Managing Potassium Additives in Chronic Kidney Disease Diets: Challenges and Interventions

Potassium-containing food additives are a broad class of compounds used in food processing and food preparation to enhance the quality, flavor, safety, stability, and health of foods. In 2023, the US Food and Drug Administration encouraged food manufacturers to replace salt with potassium-based salt substitutes, and although this change was intended to reduce hypertension in the general population, excess intake of potassium-based salt substitutes may increase the risk of hyperkalemia in people with kidney failure on dialysis. To assess and address this concern, the American Society of Nephrology produced a kidney health guidance report, which included basic, advanced, and intensive dietary strategies for mitigating hyperkalemia risk from food additives in people with reduced kidney function. The purpose of this review was to refine these recommendations to reduce hyperkalemia risk from potassium additives in patients on dialysis.