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Potassium, Phosphorus and the Dialysis Diet

by DaVita renal dietitian Helen Dorrough, RD

Potassium is a mineral found in most of the foods we eat and is necessary in the diet because it helps with muscle movement and keeping the nervous system healthy. It also helps balance the amount of water in the body. The amount of potassium in the blood is controlled by the kidneys. For people with kidney disease, potassium levels can build up to high levels in the blood. This is called hyperkalemia and can be dangerous for the heart.

Phosphorus is also a mineral that we get from eating certain foods. Phosphorus helps build strong bones and teeth. It also helps convert food into energy and helps with metabolism. Kidneys normally release extra phosphorus into the urine; however, kidney disease can prevent the body from getting rid of the extra and the buildup causes problems with the bones and heart.

Why it’s important to limit potassium and phosphorus in the hemodialysis diet

Potassium-rich foods are limited for those on hemodialysis because potassium builds up between dialysis treatments and can cause problems such as weakness, muscle cramps, tiredness, irregular heartbeat and, worst of all, heart attack. Potassium is found mostly in fruits, vegetables and dairy products. Certain fruits and vegetables are very high in potassium while others are lower. However, eating a large amount of a low-potassium food can cause potassium to add up to dangerous levels. Be aware that most foods contain some potassium — meat, poultry, bread, pasta — so it can add up. Butter, margarine and oils are the only foods that are potassium free.

Foods high in phosphorus are limited for those with chronic kidney disease (CKD) because hemodialysis removes only a small amount of phosphorus from the blood. Unless the amount of phosphorus in the diet is limited, and medicines called phosphorus binders are taken regularly, phosphorus levels can get too high. This can increase the risk of developing complications such as itching, weak and brittle bones and calcium deposits in blood vessels and organs including the heart and lungs. Phosphorus is found in almost all foods although high-protein foods, dairy products, nuts, seeds, dried beans and peas, chocolate, colas and whole grain foods contain the highest amounts. 

Do you have to limit potassium and phosphorus in the peritoneal dialysis diet?

Because peritoneal dialysis (PD) is performed daily, the diet is a little more liberal. Potassium usually is removed from the body through PD, so most peritoneal dialysis patients are able to keep their potassium at a normal or even low level. Those on PD who have low potassium will generally be instructed to eat foods that are rich in potassium such as tomatoes, orange juice and bananas to get their potassium levels up to a normal range.

On the other hand, phosphorus is not removed well during peritoneal dialysis, so PD patients still need to limit phosphorus in their diets.

Clearing up the potassium and phosphorus confusion

New dialysis patients, as well as those that have been on dialysis for years, sometimes have problems remembering which foods contain potassium and which ones have phosphorus. Part of the problem is that some foods are high in both potassium and phosphorus. These “double jeopardy” foods can make things more confusing, but these are the foods that are best to avoid or use in very small amounts. 

Most high potassium foods come from plants. Fruits and vegetables tend to be the high potassium sources.

High phosphorus foods are mainly from animals. High-protein foods, such as meats, along with dried beans and peas tend to be high in phosphorus.

Double jeopardy foods that are high in both potassium and phosphorus include dairy foods, nuts, seeds, chocolate and whole grain foods.

High potassium

High phosphorus

Double jeopardy —High potassium and high phosphorus

  • Fruits      
  • Vegetables
  • Meat
  • Poultry
  • Fish and seafood
  • Wild game
  • Eggs
  • Dried beans and peas
  • Milk
  • Dairy products
  • Nuts and seeds
  • Chocolate
  • Whole grain products

Check the list below to see if you are eating any of the double jeopardy foods on the left. Using some of the alternatives listed on the right will help improve your chances of keeping potassium and phosphorus under control.

Double Jeopardy Foods (High Potassium & High Phosphorus)

Alternatives

Cheese

Vegan rella cheese, low-fat cottage cheese, sprinkle of parmesan cheese (use very small amounts of extra sharp cheeses for the maximum flavor)

Chocolate

Desserts made with lemon or apple, white cake, rice-crispy treats

Cream Soup

Broth-based soups made with pureed vegetables or make soups with Mocha Mix® nondairy creamer or Rich’s Coffee Rich® 

Dried beans and peas

Green beans, wax beans

Ice Cream

Mocha Mix® frozen dessert, sorbet, sherbet, popsicles

Milk

Mocha Mix® nondairy creamer, Coffeemate®, Rich’s Coffee Rich®, Rice Dream® original, unenriched rice beverage

Nuts

Low-salt snack foods including pretzels,tortilla chips, popcorn, crackers, Sun Chips®

Peanut butter    

Low-fat cream cheese, jam or fruit spread

An extra caution about phosphorus

Foods, such as deli meats and colas, which have phosphates added in processing, are especially high in phosphorus. Phosphates are often used as a preservative or as an ingredient in processed foods. For that reason you must read food labels carefully and look for words that mean phosphorus in the ingredient section such as the ones below:

  • Phosphoric acid
  • Dicalcium phosphate
  • Monocalcium phosphate
  • Pyrophosphates
  • Hexametaphosphate
  • Polyphosphates
  • Sodium phosphate

These ingredients used as preservatives may be more easily absorbed than phosphorus from natural food sources. That is why it’s important to avoid foods with these ingredients.

Talk to your doctor about your diet and ask his or her advice about consuming foods that contain potassium and phosphorus. Your renal dietitian is available to help you learn about which foods have potassium and phosphorus, and will review your lab results with you so you know how much you can eat and stay healthy. Make sure to ask your doctor and dietitian for assistance.

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