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How Much Potassium For Kidney Patients

What If Potassium Levels Are Too High

13 Low-Potassium Foods Kidney Patients Can Enjoy

In people with CKD, the improperly functioning kidneys lose the ability to filter fluids and electrolytes in the body, which can lead to dangerously high levels of potassium in the blood. Hyperkalemia is the medical term for excessively high levels of potassium.

A doctor can diagnose hyperkalemia with a blood test, and they may also order an electrocardiogram to make sure that the heart is working properly.

Hyperkalemia may not produce symptoms for some people. However, potassium levels of or higher can cause serious symptoms, including:

  • muscle weakness
  • abnormal heart rhythm
  • chest palpitations

Other possible causes of hyperkalemia besides CKD include diabetes, trauma, rhabdomyolysis, medication use, and excessive potassium intake.

To treat hyperkalemia, a doctor may recommend eating a diet with lower potassium levels or changing medications. In cases of severe hyperkalemia, they might prescribe medication to treat it.

Just as potassium levels in the body can get too high, they can also drop too low, which doctors refer to as hypokalemia. Hypokalemia is typically due to another underlying medical illness that a doctor must diagnose.

Possible causes of hypokalemia

  • artichokes, spinach, tomatoes, plantains, and winter squash
  • brown rice and potatoes

Some individuals with CKD may find it challenging to plan meals because so many foods have high levels of potassium. However, there is a method called leaching that can lower the amount of potassium in some foods.

Symptoms Of Kidney Disease

Overall, the side effects felt by those with kidney disease who are taking prednisone are very similar to the symptoms of Adrenal Fatigue Syndrome . Some of these side effects include obesity, kidney stones, irregular menstruation, high blood pressure, and osteoporosis. If people with kidney disease are taking prednisone, any problems with their adrenals may not be noticed.

Even though a person with kidney disease may have no symptoms and only discover their condition through blood work, there are some symptoms that definitely point to this condition. Swelling of the legs, blood in the urine, frothy urine, and difficulty controlling high blood pressure are some of those symptoms.

Other symptoms that may present with kidney disease include:

  • Itchy rashes due to a buildup of toxins in your blood.
  • Side, back, or leg pain.
  • Dizziness and loss of concentration can result from anemia brought on by kidney failure. This lessens the amount of blood going to your brain and a resulting lack of oxygen.

There are a set of symptoms that kidney disease and adrenal fatigue have in common. Fatigue, digestion problems, trouble with concentration, lowered sex drive, increased likelihood of catching colds and flu, and irregular menstruation are a few of these.

How Much Potassium Is Safe

Its recommended that healthy men and women over the age of 19 consume at least 3,400 mg and 2,600 mg of potassium per day, respectively.

However, people with kidney disease who are on potassium-restricted diets usually need to keep their potassium intake below 2,000 mg per day.

If you have kidney disease, you should have your potassium checked by your doctor. Theyll do this with a simple blood test. The blood test will determine your monthly level of potassium millimoles per liter of blood .

The three levels are:

  • Safe zone: 3.5 to 5.0 mmol/L
  • Caution zone: 5.1 to 6.0 mmol/L
  • Danger zone: 6.0 mmol/L or higher

Your doctor can work with you to determine how much potassium you should ingest daily, while also maintaining the highest level of nutrition possible. Theyll also monitor your levels to ensure that youre staying within a safe range.

People with high potassium levels do not always have symptoms, so being monitored is important. If you do have symptoms, they may include:

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What Else Can I Do To Lower My Potassium Levels

You may need to do more than just alter your diet to keep your potassium levels low.

Your healthcare team will check to see if there might be other reasons that your potassium is raised. Constipation, poor blood glucose control and certain medications can all affect your potassium levels. Ask your doctor for more information about this.

Stage 4 Kidney Disease: How Much Potassium Intake A Day

Potassium &  your CKD Diet

Potassium is one important mineral in our body that can be found in many foods. Just like calcium, potassium level in the blood should keep in normal range. Otherwise, both low and high potassium level can cause health problems. For patients with stage 4 kidney disease, potassium level is usually higher than the normal, so they should know how much potassium intake one daily to improve health condition.

