High levels of potassium in the bloodstream, a condition known as hyperkalemia, is potentially life-threatening. Hyperkalemia can cause shortness of breath, severe heart problems, and even sudden death. High potassium in the blood can cause more complications in people who have chronic kidney disease. Your kidneys are the body’s filtration system and are responsible for removing the waste from your bloodstream. Chronic kidney disease results in the gradual loss of kidney function, and if your kidneys are not working properly, they are unable to process the extra potassium in the blood. Let us take a closer look at the link between high potassium and chronic kidney disease.
Why Does Your Body Need Potassium?
Potassium is an essential mineral and an electrolyte that the body needs to maintain a balance of fluids.(1,2,3) Potassium is also needed by the body to support the proper functioning of the nerves, cells, and muscles, including the heart muscle. Potassium is present in many foods at varying levels, especially in fruits and vegetables.(4) However, it is important that we maintain the right balance of potassium in the bloodstream.
On average, the right levels of potassium should ideally be between 3.5 and 5.0 milliequivalents per liter (mEq/L).(5) The amount of potassium that you should have every day is around 4,700 milligrams (mg).(6) It is important, though, that you get the required potassium in your diet because your body needs potassium for supporting the muscles that control your breathing and your heartbeat. It is possible for many people to unknowingly consume more potassium than what your body needs and what your kidneys are able to filter out from the blood, especially if you have chronic kidney disease. But how is chronic kidney disease related to hyperkalemia? Let’s take a look.
Link Between High Potassium and Chronic Kidney Disease
Chronic kidney disease increases the risk of having high levels of potassium in the bloodstream, a condition known as hyperkalemia. This is why it is essential to watch how much potassium you consume if you have chronic kidney disease.(7)
The kidneys are responsible for removing the extra potassium from the bloodstream and flush it out through your urine. However, in people with chronic kidney disease, the kidney’s ability to get rid of the excess potassium from the blood is reduced.
If you leave high potassium untreated, it can interfere with the electric signals of the heart muscle, which can cause dangerous conditions like arrhythmia or abnormal heart rhythms. High potassium and chronic kidney disease can also lead to inflammation of the kidneys, which can cause further deterioration in your renal functions.(8,9)
At the same time, apart from chronic kidney disease, there are other factors as well that increase the risk of hyperkalemia. These include certain medications used for treating high blood pressure, like blood thinners and beta-blockers. These medicines can make your kidneys hold on to the excess potassium, causing it to build up in the bloodstream.(10,11)
What are the Symptoms of High Potassium Levels?
Most people seldom notice any of the signs of hyperkalemia. In fact, the levels of potassium can continue to increase in the bloodstream over weeks or even months, and very rarely, people are able to catch the signs of this condition. Some of the common symptoms of high potassium levels include:
- Tingling (feeling pins and needles) in the feet or hands
- Abdominal cramps
- Muscle weakness
- Nausea and/or vomiting
- Irregular heartbeat (arrhythmia)
Having severely high potassium levels may cause:
Sudden spikes in potassium levels or severely high potassium levels can prove to be life-threatening, and you should seek immediate medical assistance if you experience any of these symptoms.(12)
Preventing High Potassium with Chronic Kidney Disease
If you have chronic kidney disease, your doctor is likely to recommend that you restrict your intake of high potassium fruits and vegetables in order to lower the risk of hyperkalemia. However, it is necessary to consume these foods to maintain a nutritious and well-balanced diet to maintain overall health. Your doctor might recommend that you consult a dietitian to find the right balance of how much potassium you should be consuming and from what sources.
Fruits and vegetables are necessary for any nutritious diet, but limiting the ones that are high in potassium should be the primary objective of your meal plans. Here are some foods you should restrict if you want to prevent hyperkalemia with chronic kidney disease:
- Cooked spinach
- Honeydew melon
- Dried fruits such as raisins and prunes
- Winter squash
At the same time, you should focus on having fruits and vegetables that are low in potassium, such as:
- Bell peppers
- Green beans
- Mashed potatoes
- Summer squash
Here are some other tips to have a healthy potassium level in the blood even when you have chronic kidney disease:
- Avoiding salt substitutes.
- Maintaining a regular dialysis schedule.
- Restricting the intake of dairy products or opting for dairy alternatives like soy milk or rice milk.
- Reading the food labels to check for potassium levels and also paying attention to your serving sizes.
Treating High Potassium Levels in the Blood
If you have chronic kidney disease, your doctor is likely to recommend one of the following strategies for maintaining healthy levels of blood potassium.
