Introduction: Chronic kidney disease (CKD) affects approximately 13% of the adult population worldwide and represents a significant health problem. In recent years, the morbidity and mortality associated with kidney diseases have increased significantly, and by 2040 these diseases are expected to become the fifth leading cause of disease burden. Potassium is an important electrolyte that plays an essential role in the proper functioning of the kidneys and must be maintained within reference limits to prevent dyskalemia conditions. Management of dyskalemia is key in CKD and requires the application of appropriate pharmacological and non-pharmacological approaches.
Aim: The objective is to review the possibilities of maintaining potassium balance through nutrition, as potassium balance is important for managing dyskalemia and reducing the risk of complications in patients with CKD.
Material and Methods: The review included publications related to CKD, potassium, dyskalemia, and dietary approaches to managing the condition, based on evidence from scientific databases. The search was performed using the following keywords in English: chronic kidney disease, potassium, dyskalemia, diet foods, low potassium foods, hyperkalemia, hypokalemia, diet.
Results: The review shows that dietary interventions, including the restriction of potassium-containing foods and the selection of appropriate cooking methods, effectively control potassium balance in patients with CKD. Replacing common salt with potassium-fortified substitutes may reduce cardiovascular risks but requires caution in these patients due to the risk of hyperkalemia.
Conclusions: Effective management of potassium balance in patients with CKD requires an integrated approach with dietary and medical interventions. Individualized dietary strategies tailored to the stage of the disease are key to preventing complications and improving quality of life.
Arnold R, Pianta TJ, Pussell BA, Kirby A, O’Brien K, et al. 2017. Randomized, Controlled Trial of the Effect of Dietary Potassium Restriction on Nerve Function in CKD. Clin. J. Am. Soc. Nephrol. CJASN. 12(10):1569–77
Ayach T, Nappo RW, Paugh-Miller JL, Ross EA. 2014. Life-threatening hyperkalemia in a patient with normal renal function. Clin. Kidney J. 7(1):49–52
Bethke PC, Jansky SH. 2008. The Effects of Boiling and Leaching on the Content of Potassium and Other Minerals in Potatoes. J. Food Sci. 73(5):
Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, et al. 2018. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet. 392(10159):2052–90
Gilligan S, Raphael KL. 2017. Hyperkalemia and Hypokalemia in CKD: Prevalence, Risk Factors, and Clinical Outcomes. Adv. Chronic Kidney Dis. 24(5):315–18
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, et al. 2016. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PloS One. 11(7):e0158765
Hunter RW, Bailey MA. 2019. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol. Dial. Transplant. 34(Supplement_3):iii2–11
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero J-J, et al. 2020. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am. J. Kidney Dis. 76(3):S1–107
Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. 2021. Chronic kidney disease. The Lancet. 398(10302):786–802
Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. 2018. Hypokalemia: a clinical update
Kim SM, Jung JY. 2020. Nutritional management in patients with chronic kidney disease. Korean J. Intern. Med. 35(6):1279–90
Kovesdy CP. 2016. Epidemiology of hyperkalemia: an update. Kidney Int. Suppl. 6(1):3–6
Kovesdy CP. 2022. Epidemiology of chronic kidney disease: an update 2022. Kidney Int. Suppl. 12(1):7–11
Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, et al. 2011. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 80(1):17–28
Lightfoot CJ, Nair D, Bennett PN, Smith AC, Griffin AD, et al. 2022. Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease? Kidney Dial. 2(1):91–105
Lightfoot CJ, Wilkinson TJ, Smith AC. 2023. Non-pharmacological management of chronic kidney disease. Medicine (Baltimore). 51(3):170–75
Macdonald-Clarke CJ, Martin BR, McCabe LD, McCabe GP, Lachcik PJ, et al. 2016. Bioavailability of potassium from potatoes and potassium gluconate: a randomized dose response trial. Am. J. Clin. Nutr. 104(2):346–53
Marklund M, Tullu F, Raj Thout S, Yu J, Brady TM, et al. 2022. Estimated Benefits and Risks of Using a Reduced-Sodium, Potassium-Enriched Salt Substitute in India: A Modeling Study. Hypertens. Dallas Tex 1979. 79(10):2188–98
Montford JR, Linas S. 2017. How Dangerous Is Hyperkalemia? J. Am. Soc. Nephrol. 28(11):3155
Morimoto N, Shioji S, Akagi Y, Fujiki T, Mandai S, et al. 2024. Associations Between Dietary Potassium Intake From Different Food Sources and Hyperkalemia in Patients With Chronic Kidney Disease. J. Ren. Nutr.
Naber T, Purohit S. 2021. Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease. Nutrients. 13(9):3277
Nascimento A, Santiago S, Coelho I, Ventura M, Gueifão S, et al. 2021. Sodium and potassium contents in food samples from the first Portuguese total diet pilot study. J. Food Compos. Anal. 104:104091
Neuen BL, Bello AK, Levin A, Lunney M, Osman MA, et al. 2023. National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas. PLOS Glob. Public Health. 3(2):e0001467
Palmer BF. 2020. Potassium Binders for Hyperkalemia in Chronic Kidney Disease—Diet, Renin-Angiotensin-Aldosterone System Inhibitor Therapy, and Hemodialysis. Mayo Clin. Proc. 95(2):339–54
Pereira RA, Ramos CI, Teixeira RR, Muniz GAS, Claudino G, Cuppari L. 2020. Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy. Rev. Assoc. Médica Bras. 66:s59–67
Potassium | National Kidney Foundation. https://www.kidney.org/kidney-topics/potassium
Rodan AR. 2017. Potassium: Friend or Foe? Pediatr. Nephrol. Berl. Ger. 32(7):1109–21
Shokunbi OS, Adepoju OT, Ramaite IDI, Shokunbi OS, Mojapelo PEL, Akinyele IO. 2023. Potassium, sodium, calcium and magnesium levels of commonly consumed foods and estimates of dietary intakes of selected Nigerian adults. Heliyon. 9(3):e13729
The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Wani MM, Rather JI. 2023. Salt Substitutes – Utility and Safety in Chronic Kidney Disease. J. Ren. Nutr. Metab. 8(1):35
WHO issues new guidance on dietary salt and potassium. https://www.who.int/news/item/31-01-2013-who-issues-new-guidance-on-dietary-salt-and-potassium
Евгений Възелов, Фани Рибарова. 2013. Съвременни аспекти на храненето при хронично бъбречно заболяване. Демакс АД. 158 pp. първо ed.
Петър Петров. 2023. ДИЕТИЧНИ ПРЕПОРЪКИ ПРИ ХРОНИЧНО БЪБРЕЧНО ЗАБОЛЯВАНЕ (ПРАКТИЧЕСКО РЪКОВОДСТВО ЗА ПАЦИЕНТА). Актуална Нефрология. 17(1):
Петър Петров. Здравословно хранене при хронично бъбречно заболяване. Варна: Сити център, 2023. 258 pp. първо ed.
