4.7 Review

Overview of research progress on the association of dietary potassium intake with serum potassium and survival in hemodialysis patients, does dietary potassium restriction really benefit hemodialysis patients?

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Research Progress on the Efficacy and Safety of Spironolactone in Reversing Left Ventricular Hypertrophy in Hemodialysis Patients

Zuoya Sun et al.

Summary: The efficacy and safety of the mineralocorticoid receptor antagonist spironolactone in hemodialysis patients have not been consistent. Abnormal aldosterone secretion plays a critical role in the formation of left ventricular hypertrophy. Low-dose spironolactone (25 mg/d) has shown significant positive effects in decreasing left ventricular mass index, increasing left ventricular ejection fraction, reversing left ventricular hypertrophy, and improving cardiovascular function while still being safe in small-sample clinical studies. More prospective multicenter clinical trials with large sample sizes are needed to provide convincing evidence.

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Plant-Dominant Low Protein Diet: A Potential Alternative Dietary Practice for Patients with Chronic Kidney Disease

Yusuke Sakaguchi et al.

Summary: Dietary protein restriction has long been practiced in the nutritional therapy of chronic kidney diseases (CKD), but the recommended amounts vary across guidelines due to conflicting results from previous trials. Recent studies have shown that a vegetarian, very low protein diet can reduce the risk of kidney failure among advanced CKD patients without increasing hyperkalemia. Plant-dominant low-protein diets (PLADO) are proposed as an alternative therapy for CKD patients, offering several potential benefits such as reducing toxin production, correcting metabolic imbalances, and preventing vascular calcification. However, further evidence is needed to establish the efficacy, safety, and feasibility of PLADO in real-world CKD patients.

NUTRIENTS (2023)

Article Nutrition & Dietetics

Potassium Intake-(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers

Cristina Garagarza et al.

Summary: The study found that following the potassium-rich DASH dietary pattern in HD patients does not lead to increased serum potassium levels, and may even predict lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be suitable for HD patients following a DASH diet plan.

NUTRIENTS (2022)

Article Nutrition & Dietetics

Handouts for Low-Potassium Diets Disproportionately Restrict Fruits and Vegetables

Kelly Picard et al.

Summary: The research investigated current recommendations for low-potassium diet, finding that the diet primarily restricts intake of fruits and vegetables, with less emphasis on ultraprocessed foods. New recommendations suggest a greater focus on ultraprocessed foods, contrary to the current emphasis on restricting plant-based foods. Updates may be needed to reflect these new recommendations in teaching materials.

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Nutritional status, hyperkalaemia and attainment of energy/protein intake targets in haemodialysis patients following plant-based diets: a longitudinal cohort study

Ailema Gonzalez-Ortiz et al.

Summary: The study found that adherence to a healthy plant-based diet in patients undergoing hemodialysis was not associated with serum potassium levels, hyperkalemia, or differences in energy intake. However, there may be a risk of low protein intake with higher HPDS. Nevertheless, higher HPDS was associated with better nutritional status.

NEPHROLOGY DIALYSIS TRANSPLANTATION (2021)

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Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis

Amelie Bernier-Jean et al.

Summary: Study on over 8000 adults undergoing maintenance hemodialysis found no significant association between high dietary potassium intake and mortality or hyperkalemia.

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY (2021)

Article Transplantation

Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

Christiane Ramos et al.

Summary: The study found that dietary potassium intake was not associated with serum potassium or hyperkalemia in chronic kidney disease patients. Hyperkalemia was mainly linked to factors such as diabetes mellitus and metabolic acidosis.

NEPHROLOGY DIALYSIS TRANSPLANTATION (2021)

Review Medicine, General & Internal

The safety and efficacy of low-dose mineralocorticoid receptor antagonists in dialysis patients A meta-analysis

Yifan Zhu et al.

Summary: Low-dose MRAs may reduce cardiovascular mortality and all-cause mortality in dialysis patients without significantly increasing the risk of hyperkalemia.

MEDICINE (2021)

Article Nutrition & Dietetics

Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort

Yoko Narasaki et al.

Summary: Excessive restriction of dietary potassium intake may increase mortality risk in hemodialysis patients. Female sex, higher serum bicarbonate levels, and lower dietary energy, protein, and fiber intake may be associated with low dietary potassium intake.

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Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum 2019

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Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider

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Potassium Additives and Bioavailability: Are We Missing Something in Hyperkalemia Management?

Kelly Picard

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Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients

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INTERNATIONAL JOURNAL OF CARDIOLOGY (2017)

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JOURNAL OF CLINICAL HYPERTENSION (2016)

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Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

Akeem A. Yusuf et al.

AMERICAN JOURNAL OF NEPHROLOGY (2016)

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Meta-Analysis of Potassium Intake and the Risk of Stroke

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Dietary and Fluid Restrictions in CKD: A Thematic Synthesis of Patient Views From Qualitative Studies

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Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease

Georges N. Nakhoul et al.

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A relationship between serum potassium concentration and insulin resistance in patients with type 2 diabetes mellitus

Hyun Woo Kim et al.

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X. Muschart et al.

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Serum and dialysate potassium concentrations and survival in hemodialysis patients

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