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Eat the Renal Way- Controlling Potassium Intake
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Diet Tips for the Management of Chronic Kidney Disease prior to Dialysis

Potassium can easily be found in almost all foods. It is essential to your body for regular heart beat and muscle contraction. Kidneys are the main organ that regulates its levels in your body. If your kidneys cannot carry out its work properly, you may need to watch out your potassium intake. It is especially true when your blood test result reveals that your blood potassium levels go beyond normal range. In severe case, high blood potassium levels can lead to severe muscle weakness, irregular heart beat and/or heart attack.

Here are some tips to control dietary potassium intake:-

1. Know your limit. Daily potassium requirement varies, especially depending on your kidney functionality. In general, individuals with chronic kidney disease and high potassium levels should limit their potassium intake at 2000-3000mg/day.

2. Familiarise common foods with different levels of potassium content. Almost all foods contain potassium, particularly fruits, vegetables, beverages, pulses, legumes, and spices. In fact they can be categorised into high, moderate, and high potassium foods and these categories are shown in the table below. You should choose foods with low-to-moderate levels of potassium content as much as possible.

  Low
(< 50mg/serving)
Moderate
(50-100mg/serving)
High
(>100mg/serving
Beverages Syrup drink 1 glass Barley water 1 glass, Chinese tea 1 glass, non-cola beverages 1 glass, sugar cane juice1 glass Canned fruit juice 1 glass, cocoa or chocolate based drink 1 glass, coconut water 1 glass, fresh fruit juice 1 glass, malted beverages 1 glass
Vegetables Bean sprouts/taugeh ½ cup, bitter gourd ½ cup, leek ½ cup, cucumber ½ cup, kangkung ½ cup, cabbage ½ cup, sweet potato leaves ½ cup, white raddish ½ cup, snake gourd ½ cup, ketola ½ cup All variety of beans (long beans, French beans, broad beans, peas) ½ cup, asparagus ½ cup, bamboo shoots ½ cup, brinjal ½ cup, capsicum ½ cup, red carrot ½ cup, cauliflower ½ cup, lettuce (sang coy) ½ cup, pumpkin ½ cup, sengkuang ½ cup, tomato ½ cup Banana stem ½ cup, drumstick leaves (murrangai/kelor) ½ cup, jantung pisang ½ cup, petai ½ cup, bayam ½ cup, sawi ½ cup, broccoli ½ cup, ulam ½ cup, cekur manis ½ cup, kalian ½ cup, tubers (potato, sweet potato, yam, tapioca) 1 cup
Fruits Apple (red or green) 1 whole, pear 1 whole, guava ½, papaya 1 slice, watermelon 1 slice, pineapple 1 slice Canned fruits (minus syrup) ½ cup, lime 1 whole, lemon 1 whole, lychee (minus syrup) ½ cup, oranges 1 whole, persimmon 1 whole, pomelo, rambutan banana 1 whole, cempedek, ciku, durian, nangka, grapes, langsat, mata kucing, peach, plum
Miscellaneous items that are high in potassium include:
All varieties of legumes and pulses (dhal, chickpeas, soya, etc.), nuts, spice powder (serbuk kari, rempah, etc.), brown sugar, baked beans, fresh grounded chilli/cili boh, chocolate based products, coconut based products, dried fruits, dried mushrooms, dried prawns/fish, essence of chicken, asam jawa, tempoyak, wholemeal products, etc.

Adopted from Tilakavati et al. (2001)

3. Mind your portion and consumption frequency. Dietary potassium intake increases with food portion size and consumption frequency. You are possible to exceed your potassium allowance by consuming low-to-moderate potassium foods in large portion and/or more frequent. Hence, your focus should put on total daily potassium intake.

4. Change food preparation and cooking method. Your potassium intake can be reduced by doing some minor changes in food preparation and cooking methods. Here are some practical tips:-

  • Potassium is water-soluble and potassium content can be reduced by the process of leaching. You can cut certain high-potassium foods (e.g. vegetables, tubers, carrots and beets) into small bits and soak them for 1-2 hours in several changes of warm water.  
  • Do not drink or use the liquid from canned/cooked fruits and vegetables, or the juices from cooked meat. Limit the consumption of soup too.
  • Peel off the skin from fruit.
  • Use whole rather than ground spices.
  • Watch out for salt substitutes. Salt substitutes can be high in potassium and hence be sure that you know the content. 

5. Be prudent to the use of herbal and traditional remedies. Herbs and botanical products can be high in potassium and hence dangerous to you. The essence of these products can be even worse. You are advised to consult your healthcare providers before using any herbal and traditional remedies.

6. Consult dietitian. Restricting food unnecessarily and adopting fad diet can be life-threatening. If you have questions and/or face difficulties in managing your diet, do not hesitate to talk to a dietitian (a well-trained and qualified professional in food and nutrition).

Reference:

  1. Malaysian Dietitians’ Association. Medical Nutrition Therapy Guidelines for Chronic Kidney Disease, 2005.
  2. Ministry of Health. Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, 2011.
  3. Tilakavati K, Chee WSS & Ruzana A. Developing a nutrition education package for Mlaysian Hemodialysis Patients. J Renal Nutr 2001;11(4):220-227.
  4. National Kidney Foundation. Potassium and Your CKD Diet. [cited 6th February 2013] Available from http://www.kidney.org/atoz/content/potassium.cfm