Approach to Hyperkalemia: The Role of Diet and Pharmacological Therapies

Hyperkalemia is a common complication of kidney disease and incidence increases as kidney function declines. Renin angiotensin system blockade, which improves renal and cardiovascular outcomes, increases the risk of hyperkalemia. Unfortunately, hyperkalemia often leads to discontinuation of these medications, which can increase adverse outcomes. Treatment of chronic hyperkalemia includes diet and pharmacologic interventions. However, the association is weak of dietary potassium intake with serum potassium levels and does not consider important internal and external balance factors that affect serum levels. Traditional dietary interventions that limit dietary potassium can lead to a restrictive diet that limits fruits and vegetables, whole grains, and plant-based proteins. This restrictive approach may unnecessarily limit dietary quality and variety in a population already at risk for poor nutritional status and complications of chronic kidney disease. The management of hyperkalemia requires a comprehensive, individualized approach that moves beyond blanket dietary restrictions. The objective of this review is to describe the role of diet and pharmacologic approaches to manage hyperkalemia, highlighting newer dietary approaches.