Low potassium diet in chronic kidney disease

Chronic kidney disease is the combination of a low glomerular filtration rate below 60ml per minute which is lesser than the normal range and reduced renal functioning with respect to homeostasis. As the kidney is the major organ that is responsible for electrolyte balance, it is an important aspect to take into consideration for the CKD patients to maintain proper electrolytes intake and consistently help their kidneys in proper bodily metabolism.

How does potassium imbalance affect a patient with chronic kidney disease?

Potassium is an important element of the body that is responsible for muscle contraction as it plays an important role in the neuromuscular junction, to maintain consciousness and cerebral functions, and so on. 

In patients with chronic kidney diseases such as renal failure, glomerulonephritis, diabetes type 1 and 2, uncontrolled hypertension, it is important to note that parenchymatous inflammation of the kidney causes reduced function. In such a case the electrolyte balance cannot be maintained as the formation of urine is hampered and excretion of potassium and other elements like sodium, phosphate and other compounds does not occur which leads to its retention. Various clinical features like dyspnoea or breathlessness, chest discomfort, muscle twitching, mental confusion, heart rhythmicity are lost, abnormal ECG waves are likely to denote hyperkalemia which can be a life-threatening consequence for a person with CKD.

How to control potassium levels by diet in Chronic kidney condition?

Hyperkalaemia which means excess potassium in serum is an indicator of renal failure or kidney disease.

Intake of potassium has to be controlled and calculated to reduce the load on inflamed kidneys. Low salt intake is a common piece of advice that in turn reduces excess water retention and thereby reduces stress on the kidney.

Point to remember- food containing low potassium should be consumed in a strictly limited amount. Consuming a large amount of a low potassium diet is of no use.

Intake control and food to consume and avoid-

• Low potassium vegetables include- beans, cabbage, brinjal, cucumber.
• Cooking or boiling of these vegetables also helps in reducing the potassium content.
• Low potassium fruits include- apples, apricots, berries.
• A low potassium diet includes- low salt, cooked vegetables, and avoiding meat.
• Food to avoid( food containing high potassium levels)- bananas, dates, figs, grapes, raisins, tomatoes, potatoes.
• Indian food stuffs to consume that contain low potassium- rice, peas, beans, papaya, beetroots, coconuts, tamarind, indian breads like roti and parathas.
• Indian foods to avoid in CKD patients( food containing high potassium level)- goat, chicken, lamb, yogurt, ghee, milk, paneer.

Care while preparing and choosing food for CKD patients-

• Leafy vegetables are good for health in general, but for these patients, additional efforts are to be taken such as boiling of vegetables and excessive rigorous washing of the raw food materials.
• Reduced usage of oils, mineral-rich spices, and packaged foods containing preservatives.
• Light food served frequently with small intervals can prove to be beneficial as the load on renal glands is redistributed along the time.
• Food products prone to cause kidney diseases such as tomatoes should be avoided.
• Water intake should be controlled.

How much potassium should CKD patients consume?

The potassium requirement in a normal individual is 3-4gm per day.

Potassium in CKD patients should be less than 2000mg per day. Serum potassium should be maintained

How to make a low potassium diet with normal and common foodstuffs?

Various simple and known methods can reduce the potassium content in a lot of raw food substances. Some of them are mentioned below.

• Boiling is an old and effective method of removing potassium from foodstuffs like carrots and spinach. Potassium bound to the elements of spinach and lettuces is broken down by increased temperature which is an irreversible chemical reaction further leading to the release of potassium ions in the water.
• Washing is a simple way but not as effective as boiling. Repeated washing of vegetables under running water ensures washing away of potassium from it. This makes the green leafy vegetable edible for patients with chronic kidney disease.
• Soaking of vegetables can remove some of the content which can then be boiled for better results.
• Eating and choosing proper food items.

low potassium diet specific to the cause of chronic kidney disease.

1. Chronic nephritis: Avoid milk and milk -based products. It contains a high level of potassium and calcium. Plum, peaches are preferred fruits.
2. Slow poisoning due to continuous medication or metal poisoning: alternative medications to be taken after consulting your doctor. Stop the usage of drugs. Light diet avoiding banana, dry fruits. Eat more boiled vegetables and apples.
3. Atherosclerosis of renal hypertension: limited water intake of less than 1.5 liters per day. Reduce salt intake to less than 2mg per day. Avoid potatoes, high cholesterol diet, and an unhealthy lifestyle. The DASH diet (dietary approach to reduce hypertension) includes fruits, vegetables, and a low cholesterol diet.
4. Renal tuberculosis: requires medical attention due to necrosis of the affected kidney and hypertrophy and hyperplasia of the unaffected kidney. A soft bland diet with limited water intake is advised.
5. Renal calculi: usually formed due to calcium retention or improper clearance of calcium carbonate which causes kidney stones. Excessive water intake is advised in this case.

Features of CKD and how to manage it?

• Features of CKD are: Uraemia, metabolic acidosis, renal edema, bleeding and hemorrhage, anemia, hyperparathyroidism, etc.
• General features: drowsiness, weakness, and lethargy, hyperpigmentation of the skin, mental confusion, muscular twitching or tetany, anorexia, fever, loss of interest in the environment.
• Common management: adequate potassium level maintenance in plasma by calculating potassium intake and limiting it to less than 2 grams per day.

How is potassium important to the body and is extremely essential?

• It maintains the water and acid-base balance of any particular cell of the body.
• It is necessary to conduct nerve impulses.
• It is essential in protein production in the ribosome.
• Required in cardiac functioning and maintaining proper heart rhythm.
• Associated with calcium metabolism.
• Platelet production requires potassium.
• The vasodilation process requires potassium as the main member.

So how to avoid secondary complications of a low potassium diet in CKD patients?

• Bleeding disorders: avoid falls or cuts to the skin as far as possible. Use of assistance and avoiding exposure to sharp instruments. Use of bandages and quick medical assistance in excess blood loss.
• Anemia: controlled but high calorie diet is advised. Nuts, fruits, iron rich food stuff are advised.
• Osteoporosis or weak bones: use of assistive devices like the cane. Crutch, walkers, railings. Bracings to avoid pathological fractures. Nutritional supplements and a calcium rich diet are advised with precaution.
• Severe dehydration due to prolonged diarrhea: cautious intake of water. Saline administration.
• Flat T wave in ECG and Cardiac arrest: sublingual nitroglycerin. Immediate CPR and medical management.

What is the Lifestyle modification to be made along with a low potassium diet?

• Smoking cessation.
• Stop alcohol consumption.
• No drug abuse.
• Stop or limit cortisol therapy.
• Relaxation technique to be practiced.
• Mild home exercise programs.
• Proper sleep and food intake within calculated time intervals.
• Stress reduction and self care practices.
• Motivation and psychological counseling to the patient and family.
• Diabetes control by reduced starch intake.
• Reduce weight and obesity.