What does potassium do in the body?

As one essential mineral, potassium is responsible for controlling nerve and muscle function, regulating heartbeat, and maintaining the balance of fluid, electrolyte balance and PH level. Nearly all potassium in our body comes from foods what we eat, and normally, it ranges from 3.5 to 5.5 mEq/L.

Why do patients with Stage 4 CKD need to restrict potassium intake?

In general, healthy kidneys can eliminate extra potassium from the body and make it range among the normal values. However, in stage 4, more than 70% of kidney function has lost, so extra potassium is more likely to accumulate in the body. We call this condition hyperkalemia that can cause nausea, irregular heartbeat, weakness and numbness. To reduce high potassium level and avoid these problems, stage 4 kidney disease patients should develop a low-potassium diet.

How much potassium to take in one day with Stage 4 Chronic Kidney Disease?

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Should You Take Supplements

Surprisingly, potassium supplements are usually not significant sources of this mineral.

The Food and Drug Administration limits over-the-counter potassium chloride supplements to less than 100 mg per serving just 2% of the U.S. daily recommendation .

However, that doesnt apply to other forms of supplements that contain potassium.

Taking too much of this mineral can cause excess amounts to build up in the blood, which is known as hyperkalemia. In some cases, this may cause an irregular heartbeat, called cardiac arrhythmia, which can be fatal .

Furthermore, studies have found that potassium supplements that provide high doses may damage the lining of the gut .

However, people who are deficient or at risk for deficiency may require a high-dose potassium supplement. In these cases, your healthcare provider may prescribe a higher-dose supplement and monitor you for any reactions.

Summary

Potassium supplements arent necessary for a healthy adult. However, some people may be prescribed a higher-dose supplement.

An excessive level of potassium in the blood is known as hyperkalemia. The condition is characterized by a blood level higher than 5.0 mmol per liter, which can be dangerous.

For a healthy adult, theres no significant evidence that potassium from foods can cause hyperkalemia .

For this reason, potassium from foods doesnt have a tolerable upper intake level. This is the most a healthy adult can consume in a day without negative effects .

Mg Transport And Homeostasis

The total amount of Mg in the body is approximately 22.6 g, and the concentration in serum ranges from 2.1 to 3.1 mg/dL. Approximately 1% of the total Mg in the body is located in the extracellular space 60% is ionized or free, 30% is bound to proteins and 10% as phosphate, citrate, or oxalate salts , and bone is an important reservoir of Mg .

Most Mg is within the intracellular compartment, and the passage to the extracellular space is slow. It is interesting to mention that the Mg concentration in the cytosol and the extracellular space is similar this is in contrast with other divalent anions such as calcium with an intracellular concentration approximately 20,000-fold lower than in the extracellular compartment.

Homeostasis of Mg is maintained by a controlled balance between the intestinal absorption and renal excretion with a serum concentration ranging from 1.3 to 2.7 mg/dL, although this range may vary between the different laboratories .

Daily intake of Mg is around 300 to 400 mg, and 50% is absorbed in the gastrointestinal tract . Proximal renal tubules reabsorb only 15 to 25% of the filtered Mg 6070% is reabsorbed in the ascending limb of the loop of Henle, and the distal tubule reabsorbs a 5 to 10% . Hypomagnesemia is defined as serum Mg concentrations lower than 1.7 mg/dL, whereas hypermagnesemia is considered if serum Mg levels are higher than 2.5 mg/dL.

Figure 1. Potential causes of Hypomagnesemia.

Figure 2. Causes and Symptoms of Hypomagnesemia.

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Dietary Potassium Intake And Disease Progression In Early

Out of the 9 studies conducted in patients in early CKD , 6 reported either a protective effect of high dietary potassium intake on CKD progression or a harmful effect of low potassium intake on CKD progression 3 reported a neutral association . Dietary potassium intakes in the highest quartile/quintile averaged > 2500 mg/d, whereas the lowest quartile/quintile had an average potassium intake of 1500 mg/d. For studies that reported a protective effect of dietary potassium on CKD progression when comparing the highest quartile with the lowest quartile, the HR ranged from 0.33 to 0.74 .

