Pediatric Nephrology and Rheumatology, ERKNet Center, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Nephrology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Pediatr Nephrol. 2022 Jul;37(7):1657-1665. doi: 10.1007/s00467-021-05365-5. Epub 2022 Jan 7.
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.
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.
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 m 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.
Dietary potassium and fiber intake are closely related but were not associated with circulating potassium levels in pediatric CKD. A higher-resolution version of the graphical abstract is available as Supplementary information.
为避免高钾血症，通常不鼓励患有慢性肾脏病（CKD）的儿童摄入水果和蔬菜。然而，缺乏支持这一普遍做法的直接证据。此外，由此导致的膳食纤维摄入量减少可能使 CKD 患者无法获得与后者相关的潜在健康益处。因此，我们研究了儿科 CKD 患者的膳食钾摄入量、膳食纤维摄入量和血清钾水平之间的关系。
这是一项为期 2 年的前瞻性多机构研究的纵向分析，每 3 个月对 CKD 患儿进行随访。在每次就诊时，通过 24 小时回顾法和 3 天食物记录法评估膳食钾和膳食纤维摄入量。同时，还测定了血清钾浓度。使用线性混合模型确定膳食钾摄入量、膳食纤维摄入量与血清钾浓度之间的关系。
共纳入 52 例 CKD 患儿（7 例肾移植受者，无透析患者），年龄为 9 [4；14] 岁，估算肾小球滤过率（eGFR）为 49 [25；68] mL/min/1.73 m。膳食钾摄入量每降低 1 g/天，估计平均每日膳食纤维摄入量就会降低 5.1 g（95%置信区间[CI]：4.3-5.9 g/天；p<0.001）。在调整时间点、eGFR、肾素-血管紧张素-醛固酮系统阻滞剂治疗、血清碳酸氢盐浓度和体表面积后，膳食钾摄入量（p=0.40）和膳食纤维摄入量（p=0.43）均与循环钾无相关性。
在儿科 CKD 中，膳食钾和膳食纤维摄入量密切相关，但与循环钾水平无关。该研究的高分辨率图形摘要可在补充材料中查看。
