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Managing High Potassium While on Dialysis

Managing High Potassium While on Dialysis

This article is for people who are on dialysis for their kidney disease or for anyone who wants to learn more about managing high blood potassium while on dialysis. The goal of this patient education activity is to learn about ways to manage high blood potassium while you are on dialysis.

You will learn:

  • How dialysis affects blood potassium level

  • Why a high potassium level is harmful

  • How to know if you have high a potassium level

  • Ways to manage high blood potassium, including diet and the use of potassium-lowering medicines

  • How to take care of yourself in between dialysis sessions

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Dialysis and Your Potassium Levels

When your kidneys are not functioning well, dialysis acts like an artificial kidney to clean your blood by:

  • Removing waste, toxins, salt, extra water

  • Helping to control blood pressure

  • Keeping a safe level of electrolytes (like potassium, sodium, and magnesium)

During dialysis, blood and a special dialysis fluid (called dialysate) flow through a filter. Smaller molecules in your blood, like toxins and extra potassium, are able to cross through the filter. These molecules stay in the dialysate and are washed out of your blood.

Why High Potassium Is Harmful

When you have too much potassium in your blood (called hyperkalemia), it can lead to a dangerously abnormal heart rate and sudden death. Things that can increase your potassium levels include:

  • High-potassium foods in your diet

  • Diseases like kidney disease, heart failure

  • Being on dialysis

  • High blood sugar (if you have diabetes or not enough insulin in your body)

  • Medicines, like those taken for blood pressure

  • Tissue damage, like a burn or trauma

When you're on dialysis and have high potassium levels, some of the potassium might not get removed. Also, as your body readjusts after dialysis, your potassium levels can go up again.

Dr Hudson, a pharmacist, describes why it is important to manage your potassium in between dialysis sessions.

How to Know if You Have High Potassium Levels

Many people don't know that they have high potassium levels until their doctor does a blood test. High potassium levels can develop slowly over weeks or months, or it can happen suddenly, such as after a dialysis session. Milder symptoms include muscle weakness, numbness, tingling, and nausea.

Having high potassium levels can be life-threatening. If you have any of these symptoms, call 911:

  • Feeling like your heart is pounding or beating fast

  • Shortness of breath

  • Chest pain

  • Nausea

  • Vomiting

How Potassium Levels Can Be Managed

Along with going to your dialysis sessions, some things that can help you manage your potassium levels include:

  • Eating foods that are low in potassium

  • Making changes to your medicines, such as lowering a dose or stopping a medicine, but only at the advice of your doctor

  • Adding medicines that help remove extra potassium, such as a diuretic or potassium binder, but only at the advice of your doctor

Your goal should be a potassium level within normal range (laboratory value: 3-5 mEq/L). Generally, a potassium level above 5 mEq/L is considered to be high. Talk to your doctor about what is the best way to manage your potassium levels.

Low Potassium Diet

As Dr Hudson mentioned, there are many things that can increase your potassium level. Therefore, maintaining a low potassium diet in between your dialysis sessions is very important.

  • Eat foods that are low in potassium (less than 200 mg of potassium) per serving

  • Limit foods that are high in potassium (more than 200 mg of potassium) or eat smaller portions of these foods

  • Avoid herbal medicines and supplements that can affect your potassium levels

  Low Potassium Foods* High Potassium Foods*
Dairy Low-fat, half cup of yogurt or cottage/ricotta/mozzarella cheese Milk/milk products; hard or processed cheese, cheese spreads
Vegetables Kale, cabbage, lettuce, zucchini, corn, onions, eggplant cauliflower, carrots (cooked), broccoli (raw or frozen), cucumber, peas, mushrooms Avocado, beans/lentils, broccoli (cooked), spinach (cooked), tomato/tomato-based products, white and sweet potatoes
Fruits Apples, blueberries, cranberries, grapes, peaches, pears, grapefruit, pineapple, plums, strawberries, raspberries, watermelon Bananas/plantains, cantaloupe, dried fruit, oranges, mangoes, pomegranate, prunes (fruit juices included)
Others Coffee, tea; bread, pasta, noodles, rice (not whole grain); tofu (6 oz); seafood, poultry Chocolate, ice cream, French fries, potato chips, creamed soups, nuts/seeds

*This is not a complete list. Talk to your doctor or dietitian about a proper low potassium diet.

