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Potassium and chronic kidney disease
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What is potassium and what does it do in the body?
Potassium is a mineral that controls nerve and muscle function. One very important muscle—the
heart—beats at a normal rhythm because of potassium. In addition potassium is necessary for
maintaining 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. The kidneys help keep potassium at a normal level. Potassium levels that are too high or
too low can be dangerous.
How will I know if my potassium is too low or 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.
Since most foods have potassium, low potassium (hypokalemia) is uncommon in people who eat
a healthy diet. Poor food intake, excessive vomiting and diarrhea and taking certain medications,
such as diuretics, can cause low potassium levels.
Some of the effects of low potassium (hypokalemia) include:
muscle weakness
cramping
fatigue
confusion
problems with muscle coordination
irregular heartbeat
heart failure
Low potassium (hypokalemia) is rarely a problem for people with advanced kidney failure,
because the kidney loses the ability to remove potassium. Blood tests are performed to help the
doctor evaluate potassium levels.
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. This may occur in people with
advanced stages of chronic kidney disease (CKD).
Some of the effects of high potassium (hyperkalemia) are:
nausea
weakness
numbness or tingling
slow pulse
irregular heartbeat
heart failure
sudden death
For people with stage 5 CKD (also known as end stage renal disease or ESRD), dialysis is
necessary to help regulate potassium. Dialysis is very effective at removing excess potassium
from the blood. Between dialysis treatments, however, potassium levels rise. Because of this,
high potassium foods must be limited so potassium levels do not get too high before the next
treatment.
High potassium (hyperkalemia) is likely to occur when dialysis treatments are skipped or
shortened. Missed treatments allow potassium to build up to dangerous levels in the blood. This
can lead to irregular heartbeats and even cause the heart to stop beating.
Know your potassium levels
Your potassium levels will be checked regularly. Ask your renal dietitian or doctor about your
potassium results. Checking your potassium levels will guide your healthcare team to help keep
your potassium in a safe range.
Laboratory ranges for CKD
Low range
less than 3.5 mEq/L
Safe range
3.5 - 5.5 mEq/L
Unsafe range
5.6 - 6.0 mEq/L
Dangerous
more than 6.0 mEq/L
If your potassium is too high, your doctor will determine the cause and adjust your dialysis
treatment time, if necessary. Your renal dietitian will review your food intake and give you ways
to lower potassium in your diet. Potassium requirements vary for each individual. Your dietitian
will determine the right amount of potassium for you to have in your diet.
How to prevent potassium levels from getting too high
The following are things people with kidney failure can do to keep their potassium at safe
levels:
Talk to your renal dietitian about creating an eating plan with the right amount of
potassium.
Watch your diet. Limit foods that are high in potassium.
Limit fruits and vegetables to the amounts recommended by your dietitian.
Limit milk and milk products or replace with nondairy substitutes recommended by your
dietitian.
Discard liquids from canned fruits and vegetables.
Avoid salt substitutes and other seasonings that contain potassium.
Read labels on “low salt” or “low sodium” packaged foods to be sure potassium
ingredients like potassium chloride are not added.
Keep an eye on serving size. Almost all foods have some potassium, so even a low
potassium food can turn into a high potassium food when eaten in large amounts.
Do not skip dialysis. Stay on dialysis for the full treatment time. The full treatment time
is necessary to clean the blood adequately.
Leach high potassium vegetables, if including them in your diet. Leaching removes some
of the potassium. Ask your renal dietitian which vegetables to leach and how much you
can eat. (See instructions for leaching below.)
o How to leach vegetables to lower potassium
 Peel the vegetable, cut into small pieces and place in a very large pot of
water.
 Rinse the vegetables.
 Fill the pot with water and let the vegetables soak for at least four hours at
room temperature (or you can let them soak over night in the refrigerator).
 After soaking, rinse the vegetables with clean water.
 Cook vegetables as desired.
 Limit portion to one serving, usually 1/2 cup.
What to eat and what to limit
The suggestions and lists below will help give you an idea of some high and low potassium
foods. See your health care team for a complete guide based on your requirements.
To keep your potassium levels normal try these suggestions:
Food type
Fruit
Tip
Choose apples, berries or grapes, instead of bananas,
oranges or kiwi.
Select a small piece of watermelon, instead of cantaloupe
or honeydew.
Eat a peach, plum or pineapple, instead of nectarines,
mangos or papaya.
Choose dried cranberries, instead of raisins or other dried
fruit.
Drink apple, cranberry or grape juice, instead of orange
juice or prune juice.
Use lower potassium canned pears, peaches or fruit cocktail,
instead of fresh fruit.
Vegetables
Choose green beans, wax beans or snow peas, instead of
dried beans or peas.
Prepare mashed potatoes or hash browns from leached
potatoes, instead of eating baked potato or French fries. (Be
sure to leach your potatoes to lower potassium content.)
Use summer squashes like crookneck or zucchini, instead
of winter squashes like acorn, banana or hubbard squash.
Cook with onion, bell peppers, mushrooms or garlic,
instead of tomatoes, tomato sauce or chili sauce.
Drink ice water with sliced lemon and cucumber, instead
of drinking vegetable juices.
Dairy
Use nondairy creamer or unenriched rice milk, instead of
milk.
Prepare pudding with nondairy creamer, instead of eating
yogurt or pudding made with milk.
Enjoy sherbet, sorbet or a Popsicle®, instead of ice cream
or frozen yogurt.
Miscellaneous
Choose vanilla- or lemon-flavored desserts, instead of
chocolate desserts.
Eat unsalted popcorn or pretzels, rice cakes, jelly beans or
hard candies, instead of nuts or seeds.
Season with pepper, lemon or low sodium herb and spice
blends, instead of salt substitutes.
High potassium foods
Be sure to limit or avoid high potassium foods.
Food type
Fruits
Avocados
Bananas
High potassium foods
Kiwi
Mangos
Cantaloupe
Dried fruits
Honeydew
Oranges & orange juice
Papaya
Prune juice
Vegetables
Artichoke
Dried beans & peas
Pumpkin
Potatoes, French fries
Spinach (cooked)
Sweet potatoes
Tomatoes, tomato sauce
Vegetable juices
Winter squash
Dairy
Milk
Yogurt
Ice cream
Miscellaneous
Chocolate
Molasses
Salt substitute
Seeds and nuts
Disclaimer: The above list does not include all foods high in potassium. Portion size also plays a
role in the amount of potassium you get from the foods you eat. Consult your dietitian and doctor
about what to eat based on your individual requirements.
Low potassium foods
Ask your dietitian about the amount you can safely eat. Portion size is important. Eating too
much or too often can result in high potassium levels even when eating low potassium foods.
Food type
Fruits
Low potassium foods
Apples
Peaches
Berries
Canned Pears
Fruit Cocktail
Pineapple
Grapes
Plums
Lemon
Watermelon
Vegetables
Carrots
Cabbage
Cauliflower
Cucumber
Eggplant
Green beans
Lettuce
Onion
Summer squash
Sweet peppers
Dairy substitutes
Nondairy creamers
Rice milk (unenriched)
Sorbet or Popsicle
Nondairy whipped
topping
Snacks
Jelly Beans
Hard candies
Plain donuts
Popcorn (unsalted)
Pretzels (unsalted)
Red licorice
Disclaimer: The above list does not include all foods low in potassium. Portion size also plays a
role in the amount of potassium you get from the foods you eat. Consult your dietitian and
doctor about what to eat based on your individual requirements.