Low Potassium Diet: You will work together with a dietitian or your doctor to come up with a meal plan that focuses on consuming foods that are low in potassium.
Taking Potassium Binders: This is a class of medication that binds to the extra potassium in the bowels and then removes it through the stool. Potassium binders can be taken rectally as an enema or orally as a tablet.(13)
Diuretics: Diuretics are medications that help remove extra potassium from the body through urine.(14)
Changes In Your Medication Dosage: If you have an underlying health condition like heart disease or high blood pressure, your doctor may change the dosage of the medicines you take to manage these conditions.(15)
However, it is essential that you always consult your doctor before you stop, start, or modify the dosage of any of your medications or supplements.(16)
While potassium is a very important mineral for the body, it is possible to have too much potassium. Potassium is needed for the proper functioning of nerves, cells, and muscles in the body, due to which excess potassium affects the functioning of all the organs of the body, especially the heart.
The kidneys are responsible for flushing out the excess potassium from the blood, but in people with chronic kidney disease, kidney damage affects the removal of this extra potassium. This leads to an accumulation of potassium in the bloodstream, which can be dangerous.
If you have chronic kidney disease, you should consult your doctor or a dietitian to design a healthy meal plan that controls the intake of potassium while also ensuring you have a nutritious and well-balanced diet.
- Darrow, D.C., 1950. Body-fluid physiology: the role of potassium in clinical disturbances of body water and electrolyte. New England Journal of Medicine, 242(26), pp.1014-1018.
- Fenn, W.O., 1940. The role of potassium in physiological processes. Physiological Reviews, 20(3), pp.377-415.
- Danowski, T.S., 1949. Newer concepts of the role of potassium in disease. The American Journal of Medicine, 7(4), pp.525-531.
- He, F.J. and MacGregor, G.A., 2001. Beneficial effects of potassium. Bmj, 323(7311), pp.497-501.
- National Kidney Foundation. 2020. What Is Hyperkalemia?. [online] Available at: <https://www.kidney.org/atoz/content/what-hyperkalemia> [Accessed 28 October 2020].
- Ods.od.nih.gov. 2020. Office Of Dietary Supplements – Potassium. [online] Available at: <https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/> [Accessed 29 October 2020].
- Morris, A. and Lycett, D., 2020. Experiences of the Dietary Management of Serum Potassium in Chronic Kidney Disease: Interviews With UK Adults on Maintenance Hemodialysis. Journal of Renal Nutrition.
- Wang, W., Soltero, L., Zhang, P., Huang, X.R., Lan, H.Y. and Adrogue, H.J., 2007. Renal inflammation is modulated by potassium in chronic kidney disease: possible role of Smad7. American Journal of Physiology-Renal Physiology, 293(4), pp.F1123-F1130.
- Kovesdy, C.P., 2014. Management of hyperkalaemia in chronic kidney disease. Nature Reviews Nephrology, 10(11), p.653.
- Einhorn, L.M., Zhan, M., Walker, L.D., Moen, M.F., Seliger, S.L., Weir, M.R. and Fink, J.C., 2009. The frequency of hyperkalemia and its significance in chronic kidney disease. Archives of internal medicine, 169(12), pp.1156-1162.
- JUVET, T., GOURINENI, V.C., RAVI, S. and ZARICH, S.W., 2013. Life-threatening hyperkalemia: a potentially lethal drug combination. Connecticut Medicine, 77(8).
- Gelfand, M.C., Zarate, A. and Knepshield, J.H., 1975. Geophagia: a cause of life-threatening hyperkalemia in patients with chronic renal failure. Jama, 234(7), pp.738-740.
- Pitt, B. and Bakris, G.L., 2015. New potassium binders for the treatment of hyperkalemia: current data and opportunities for the future. Hypertension, 66(4), pp.731-738.
- Kaplan, N.M., Carnegie, A., Raskin, P., Heller, J.A. and Simmons, M., 1985. Potassium supplementation in hypertensive patients with diuretic-induced hypokalemia. New England Journal of Medicine, 312(12), pp.746-749.
- Chang, A.R., Sang, Y., Leddy, J., Yahya, T., Kirchner, H.L., Inker, L.A., Matsushita, K., Ballew, S.H., Coresh, J. and Grams, M.E., 2016.
- Antihypertensive medications and the prevalence of hyperkalemia in a large health system. Hypertension, 67(6), pp.1181-1188.
- John, S.K., Rangan, Y., Block, C.A. and Koff, M.D., 2011. Life-threatening hyperkalemia from nutritional supplements: uncommon or undiagnosed?. The American journal of emergency medicine, 29(9), pp.1237-e1.