Hyperkalemia

[RonaldoResuelto]

My resolve to drastically reduce animal protein and go semi-vegetarian ran headlong into a bevy of forum members, concerned about hyperkalemia, being very selective in their vegetable choices and even blanching vegetables to lower the potassium content. This seemingly legitimate concern would, of course, further restrict and complicate my menu choices. However, after some searching, I encountered a number of studies that show no hyperkalemia in persons with CKD placed on a mostly vegetarian diet for extended periods of time:

cjasn.asnjournals.org/conte...

nutrition.org/alkaline-diet...;

healio.com/nephrology/chron...

In fact, four studies performed between 2014 and 2016 actually showed a nephroprotective effect of potassium supplementation. An ongoing study, ichgcp.net/clinical-trials-... which began in 2017, is attempting to address this effect. I am now leaning toward the opinion that hyperkalemia is uncommon until the GFR falls below 20, and that potassium consumption may actually be beneficial to a person, like me, with Grade 3 CKD. This is, by no means, an exhaustive search, and evidence may exist that support a different conclusion. I would welcome any comments.

[Bassetmommer NKF Ambassador]

Hi Ronaldo,

I read through the journal articles. One article said: "gave oral bicarbonate or enough fruits and vegetables that were estimated to reduce dietary acid load by 50% to CKD patients for 30 days and also observed a slowed reduction in eGFR in patients at moderate, but not mild, stages of the disease. In patients with more advanced stages of CKD, one year of bicarbonate or fruits and vegetables did not slow the decrease in eGFR, though several urinary markers of kidney injury were reduced. "

So based on that theory it may be true. The articles did not reference amounts of potassium vegetables that were consumed.

Here is the bottom line: some people are more susceptible to certain things like an increase risk of hyperkalemia. Just like some people can eat sugar and not have a diabetic reaction.

If I were you and wanted to consume vegetables that were high in potassium, I would and see what happens to my labs. It might not affect you at all. You sound like you have a clinical background. Do your own study.

[RonaldoResuelto in reply to Bassetmommer]

Hello again Bassetmommer. Thanks for your prompt response. I will continue to search the professional literature. I'll read the personal accounts and the opinions related here, and chime in now and then. My self-study is ongoing. My known GFR history is 2015-153, 2016-untested, 2017-61, 2018-67, 2019-53. My potassium stayed within the Reference Interval throughout the five year period.I don't know why the GFR varied, but my systolic BP was elevated in 2017 and potassium was one of the tools I used to bring it down. I didn't know about the 2015 GFR reading until recently. I had my serum vitamin D level checked and a urine albumin test last week. I would like to have my blood checked every six months to monitor the results of my efforts, but I'm not sure Medicare would approve.

[Bassetmommer NKF Ambassador in reply to RonaldoResuelto]

I am not sure of this, but I would think that since you are having kidney function issues that your doctor should be able to order labs more often. I know my hubby who is on Medicare has them done every four months.

[RonaldoResuelto in reply to Bassetmommer]

If your hubby gets them that often, I expect I can.

[RonaldoResuelto in reply to Bassetmommer]

Yes. My GP has started ordering them more often. I also was concerned about consulting with a dietitian. I believe I have the answer to that. According to figure 2 on page 1960 of this article, in the Journal of the Academy of Nutrition and Dietetics, medicare won't pay for a dietitian until GFR is below 50. jandonline.org/article/S221...

[lowraind in reply to RonaldoResuelto]

I am on Medicare and was being tested every four months, which my nephrologist reduced to every six months because my numbers had improved.

[RonaldoResuelto in reply to lowraind]

I have read many of your posts. Interesting and informative. Good to know that medicare will pay for a nephrologist at stage 3. Also, I'll be looking into the Yoga class at the local library. If it proves too much for my arthritis, I'll check on your other recommendations. The Mathea Ford book seems promising. I have just downloaded Stopping Kidney Disease by Lee Hull. I am doing much of what you are doing dietwise, but prefer rice milk to almond milk. I am still looking into Potassium as I expressed in the original post of this thread. The Penetrex might help the knees and restless legs. Gracias y hasta luego.

[Zazzel in reply to RonaldoResuelto]

Check around at your local lab facilities, we have one that offers self prescribed labs. I can get a renal panel function test done self pay for $20 if your Medicare doesn't cover it,

[RonaldoResuelto in reply to Zazzel]

Self prescribed labs? I'll check into that. There are only two local labs.

[Zazzel in reply to RonaldoResuelto]

Ours is actually a standard lab that many of the doctors use, but they also offer certain testing under self pay options. I live in the Southwest and there is a few additional options. One is a lab called Any Lab test now anylabtestnow.com/frequentl.... They are a little more expensive than my regular lab that offers self pay. There are other companies that do similar things in other parts of the country, or you can visit health labs.com. healthlabs.com/how-it-works order the test and pay online and they tell you a lab in your area to get the test done at. Their re al panel is about $49.

[RonaldoResuelto in reply to Zazzel]

Checked locally. Quest Direct will let you order the complete metabolic panel online and get it done at their local lab for $49. Thanks.

[Zazzel in reply to RonaldoResuelto]

Awesome! Feels good to be in the know and not have to wait around for your doctors!

[orangecity41 NKF Ambassador]

I am at CKD level 3b. My potassium was high even though on renal diet. I had to cut back more on potassium. It is now within range, but high.

[RonaldoResuelto in reply to orangecity41]

Hi Orange City,

Interesting. As Bassetmommer said, there is a lot of individual variation. This site gives us the opportunity to benefit from the experience of others. My potassium level has stayed within limits even as my GFR varied.

[renegade70]

hi ronaldo,

i was diagnosed with stage 3 ckd 1 year ago. my current egfr is 44 and creatine is 1.6. i am a 65 year old male. i have had difficult to control high blood pressure all my life. it now appears to be under control since i began to see a nephrologist on a regular basis and my meds have been adjusted. my problem seems to be bouts of hyperkalemia. i have been given sps15gm/60ml susp 30g on an emergency basis on 3 different ocassions. i was having labs taken 1x per month but nephrologist now has me coming in every 3 months. my concern is that since hyperkalemia is symptomless and very dangerous, may cause serious heart problems and even death, i feel i am in danger all the time. i am at a loss as to how deal with problem. as far as diet goes all i have been told has been to eat more fresh fruit and vegtables and stay away from salt and processed foods ? your comments would be much appreciated.

[RonaldoResuelto in reply to renegade70]

There are sites that list the potassium content of various foods. This one is pretty good

med.umich.edu/1libr/Nutriti...

You probably should limit your vegetables to the list beginning on page 3. Some members also blanch certain foods. The information is posted here on health unlocked. You also might ask your doctor about potassium binders. I think they come in the form of a powder.

[renegade70 in reply to RonaldoResuelto]

thanks for the info.

[orangecity41 NKF Ambassador]

I am male age 78 , stage 3b CKD and have hyperkalemia also. It is a challenge. I use Davita diet tracker and try to not totally eliminate foods high in potassium and phosphorus but reduce the amounts.