Plant-based diet in hyperkalemic chronic kidney disease patients receiving sodium zirconium cyclosilicate: a feasibility clinical trial.
In a 6-week feasibility trial of hyperkalemia-prone CKD patients, concomitant sodium zirconium cyclosilicate allowed a high-potassium plant-based diet to be introduced while plasma potassium remained within normal values for most patients and dietary quality improved.
Background
Plant-based diets may offer metabolic and cardiovascular benefits but raise concerns about hyperkalemia in chronic kidney disease (CKD), leading to dietary restriction of potassium-rich fruits and vegetables and consequently poorer dietary quality. This trial explored whether the potassium binder sodium zirconium cyclosilicate (SZC) could make a plant-based diet feasible and safe in hyperkalemic CKD patients.
Study design
The 6-week single-arm trial enrolled 26 hyperkalemic patients with CKD stage 4 to 5 not on dialysis. For the first 3 weeks patients received a low-protein, low-potassium diet plus SZC, then transitioned to a high-potassium plant-based diet delivered as a weekly food basket while continuing SZC for the subsequent 3 weeks. Plasma potassium was monitored weekly and SZC was titrated to maintain normokalemia.
Key findings
Mean plasma potassium decreased from 5.5 to 4.4 mEq/L within 48 to 72 hours after baseline, then rose to 4.7 to 5.0 mEq/L for the remainder of the study after SZC dose adjustments matched the increased potassium intake of the plant-based diet. During the study, 58% of patients had fasting plasma potassium between 3.5 and 5.0 mEq/L, with no episode above 6.5 mEq/L or below 3.0 mEq/L. Fiber intake, dietary quality, the physical-functioning quality-of-life domain, and serum bicarbonate (P-carbon dioxide rose from 21 to 23 mEq/L) all improved.
Clinical implications
Prescribing a plant-based diet alongside titrated SZC in hyperkalemia-prone CKD patients improved dietary quality and increased intake of healthy foods while keeping plasma potassium stable within normal values for most patients. As a feasibility study, the findings support further, larger randomized evaluation of this strategy for liberalizing diet in CKD.
Category
Research
Source
American Journal of Clinical Nutrition
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.