Updated Guidelines on Kidney Health: Managing Potassium and Phosphorus Additives

The American Society of Nephrology (ASN) has introduced new Kidney Health Guidance (KHG) focusing on how additives containing potassium and phosphorus influence health risks such as hyperkalemia and CKD mineral and bone disorder in individuals with kidney disease. Published in the Journal of the American Society of Nephrology, this guidance was developed by the ASN KHG Workgroup on Food Additives to help healthcare providers develop practical strategies for educating patients about food additive consumption.

Traditional dietary advice for CKD often involved strict restrictions on foods high in potassium and phosphorus, which could lead patients to feel limited in their food choices and sometimes adhere to restrictive diets that conflict with balanced nutritional patterns. Recognizing this challenge, the new guidance emphasizes the significant role of food additives, especially potassium and phosphorus-based ones, in managing kidney health.

"Supporting patients to understand and control their intake of these additives is crucial," said Dr. Annabel Biruete, a registered dietitian and member of the ASN Workgroup. "Many of these additives are hidden in processed foods, making awareness and management particularly complex."

The guidance highlights that phosphorus additives generally provide no health benefits for CKD patients and should be avoided, as excess phosphorus can pose ongoing health risks even without overt hyperphosphatemia. Conversely, potassium additives can sometimes be beneficial, but their use must be carefully tailored to each patient's risk of hyperkalemia.

Managing intake is complicated by inconsistent food labeling and limited regulatory clarity, emphasizing the need for personalized dietary approaches. Healthcare professionals are encouraged to account for individual medical conditions, motivation levels, health literacy, and resource access when advising patients.

Further research is encouraged to better understand the impact of these additives on health outcomes, exploring their bioavailability and potential for safe dietary inclusion. The guidance stresses that more work is needed to fill knowledge gaps and enhance patient care.

In conclusion, the ASN’s updated kidney health guidance advocates for an individualized, informed approach to dietary management, focusing on reducing unnecessary phosphorus intake while carefully managing potassium. This ensures better health outcomes for people with CKD by promoting safer dietary practices and addressing systemic barriers to healthy eating.