Handouts for Low-Potassium Diets Disproportionately Restrict Fruits and Vegetables

Objective: Several recent publications, including an expert summary on hyperkalemia management, have encouraged plant-based foods for patients with chronic kidney disease (CKD) and highlighted the impact of potassium additives on total potassium intake. The aim of this research brief was to investigate if and/or how current recommendations for low-potassium diet may incorporate these new recommendations.

Design and methods: Using a geographical approach, each province's and territory's government health and renal program (where applicable) website was reviewed for resources on dietary potassium restriction. All handouts/booklets/printable webpages were obtained and reviewed.

Results: Eighteen resources from 6 provincial health agencies in Canada were included. Six additional resources from national agencies were also included, 4 from Canada and 2 from the United States. The 5 most commonly restricted foods were bananas, potatoes, oranges, cantaloupe, and avocados. All resources recommended restriction of fruits and vegetables, 67% recommended restriction of dairy products, 57% recommended restriction of whole grain products, 62% recommended restrictions of plant-based proteins, and 67% mentioned restriction of other foods (such as coffee, tea, and chocolate), 28% mentioned restriction of potassium additives in ultraprocessed foods.

Conclusion: Low-potassium diets primarily restrict fruits and vegetables while the least common restriction is ultraprocessed food. Several recent publics have recommended a greater focus on ultraprocessed versus unprocessed food for hyperkalemia management. These new recommendations differ from current teaching materials that predominately restrict plant-based foods to manage hyperkalemia in CKD. Updates will likely be needed to current resources to reflect new recommendations.