Cooking Tips to Avoid High Levels of Potassium in Your Diet

Cooking your own meals is a great way to control how much potassium you eat:

  • Use fresh fruits and vegetables

  • Avoid prepackaged foods and fast foods

  • Soak or "leach" certain vegetables before cooking

  • Avoid salt substitutes (they are high in potassium)

Tips to Lower Your Potassium in Your Diet

Drain and rinse canned foods before cooking

Use lemon, spices, and herbs instead of salt and salt substitutes

Use a small amount of olive oil or a nonstick cooking spray instead of butter

Trim fat from meat and remove skin from poultry

Limit alcohol to less than 2 drinks

Cook or order food that is grilled, broiled, steamed, boiled, baked, roasted, poached, or stir-fried (instead of deep-fried)

To leach vegetables (such as potatoes, carrots, beets), first wash, peel, and slice the vegetables. Then soak them in warm water for at least 2 hours before cooking.

Potassium-Lowering Medicines

There are also medicines that help you remove extra potassium from your body such, as diuretics ("water pills") and potassium binders.

  • Diuretics remove extra fluid and potassium through your kidneys. Examples include: hydrochlorothiazide (Microzide®), furosemide (Lasix®), and spironolactone (Aldactone®)

  • Potassium binders specifically treat high potassium levels by binding to potassium in your stomach and removing it through your colon. Examples include sodium polystyrene sulfonate (Kayexalate®) and 2 newer agents: patiromer (Veltassa®) and sodium zirconium cyclosilicate (LokelmaTM)

Your doctor will let you know when you should take these medicines based on your dialysis schedule.

Dr Hudson talks about potassium-lowering medicines.

Side Effects of Potassium-Lowering Medicines

Potassium-lowering medicines are generally well-tolerated.

The use of diuretics, as well as dialysis, can cause a shift in fluid and lower your electrolytes in your body. As a result, you may develop:

  • Low blood pressure and feel dizzy, tired, thirsty, or have a fast heartbeat

  • Headache, muscle cramps, diarrhea, or itchy skin

If you have diabetes, the use of diuretics can increase your blood sugar.

Since potassium binders work mostly in the stomach and intestines, you may experience stomach-related symptoms like diarrhea or constipation, or have swelling. Your doctor might have to adjust your dose to ensure the potassium levels in your body stay within the normal range.

How to Manage Your Potassium Levels In Between Dialysis Sessions

It is important for you to go to your scheduled dialysis sessions and to maintain a low potassium diet throughout your treatment. Other ways to manage your potassium are:

  • Taking your medicines as prescribed

  • Learning how to read food labels

  • Drinking water after exercising: a total of 4 cups per day or 32 ounces

  • Cooking your own meals with fresh fruits and vegetables or using a renal diet meal delivery service

  • Meeting with a dietitian to create a meal plan that's right for you

Questions to Ask Your Doctor

  • How high is my potassium?

  • When should I get emergency help for high potassium?

  • Is a potassium binder right for me?

  • What should I do in between dialysis sessions to lower my potassium?

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View Additional Materials View Additional Materials on this topic that you may find useful

National Institute of Diabetes and Digestive and Kidney Diseases: Eating & Nutrition for Hemodialysis

National Kidney Foundation: Potassium and Your CKD Diet

National Kidney Foundation: Dialysis

National Kidney Foundation: Dialysis - Bill of Rights

My Food Data: Low Potassium Vegetables

Authors and Disclosures


Joanna Hudson, PharmD, BCPS, FASN, FCCP

ProfessorThe University of Tennessee Health Science CenterDepartments of Clinical Pharmacy and Translational Science & Medicine (Nephrology)Memphis, Tennessee

Disclosure: Joanna Hudson, PharmD, BCPS, FASN, FCCP, has disclosed the following relevant financial relationships:Served as a speaker or a member of a speakers bureau for: Amgen

Clinician Reviewer

Susan L. Smith, MH, PhD

Senior Medical Education Director, Medscape, LLC

Disclosure: Susan L. Smith, MH, PhD, has disclosed no relevant financial relationships.


Asha P. Gupta, PharmD, RPh

Senior Scientific Content Manager, Medscape, LLC

Disclosure: Asha P. Gupta, PharmD, RPh has disclosed no relevant financial relationships.


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