Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet

Abstract

Diet is a key determinant of several common and serious disease complications in hemodialysis (HD) patients. The recommended balance and variety of foods in the HD diet is designed to limit high potassium and phosphorus foods while maintaining protein adequacy. In this report, we examine the potassium, phosphorus, and protein content of foods, and identify critical challenges, and potential pitfalls when translating nutrient prescriptions into dietary guidelines. Our findings highlight the importance of individualized counseling based on a comprehensive dietary assessment by trained diet professionals, namely renal dietitians, for managing diet-related complications in HD patients.

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Fruits and vegetables, meat, poultry, and fish are important sources of potassium ( Supplementary Table S1). Food patterns associated with potassium intake and dietary potassium sources vary around the world 52,53 ; the estimated daily potassium intake ranges from w52 mmol (2.1 g) in China, w68 mmol (2.6 g) in the United States, to w125 mmol (4.8 g) in Spain. [53][54][55] Potassium-rich diets are generally consistent with dietary patterns considered healthy; a typical Mediterranean diet can provide up to 155 mmol/d (6 g/d) of potassium, whereas a dietary approaches to stop hypertension (DASH) diet would contribute up to 120 mmol/ d (4.7 g/d).…”

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

“…The most common foods that nephrologists, nurses, and patients believe should be limited or avoided are those rich in potassium, phosphate, and sodium [3][4][5]7,[13][14][15]. However, these restrictions are virtually incompatible with a healthy diet (rich in plant-based food), high protein intake (coupled with phosphate intake), and high calorie intake (associated with varied and good-tasting food) [4][5][6][7][8][9][10].…”

“…Towards an unrestricted, personalized approach to diet in dialysis patients. Dialysis and nutrition are two sides of the same coin-dialysis depurates the metabolic waste that is typically produced by food intake; hence, dietetic restrictions are commonly imposed on dialysis patients in order to limit, in particular, potassium and phosphate and avoid fluid overload [1][2][3][4][5][6][7][8][9]. This restrictive approach is being increasingly challenged, however, since it makes the difficult life of dialysis patients even harder, and the generic nutritional restrictions prescribed have significant limitations and side effects (Table 1) [1,2,[10][11][12].…”

Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients

“…This is a complicated and evolving science and one that requires significant research. 51,52 In this trial, we tested foodbased recommendations, individualized to meet each patient's requirements. Although the focus was only on phosphorus, all other nutrient restrictions were considered and incorporated into the prescribed diet.…”