Reframing Dietary Potassium Management in Chronic Kidney Disease: A Proportionate, Risk-Informed Approach for Multidisciplinary Practice

Dietary potassium restriction is a longstanding component of nutrition care in chronic kidney disease (CKD), yet its application often varies across practice settings and lacks consistent evidence for improved clinical outcomes. While clinicians routinely balance biochemical risk, nutritional adequacy, and patient context, the reasoning behind potassium-related decisions is rarely made visible in guidelines or multidisciplinary practice. This paper introduces the Proportionate Potassium Management Framework (PPMF), a practice-oriented model that supports transparent, risk-calibrated dietary decisions in CKD care. The framework prioritises systematic consideration of non-dietary contributors to hyperkalaemia and promotes selective, context-sensitive use of dietary restriction. Rather than prescribing uniform actions, the PPMF legitimises professional judgement as a core safety mechanism, offering a structure for documenting and justifying dietary decisions in complex, uncertain, or contested cases. In doing so, it aims to support nutritionally adequate, person-centred care without compromising biochemical safety or team accountability.