Plant-based low-protein diets do not increase the risk for moderate to severe hyperkalemia in chronic kidney disease (CKD) patients, new study findings suggest.

Among 219 nondialysis CKD patients managed in a renal nutrition clinic, 26.1% had hyperkalemia. The vast majority had mildly elevated serum potassium levels (5.1 to 5.9 mEq/L), and only 6 patients had moderate hyperkalemia (6.0 to 6.9 mEq/L). As estimated glomerular filtration rate (eGFR) decreased from 60 to less than 20 mL/min/1.73m2, hyperkalemia prevalence increased from 4.4% to 36.4%.

Serum potassium levels did not differ significantly between patients on animal-based (0.6 g/kg/day) and plant-based (0.7 g/kg/day) low-protein diets at the same level of residual kidney function, Adamasco Cupisti, MD, and colleagues from the University of Pisa in Pisa, Italy, reported in Internal and Emergency Medicine. Medication use was similar between patients with and without hyperkalemia. As many as 85% received renin-angiotensin-aldosterone system inhibitors (RAASi), but none discontinued the medications, although there were dose adjustments. Hyperkalemia nonsignificantly increased the risk for end-stage kidney disease, but it did not increase the risk for early mortality.

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“Vegetable-based diets are considered ‘at risk’ because of the high potassium content of fruit, vegetables and pulses, but this thought is changing due to the positive effects of plant-based diets,” Dr Cupisti’s team explained. These potential benefits include prevention of gut dysbiosis, constipation, and metabolic acidosis.

All patients received personalized nutritional counseling, which may explain the lower prevalence of hyperkalemia in this study compared with a recent Italian study, Maurizio Gallieni, MD, of the University of Milan in Milan, Italy, and colleagues commented in an accompanying editorial.

“Educational strategies, often time-consuming, by dedicated and well-trained dietitians, are fundamental,” the editorialists wrote. “Adequate cooking and preparation techniques can reduce up to 50% the potassium content of the plant-based diet, with preserved taste and nutritional properties.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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D’Alessandro C, Cumetti A, Pardini E, et al. Prevalence and correlates of hyperkalemia in a renal nutrition clinic [published online May 7, 2020]. Intern Emerg Med. doi: 10.1007/s11739-020-02353-9