It’s one of the biggest conundrums nephrologists face — how to prevent or treat chronic hyperkalemia by managing diet in patients with chronic kidney disease. Hyperkalemia is the medical term that describes potassium levels in a patient’s blood that are higher than normal. Hence, the traditional recommendation for managing these with patients is to keep them off foods high in potassium. The problem, as pointed out by Kamyar Kalantar-Zadeh, MD, MPH, PhD, chief of nephrology, hypertension, and kidney transplantation at the University of California Irvine School of Medicine, is that potassium is critical to the normal functioning of cells, and ensures the proper functioning of nerves and muscles, including the heart. According to the National Kidney Foundation, a normal amount of potassium in the typical healthy American’s diet is 3, to 4, mg per day, while a potassium-restricted diet will usually be 2, mg per day. Foods that are high in potassium and likely to be targeted for restriction include many fruits and vegetables including such mainstays as bananas, avocados, and oranges. Heart-healthy diets are therefore loaded with potassium, he continued. So, restricting diet can present patients and caregivers with therapeutic tradeoffs and associated challenges. For example, a recent article in Kidney Medicine noted that low-potassium diets can adversely affect patients’ acid-base balance and intestinal microbiota, and result in nutritional deficiencies that reduce health-related quality of life. The authors also wrote that patient adherence to these dietary restrictions can be problematic since it requires individualized dietary regimens and access to skilled dietitians and regular counseling — something that may not be too common in regular clinical practice. Furthermore, the article stated, there are a number of patient-reported barriers to adherence that are associated with diet restriction, including “a lack of appetite, craving salty foods, being too tired to cook, finding the diet bland and tasteless, difficulty tracking nutrient intake, feeling deprived, and lack of motivation to eat the right foods.
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