Potassium intake in early and late CKD and risk of disease progression Legend: significant95% CI does not cross 1 not significant95% CI crosses 1 NOTE: The potassium intake used by each author to determine the HR or OR of 1.0 was: 1 < 1720, 2 < 1302, 3 < 1500, 4 > 3342, 5 median=1700, 6 < 1537, 7 3600±660, 8 < 1500, 9 median=1700. *Displaying OR of the highest tertile compared to lowest tertile for participants with eGFR between 45-60 mL/. **Displaying OR highest tertiles compared to the lowest tertile for participants with eGFR below 45 mL/.

Foods To Add To Your Diet

High Potassium and Chronic Kidney Disease: A Patient’s Story

Foods are considered low in potassium if they contain 200 milligrams or less per serving.

Some low-potassium foods include:

Although reducing intake of potassium-rich foods is important for those on potassium restricted diets, keeping total potassium intake under the limit set by your healthcare provider, which is typically 2,000 mg of potassium per day or less, is most important.

Depending on your kidney function, you may be able to include small amounts of foods higher in potassium in your diet. Consult your healthcare provider if you have questions about your potassium restriction.

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Considerations In Evaluating The Evidence

Another finding from this systematic review is how much potassium CKD patients are consuming . The highest quartiles/quintiles reported intake in the 3000-mg range, which falls within the potassium-restricted diet definition provided by KDOQI. Aside from potential limitations of methodology, which are discussed in detail below, this finding highlights several unknown factors about these patients. First, it is unknown if patients who were included in this review were already following potassium-restricted diets. Second, even if patients were consuming potassium ad libitum, potassium intake may be impacted if they were following other dietary restrictions, such as low protein, low sodium, and/or low phosphorus, which are all components of diet therapy to protect kidney health . Additionally, as none of the authors commented on overall nutritional status, it is possible that better overall nutritional intake and lower rates of malnutrition in the top quartile for potassium intake contributed to the beneficial effects seen in the higher quartiles. Thus, this lack of information may limit the interpretation of these results.

Potassium And Chronic Kidney Disease

What is potassium and what does it do in the body?

Potassium is a mineral that controls nerve and muscle function. Theheart beats at a normal rhythm because of potassium. Potassium is also necessary formaintaining fluid and electrolyte balance and pH level.

In order for potassium to perform these functions, blood levels must be kept between 3.5 and 5.5 mEq/L. Thekidneys help keep potassium at a normal level.

When is potassium too low or too high?

Low potassium

Potassium comes from the foods we eat. Healthy kidneys remove excess potassium in the urine to help maintain normal levels in the blood.

Because most foods have potassium, low potassium is uncommon in people who eat a healthy diet.

Some of the effects of low potassium include muscle weakness, cramping and fatigue.

High potassium

When kidneys fail they can no longer remove excess potassium, so the level builds up in the body. High potassium in the blood is called hyperkalemia, which may occur in people with advancedstages of chronic kidney disease . Some of the effects of high potassium are nausea, weakness, numbness and slow pulse.

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Leaching Vegetables To Lower Potassium Content

For those people with high blood potassium, leaching is a way to remove some of the potassium from high-potassium vegetables.

Directions for potatoes, sweet potatoes, carrots, beets, and rutabagas:

  • Peel and cut vegetables into ?-inch thick slices.

  • Rinse vegetable slices in water for a few seconds.

  • Soak vegetable slices in water for a minimum of two hours. Use ten times the amount of water to the amount of vegetables.

  • After soaking, rinse vegetable slices again in water for a few seconds.

  • Cook vegetable slices with five times the amount of water to the amount of vegetables.

Directions for mushrooms and frozen greens:

  • Thaw frozen vegetables and drain.

  • Rinse vegetables in water for a few seconds.

