6 spears, raw), Beans (green beans, wax beans), Broccoli, Cabbage, Carrots, Cauliflower, Celery, Corn, Cucumber, Eggplant, Kale, Lettuce, White mushrooms, Onions, Parsley, Peas, Peppers, Radish, Rhubarb, Water chestnuts (canned), Watercress, Yellow squash, Zucchini Squash  

Below, I have listed the fruits and vegetables that are high in potassium. (greater than 200 milligrams per serving). You should try to avoid these. Serving size is ½ cup unless otherwise noted.

‍Fruits high in potassium

Apricot, raw (2 medium) dried (5 halves), Avocado (¼ of whole),  Banana (½ of whole),  Cantaloupe, Dates (5 whole),  Figs, dried,  Grapefruit juice,  Honeydew,  Kiwi (1 medium),  Mango (1 medium),  Nectarine (1 medium),  Orange (1 medium),  Orange juice,  Papaya (½ of whole),  Pomegranate (1 whole),  Pomegranate juice,  Prunes,  Prune juice,  Raisins

‍Vegetables high in potassium

Acorn squash,  Artichoke,  Bamboo shoots,  Baked beans,  Butternut squash,  Refried beans,  Beets, fresh then boiled,  Black beans,  Broccoli, cooked  Brussel sprouts,  Chinese cabbage, Carrots, raw  Dried beans and peas,  Greens, except Kale,  Hubbard squash,  Kohlrabi,  Lentils,  Legumes,  White mushrooms, cooked (½ cup)  Okra,  Parsnips,  Potatoes, white and sweet,  Pumpkin,  Rutabagas,  Spinach, cooked  Tomatoes/Tomato products,  Vegetable juices  

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References

National Kidney Foundation

The Cleveland Clinic

DaVita

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About the Author

Elizabeth Custer is a registered dietitian at Huntington Health and USC Arcadia.  She completed her Bachelor's Degree in clinical nutrition at University of California Davis, and dietetic internship at Sacramento State University.  She has worked in many settings including acute hospital, sub-acute, skilled nursing, psychiatric, outpatient, retirement, and convalescent facilities. As a registered dietitian, her primary role includes assessing patients, providing nutrition education, and implementing medical nutrition therapy for a variety of medical conditions, such as chronic kidney disease, cardiovascular disease, hyperlipidemia, diabetes, hypertension, and more. Her passion lies with direct patient care and her experience in clinical, food service, and managerial roles has allowed her to deliver high-quality, evidenced-based strategies to promote health, well-being, and manage nutrition-related diseases. Elizabeth presented her research paper on food insecurities among students at the California Association of Nutrition and Dietetics Annual Conference in 2018.

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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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