Patients with chronic kidney disease (CKD) are at increased risk for hyperkalemia, a serious condition involving elevated plasma potassium levels. Low-potassium diets have been a key management strategy since the 1960s, as declining kidney function limits potassium excretion. Although compensatory mechanisms like colonic secretion help, many patients with CKD still experience postprandial hyperkalemia—potassium spikes after meals—due to impaired renal and cellular responses. Dietary adjustments, such as adding fiber and balancing meals, can help but do not fully address this challenge.

Potassium exchange resins, such as patiromer and sodium zirconium cyclosilicate, effectively manage chronic hyperkalemia by boosting fecal potassium excretion but show limited efficacy in preventing postprandial potassium spikes. Their mechanisms, which bypass kidney-like regulation, may not align with meal-related potassium absorption. While these medications are valuable for chronic management, they do not replace the need for dietary considerations or replicate healthy kidney function. Further research is needed to refine strategies for managing postprandial hyperkalemia in CKD.

Reference: St-Jules DE, Clegg DJ, Palmer BF, Carrero JJ. Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet? A Cautionary Tale. Clin J Am Soc Nephrol. 2022;17(3):467-472. doi: 10.2215/CJN.09660721.