A Systematic Evaluation of Online Guidance for Managing Hyperkalemia Through Dietary Approaches in Individuals With Chronic Kidney Disease.

OBJECTIVE

The scientific literature on diet therapy for managing hyperkalemia risk in people with kidney disease has shifted in the last decade away from a focus on restricting potassium-rich foods. However, the extent to which this change is reflected in online resources has not been systematically studied.

DESIGN AND

METHODS

The first 50 webpages from Google and Bing search engines were obtained using the terms "diet" and "potassium" with: 1) hyperkalemia, 2) high blood potassium, 3) kidney disease, 4) dialysis, 5) kidney failure, 6) chronic kidney disease, 7) low, and 8) restriction. Dietary guidance was classified as recommended, restricted, or mixed using a hierarchical approach (e.g., advice to restrict oranges was also counted as restricting citrus fruit and fruit). After removing duplicate (n = 468) and unrelated/excluded resources (n = 224), 106 resources (13.3%) were available for analyses.

RESULTS

Online resources provided advice on 559 food items. Fruit and vegetables comprised the majority of restrictions (59%) and recommendations (58%). Plant-based protein foods, low-fat dairy products, and whole grains tended to restricted, and animal-based protein foods, high-fat dairy products, and refined grains tended to be recommended. Dietary guidance was usually at the level of individual food items, often restricting (nectarines) and recommending (peaches) foods in the same sub-group, and more than half of the food items (55%) mentioned in at least two resources had inconsistent advice across resources (restricted and recommended).

CONCLUSION

Dietary guidance online for managing hyperkalemia risk did not reflect recent shifts in the literature and primarily consisted of complicated food lists that lacked consistency. Research is needed to standardize and evaluate the efficacy of the food list-based approach to practice.