ESPN 53rd Annual Meeting

ESPN 2021


 
POTASSIUM AND FIBRE: A CONTROVERSIAL COUPLE IN THE NUTRITIONAL MANAGEMENT OF CHILDREN WITH CHRONIC KIDNEY DISEASE
Amina El Amouri 1 Kato Delva 1 Aurélie Foulon 2 Charlotte Vande Moortel 2 Koen Van Hoeck 3 Griet Glorieux 2 Wim Van Biesen 2 Johan Vande Walle 1 Evelien Snauwaert 1 Sunny Eloot 2 Ann Raes 1

1- Paediatric Nephrology, Ghent University Hospital
2- Nephrology, Ghent University Hospital
3- Paediatric Nephrology, Antwerp University Hospital
 
Introduction:

Life-threatening hyperkalaemia is the most dreaded metabolic complication in children with chronic kidney disease (CKD). However, direct evidence in support of the widespread practice of dietary potassium restriction for the prevention and management of hyperkalaemia is lacking. Furthermore, the resultant lower fibre exposure from avoiding potassium-rich fruits and vegetables may deprive CKD patients from potential health benefits. Therefore, we examined whether potassium and fibre intake correlate and investigated associations between dietary potassium, fibre intake and serum potassium levels in paediatric CKD.

Material and methods:

This study is a longitudinal analysis of a 2-year, prospective, multi-institutional study, following children with CKD at 3-month intervals. 24-h recalls and 3-day food records were used to assess dietary potassium and fibre intake and coupled to serum potassium concentrations. Associations between dietary potassium intake, dietary fibre intake and serum potassium concentrations were determined using linear mixed models. 

Results:

52 patients (7 transplant recipients, none on dialysis) aged 9[4;14]years with an estimated glomerular filtration rate (eGFR) of 49[25;68] mL/min/1.73 m², were included. For every g/day decrease in dietary potassium intake, the estimated mean daily fibre intake was 5.1g (95% confidence interval(CI), 4.3 to 5.9g/day; p < 0.001) lower. Regarding potassium intake, the relative contribution of fruits and vegetables was 16[12;33]%, while non-nutritious sources (fastfood, sugar…) accounted for 29[11;45]%. Neither dietary potassium intake (p = 0.403), nor dietary fibre intake (p = 0.432) were associated with circulating potassium in a model adjusted for time point, eGFR, treatment with a renin–angiotensin–aldosterone system blocker, serum bicarbonate concentration and body surface area.

Conclusions:

Dietary potassium and fibre intake are closely related and were not associated with circulating potassium levels in paediatric CKD. If downward adjustments of potassium intake are necessary, the focus should shift from mere potassium content to potassium sources to safeguard fibre intake.