  • Soak vegetables in water for a minimum of two hours. Use ten times the amount of water to the amount of vegetables.

  • After soaking, rinse vegetables again in water for a few seconds.

  • Cook vegetables with five times the amount of water to the amount of vegetables.

Leaching removes only some of the potassium in high-potassium vegetables. It is still important to limit how much and how often you eat these vegetables if you have high blood potassium .

Potassium As A Shortfall Nutrient

Potassium &  your CKD Diet

Potassium has been designated a shortfall nutrient or a nutrient of concern, meaning that it is often under-consumed across populations in the U.S. In an attempt to increase awareness surrounding nutrients of public health significance, a new proposed ruling has affected the information presented on Nutrition Facts labels.¹ Previously, potassium was not required to be listed on the Nutrition Facts label its inclusion was completely voluntary. However, in order to draw more attention to potassiums significant contributions to health as well as its current insufficient intake, potassium is now a required component of the recently updated Nutrition Facts label.¹ It is important to note that the % DV listed for potassium on Nutrition Facts labels is still calculated using the previous AI of 4,700 mg per day.

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Limit Shellfish And Meat

Research has found that a toxin called domoic acid in shellfish and some fish that eat algae can harm kidneys in mice. People are not mice. But, the really troubling finding was that very tiny levels of the toxin could harm kidneys. Shellfish also have high levels of purines, which can be a problem if you have gout. So, it may be wise to cut back on shellfish if you eat it a lot.

Medicare And Insurance Coverage For Mnt

If you are enrolled in Medicare and have CKD, Medicare will cover MNT services. You need a written referral from a doctor, and the MNT must be provided by a registered dietitian or nutrition professional. If you have insurance other than Medicare, ask your insurance provider if your insurance covers MNT for people with kidney disease.

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Tips To Reduce Your Potassium Intake

  • Potassium-rich foods should be limited. A kidney dietitian can help you adjust your diet to ensure you get the right amount of potassium.
  • Ask your dietitian how safe it is to include potassium-rich vegetables in your diet.
  • Remember, almost all foods contain potassium, and serving size is very important. Consumption of high amounts of low potassium foods can result in high potassium foods.
  • If you are on dialysis, make sure to get all the treatments prescribed for kidney patients.

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Quality Assessment For Risk Of Bias Within Studies

Potassium and the Kidney Diet

There were no intervention trials found related to this topic. Among the 11 reference articles analyzed in this systematic review, 10 were cross-sectional post hoc analyses of cohort studies . One was a retrospective observational cohort specially designed to assess the association between potassium intake and renal outcomes in patients with diabetes . We used the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort, Cross-sectional Studies, and Case-Control Studies to assess the quality of each study. Studies were graded in 3 broad categories: the definition and representativeness of the studied population, definition and measurement of exposure and outcome, and data analysis. Each category was broken down into subcategories, with 1 point awarded per subcategory if clearly presented in the article. The maximum score was 20 points, and a score 16 was defined as high quality .

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Processed Foods Are A Hidden Source Of K+

The transition from raw to processed foods began approximately 10,000 years ago with the onset of agriculture. Processing foods has increased the amount of Na+ and, in some cases, has reduced the amount of K+ intake. As previously discussed, inadequate consumption of K+ combined with excessive intake of Na+ is thought to contribute to the pathophysiology of a variety of chronic diseases such as obesity, hypertension, diabetes, kidney stones, and bone disease. As consumers and health agencies have pushed to reduce the amount of Na+ in processed foods, the food industry has begun to use food additives and preservatives, which are hidden sources of K+. These additives can significantly contribute to the total daily K+ content of foods because some preservatives in meat may add 300575 mg of K+ per 100 g of intake . Additionally, there are products used to enhance flavor which are KCl based and include salt substitutes where 20% of salt is replaced by KCl, which adds approximately 12 mmol/d to the usual K+ intake . In many cases, low K+ products may be high in Na+, making it difficult for patients with CKD to simultaneously adhere to low K+ and low Na+ food selections on a chronic basis .

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