Plant-Based Diet is Not Linked to Hyperkalemia in CKD Patients

Hyperkalemia generally experienced in CKD patients. It was previously known that a plant-based diet rich in potassium was linked to HK. A recent study shows no link between a plant-based diet and HK.

Highlights:

Plant-based low protein diets are not associated with higher prevalence of hyperkalemia
Prevalence of hyperkalemia in 26.1% of the cases
No association of hyperkalemia with mortality
Mild hyperkalemia is seen in most cases

Patients with chronic kidney disease (CKD) often experience hyperkalemia (HK). Consumption of vegetable-based diets are considered risky as they contain a high amount of potassium (K).

Plant-based diets with low protein are now considered to be safe for CKD patients according to a new study.

Drug-Induced Hyperkalemia | High Potassium Levels
Intake of drugs like ACE inhibitors, angiotensin receptor antagonists, NSAIDs, certain antibiotics and immunosuppressants increase potassium levels in blood leading to hyperkalemia.

‘Plant-based low-protein diet is not associated with a significantly higher prevalence of hyperkalemia (HK) when compared to animal-based low protein diets in chronic kidney disease (CKD) patients.’
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Hyperkalemia (HK) and Chronic Kidney Disease (CKD)
Chronic Kidney Disease is a condition where the kidneys are damaged and are unable to filter blood properly. As the disease progresses slowly over a long period of time it is called as chronic kidney disease.

Hyperkalemia is a term that describes high potassium levels in the blood.

Hyperkalemia is a complication of chronic kidney disease. The main risk factors for hyperkalemia are the abnormalities in the mechanisms of renal excretion, presence of cardiovascular diseases or diabetes.

Prevention of Kidney Disease - Causes & Prevention
Kidney damage is usually detected at advanced stages. Healthy lifestyle, keeping diabetes and blood pressure under check, and regular tests can help prevent it.

Renal Diet for Chronic Kidney Disease Patients

Recommended renal diets are vegetables, fruits, nuts and pulses. Renal diets are thought to favor hyperkalemia as they are all rich in potassium.

Diabetic Kidney Disease - Symptoms, Signs, Causes, Diagnosis, Stages & Treatment
Diabetic nephropathy refers to kidney damage due very high levels of blood sugar levels in diabetics.

The nutritional therapy in CKD aims to reduce the intake of foods that result in the production of waste substances that kidney failure patients cannot excrete.

The diet includes a low protein diet which includes a combination og protein-free products , standard low-protein diet from animal sources or a combination of cereals and pulses as sources of vegetable proteins.

Not All Plant-Based Diets Are Equally Healthy
Consuming plant-based diets along with sweets, sweetened beverages and refined grains can significantly increase the risk of heart disease.

The implementation of vegetable based renal diets are limited by fear if inducing hyperkalemia. Hence, the research study focused on the risk of hyperkalemia in patients on plant-based versus animal-based low protein diets (LPD).

Study Details

The study included patients affected by CKD stage I-VND. They were followed up at the renal nutrition clinic from November 2014 to May 2019.

There was a total of 219 patients who had about 870 visits in the clinic. Hyperkalemia was defined based on the potassium serum level as:

Mild HK- when K serum level is 5.1-5.9 mEq/l
Moderate HK- when K serum level is 6.0-6.9 mEq/l
Severe HK – when K serum level is ≥ 7 mEq/l

Biochemical data, anthropometric data, and medications of all the patients were recorded.

Study Findings

The key study findings are:

The presence of HK in all the renal nutrition visits was 26.1%. No severe HK cases were observed. All cases but six cases were mild HK cases.
Prevalence of HK increased with the CKD stages
Prevalence of HK was associated with decreased estimated glomerular filtration rate (eGFR), up to around 36.5% for eGFR < 20 ml/min.
Medications were similar in both hyperkalemic patients and non-hyperkalemic patients with RAASi being present in up to 85% of the patients
In the follow up of about 40 ± 14 months, there was no association between hyperkalemia and mortality. However, HK at the beginning of the follow-up, showed a trend to increased end-stage renal disease risk (ESRD).
No difference is observed in the serum potassium levels and prevalence of HK in patients on animal-based low-protein diet and plant-based low-protein diet.
Chronic HK is prevalent in the renal nutrition clinic, especially when eGFR falls below 60 ml/min. HK reached the highest prevalence in CKD stage 4.
HK is mostly mild. Moderate to severe HK is quite infrequent.
Hyperkalemia is not associated with the higher risk of mortality.

The authors concluded that plant-based low-protein diet is not associated with high prevalence of HK with respect to animal-based low protein diet at the same residual kidney function.

Source-Medindia