Potassium Binding for Conservative and Preservative Management of Chronic Kidney Disease

Deborah J. Clegg; Biff F. Palmer


Curr Opin Nephrol Hypertens. 2020;29(1):29-38. 

In This Article

Potassium-enriched Diet for the Preservative Management of Chronic Kidney Disease

Where we have highlighted the concerns associated with hyperkalemia, we would be remiss if we did not discuss the fact there are significant health benefits associated with eating diets high in K+. In fact, one prevailing hypothesis is that our current diet represents a mismatch between what our body has the capability to process with respect to dietary K+ versus what we are consuming. Furthermore, there are data demonstrating diets low in K+ are associated with chronic diseases, such as obesity, hypertension, diabetes, kidney stones, and bone disease.[43–45]

Although ingestion of a K+-enriched diet can safely provide the aforementioned benefits to patients with normal renal function, development of life-threatening hyperkalemia may limit the ability to utilize such a diet in patients with CKD. Like dosing with RAASi therapy, the potential risk of hyperkalemia associated with diets enriched in fruits and vegetables causes a therapeutic dilemma in patients who could most benefit from diets enriched in K+. In fact, there are now data demonstrating diets enriched in plant protein are viable strategies to confer favorable kidney disease outcomes.[46,47] Such diets can provide adequate protein intake while reducing the tendency to cause phosphorus overload. The alkali load afforded by a plant-based diet can also slow the progression of CKD through correction of metabolic acidosis.[48] An area deserving of additional exploration is the use of new K+-binding drugs as a way to maintain normokalemia during liberalization of the diet in patients at risk for hyperkalemia. These binders may provide an opportunity to allow patients to maintain optimal dosing of RAASi therapy and, at the same time, eat a diet high in K+ to improve the quality of life through liberalization of diet while allowing the benefits of drugs, which enhance cardiorenal benefit in these high-risk patients.