Potassium Intake—(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers

Abstract

As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.