plant-based diets kidney disease
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For most people, a diet rich in fruits and vegetables, whole grains, and plant-based protein is healthy and nutritious. However, if you are one of the millions of people who live with chronic kidney disease (CKD), a plant-based diet may be hazardous to your health.

High potassium and chronic kidney disease 

Plant-based diets are high in nutrients such as potassium. Potassium-rich foods are generally considered healthy due to their alkalinity as well as a high micronutrient, fiber, and phytochemical content that benefits the body.[1]

However, if you are living with chronic kidney disease (CKD), watching your intake of nutrients, such as potassium, can be important. This is because high levels of potassium in the body, a condition known as hyperkalemia, can potentially be fatal for people with CKD.[2],[3]

Hyperkalemia can result in abnormal heart rhythms and even sudden death.2, 3 With more than three million people in the United States living with hyperkalemia, this is a serious concern. Further, those with conditions such as CKD or heart failure are at the highest risk for hyperkalemia.[4],[5]

Related reading: Failing kidneys and the risk of high potassium

The benefits of plant-based diets

Growing evidence supports the health benefits of plant-based diets, such as the Dietary Approaches to Stop Hypertension (DASH) diet. These diets are high in fiber, low in saturated fat, and contain sources of potassium, magnesium, and calcium. They also have low levels of sodium for preventing heart disease and hypertension.[6]

In contrast to meat-based diets, which are high in full-fat dairy foods and higher in sulfur-containing amino acids, plant-based diets are lower in these amino acids. These lower amounts of amino acids in plant-based diets have been associated with reductions in cardiovascular disease and CKD. 4,[7]

The risk of plant-based diets in chronic kidney disease

Kidneys serve to filter extra water and wastes out of the body. If the kidneys are damaged, they cannot filter wastes the way they should. This may cause potassium to build-up in the body and eventually lead to hyperkalemia.

Since plant-based diets are rich in potassium, they can be risky for people with CKD and therefore they are usually advised to avoid them. As a result, they may be deprived of the health benefits associated with consumption of plant-based diets. Further, their alternative diet may lack essential vitamins and minerals normally found in potassium-rich food sources.

Newer research, however, suggests that individuals with CKD can benefit from plant-based diets. And, there are now treatment options for people who are at risk of high potassium, such as potassium binders, which may allow for the consumption of plant-based diets while maintaining the balance of potassium in the body.2  These binders stick to potassium to increase its excretion from the body, helping to keep potassium levels low.

Why tailor plant-based diets to meet the needs of CKD Patients

In the general population, increased consumption of fruits and vegetables has been shown to reduce the risk for the following conditions:

  • Cardiovascular disease
  • Alzheimer’s Disease
  • Cancer
  • Diabetes
  • Cataracts

Tailoring a plant-based diet to meet the needs of CKD patients would allow them to benefit from the improved nutritional profile of their diet. A reduction in cardiovascular disease, in particular, is important for CKD patients as it is the leading cause of death.[8]

Related reading: What You Need to Know About Plant-based Diets

Insulin and potassium

What has been underappreciated is that meat is also a source of potassium. Plant-based foods are typically higher in carbohydrates. Ingestion of carbohydrates, amongst other things, stimulates insulin release. Further, it is well known that potassium homeostasis is facilitated by insulin. Therefore, it is possible that foods that contain carbohydrates and stimulate insulin release, might not cause the same overall rise in potassium as foods that are low in carbohydrates, such as meats.1

Given the disconnect between the restrictions of the CKD diet and what is recommended for a heart-healthy diet, it may be reasonable to try to tailor a plant-based to the specific needs of CKD patients.

This could be phased in by working with physicians and dietitians to begin to encourage the consumption of more fruits and vegetables. This would, of course, require frequent monitoring of potassium and other tests, such as sodium and phosphate and kidney function tests.

The bottom line

If you have CKD and are concerned about high potassium as a result of a plant-based diet, talk to your physician and dietitian about your options.

You may be able to increase your consumption of fruits and vegetables with frequent evaluations but without any change in your medications. On the other hand, your doctor may recommend water pills or potassium binders to help rid the body of any excess potassium that occurs as a result of your change in diet. 

Adding more fruits and vegetables to your diet may provide you with the known benefits of a more plant-based diet. And, for sure, the added variety of a liberalized diet can make meals more enjoyable.

References

[1] St-Jules DE, GoldfarbDS, Sevick MA: Nutrient non-equivalence: Does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients? J RenNutr 26: 282–287, 2016

[2]   Clegg D: Plant-Based Diets in Chronic Kidney Disease. CJASN: 2018

[3]   Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis, and management of hyperkalemia. Pediatr Nephrol. 2011; 26:377–384.

[4]   Betts KA, et al. The prevalence of hyperkalemia in the United States. Current Medical Research and Opinion. https://doi.org/10.1080/03007995.2018.1433141. Accessed April 26, 2018.

[5]   Collins AJ, et al. Association of Serum Potassium with All-Cause Mortality in Patients with and without Heart Failure, Chronic Kidney Disease, and/or Diabetes. Am J Nephrol. 2017;46(3):213-221.

[6] Banerjee T, Liu Y, Crews DC: Dietary Patterns and CKD Progression. Blood Purif, 41: 117-122, 131 2016

[7] Banerjee T, Crews DC, Wesson DE, Tilea AM, Saran R, Rios-Burrows N, Williams DE, Powe NR: Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. High Dietary Acid Load Predicts ESRD among Adults with CKD. J Am Soc Nephrol, 26: 1693-1700, 2015

[8] Liu M: Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci. 2014 Oct;18(19):2918-26.

Disclosure: Relypsa, Inc. (a Vifor Pharma Group company) supports some of Dr. Clegg’s research on plant-based diets. 

Deborah Clegg Ph.D.
Deborah Clegg, PhD Dr. Clegg is a known expert in the field of metabolism with a specific interest in nutrition and how it interacts with physiology. She has authored over 150 articles in impactful journals such as The New England Journal of Medicine, JAMA, American Journal of Physiology, and the National Kidney Foundation. Dr. Clegg is a clinical dietitian, and, in this role, she has advocated for personalized nutritional approaches and liberalization of diets to enhance patient compliance and satisfaction. Dr. Clegg is a Distinguished Visiting Professor at American University and holds faculty appointments in the role of Professor at Cedars-Sinai Medical Center and the University of California Los Angeles (UCLA). Dr. Clegg and her research have been featured in many forms of media, to include the television program The View, and HBO series entitled ‘Weight of the Nation’, as well as in the popular press to include magazines such as Vogue, Mademoiselle, Ladies Home Journal, and Nature.

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