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Plant Potassium Safer Nuanced CKD Diet — ESENeph MCQ

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ModerateChronic Kidney DiseasePlant Potassium Safer Nuanced CKD DietESENeph

A 60-year-old woman with CKD G3b (eGFR 36 mL/min/1.73m2) is on ramipril 10 mg daily. Her potassium is 5.4 mmol/L. She eats a diet rich in fruits and vegetables. Her dietitian suggests restricting dietary potassium. What is the nuanced current thinking on dietary potassium in CKD?

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Correct answer: C — Plant-based potassium sources may be safer than processed food potassium due to alkalinising effect and lower bioavailability

Traditional blanket potassium restriction in CKD is being reconsidered. Plant-based potassium sources (fruits, vegetables, legumes) are packaged with alkali (citrate, bicarbonate precursors) and fibre, which may offset hyperkalaemia risk by: (1) increasing faecal potassium excretion via fibre-mediated colonic secretion; (2) correcting metabolic acidosis (which causes transcellular potassium shift into the extracellular space); (3) lower bioavailability compared to additive potassium in processed foods. KDIGO 2024 and emerging evidence support a diet rich in plant-based whole foods rather than restrictive low-potassium diets, which may deprive patients of cardiovascular and renal benefits of fruit/vegetable intake. Potassium-containing salt substitutes and additives remain genuine risks.

Reference: KDIGO 2024 – CKD Guideline; St-Jules et al 2016 – Dietary Potassium CKD; Clegg & Hill Gallant 2019