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Potassium and fiber: a controversial couple in the nutritional management of children with chronic kidney disease

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Abstract

Background

Fruit and vegetable intake is commonly discouraged in children with chronic kidney disease (CKD) to avoid hyperkalemia. However, direct evidence in support of this widespread practice is lacking. Furthermore, the resultant restricted fiber exposure may deprive CKD patients from potential health benefits associated with the latter. Therefore, we investigated associations between dietary potassium intake, fiber intake, and serum potassium levels in pediatric CKD.

Methods

This study is a longitudinal analysis of a 2-year, prospective, multi-institutional study, following children with CKD at 3-month intervals. At each visit, dietary potassium and fiber intake were assessed, using 24-h recalls and 3-day food records. On the same occasion, serum potassium concentrations were determined. Associations between dietary potassium intake, dietary fiber intake, and serum potassium concentrations were determined using linear mixed models.

Results

Fifty-two CKD 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 fiber intake was 5.1 g lower (95% confidence interval (CI), 4.3–5.9 g/day; p < 0.001). Neither dietary potassium intake (p = 0.40) nor dietary fiber intake (p = 0.43) was 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 fiber intake are closely related but were not associated with circulating potassium levels in pediatric CKD.

Graphical abstract

A higher-resolution version of the graphical abstract is available as Supplementary information.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors wish to thank Sofie Vermeiren, Els Holvoet, Sophie Lobbestael, Tom Mertens, Maria Van Landschoot, An Desloovere, Sofie Eerens, Kimi Lambregts, Katrien Wellens, and Jarrik Fransen for their assistance.

Funding

The UToPaed study was funded by the Agency for Innovation by Science and Technology (IWT), from the ‘Applied Biomedical Research with a Primary Societal Goal’ (TBM) program in Flanders (Belgium): grant number IWT-TBM 150195. The first author is supported by a University Starting Grant issued by the Special Research Fund, project number 01N11119, Ghent University, Flanders, Belgium.

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Author notes

  1. Ann Raes, Evelien Snauwaert and Sunny Eloot contributed equally to this work.

Authors and Affiliations

  1. Pediatric Nephrology and Rheumatology, ERKNet Center, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Amina El Amouri, Johan Vande Walle, Ann Raes & Evelien Snauwaert

  2. Nephrology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Kato Delva, Aurélie Foulon, Charlotte Vande Moortel, Griet Glorieux, Wim Van Biesen & Sunny Eloot

  3. Pediatric Nephrology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium

    Koen Van Hoeck

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  1. Amina El Amouri
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Contributions

Conceptualization, A.E.A., E.S., S.E., A.R., J.V.W., G.G. and W.V.B.; methodology, A.E.A., E.S., G.G., S.E. and A.R.; formal analysis, A.E.A., K.D., A.F., C.V.M. and E.S.; investigation, A.E.A., A.F., C.V.M., E.S., K.V.H.; resources, A.R., J.V.W., K.V.H., G.G. and S.E.; data curation, E.S., A.F., C.V.M., A.E.A.; writing—original draft preparation, A.E.A.; writing—review and editing, A.E.A., K.D., E.S., S.E., A.R., J.V.W., G.G. and W.V.B.; visualization, A.E.A., E.S., A.R., G.G. and W.V.B. and S.E.; supervision, S.E.; project administration, A.R. and S.E.; funding acquisition, A.R. and S.E. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Amina El Amouri.

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Approval was obtained from the ethics committee of Ghent University.

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Written informed consent was obtained from the parents and children above the age of 12 years.

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Conflict of interest

J.V.W. received lecture fees from Vitaflo and is member of the European Society for Pediatric Nephrology (ESPN) nutritional task force (with Vitaflo grant). The other authors have no conflicts of interest to declare.

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El Amouri, A., Delva, K., Foulon, A. et al. Potassium and fiber: a controversial couple in the nutritional management of children with chronic kidney disease. Pediatr Nephrol 37, 1657–1665 (2022). https://doi.org/10.1007/s00467-021-05365-5

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  • DOI: https://doi.org/10.1007/s00467-021-05365-5

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