Table 4.
Summary of recommendations
| Category | Recommendation | Grade | |
|---|---|---|---|
| 1 | Main dietary sources of potassium for children with CKD2–5D | 1.1 The main dietary sources of potassium for infants are breastmilk or infant formula. | Not graded |
| 1.2 The main natural dietary sources of potassium for children and adolescents are milk, potatoes, vegetables, cereals, fruits and meat. | Not graded | ||
| 1.3 Food additives that contain potassium salts contribute to potassium intake. | D Weak | ||
| 2 | Assessment of potassium intake for children with CKD2–5D | 2.1 A diet history may not give an accurate assessment of potassium intake. | Not graded |
| 2.2 Assess dietary potassium intake in those with dyskalemia. | D Weak | ||
| 2.3 A diet history of a typical 24-hour period, or food frequency questionnaire, focusing on potassium-rich foods, can identify the main dietary sources of potassium. | D Weak | ||
| 3 | Potassium requirements for children with CKD2–5D | 3.1 Potassium requirements are based on the level of kidney function, weight, growth, renal potassium losses, extra-renal potassium losses, clearance by dialysis, and medications that may increase or decrease serum potassium levels. | D Weak |
| 3.2 Adjust the dietary potassium intake based on serum potassium levels, aiming to maintain potassium levels within the normal range. | D Weak | ||
| 4 | Management of dyskalemia due to non-dietary causes | 4.1 Correct the non-dietary causes of dyskalemia, and adjust the dialysis prescription where appropriate, before adjusting the dietary potassium intake. | C Moderate |
| 5 | Management of hyperkalemia in children with CKD2–5D | 5.1 Severe, life-threatening hyperkalemia requires rapid medical intervention and discontinuation of all sources of potassium from medications, parenteral fluids, formulas and diet. | X Strong |
| 5.2 In a child with persistent or recurrent episodes of hyperkalemia, decrease the intake of potassium without compromising nutrition to maintain the serum potassium within the normal range. | C Weak | ||
| 5.2.1 For infants receiving breastmilk, reduce potassium intake by substituting some of the breastmilk with a renal-specific low potassium infant formula. | D Weak | ||
| 5.2.2 For children receiving formula or enteral tube feed, reduce potassium intake by combining standard formula stepwise with a renal-specific low potassium formula. | D Weak | ||
| 5.2.3 If a renal-specific low potassium formula is not available, use of a potassium-binding resin and decanting of the formula may be considered. Monitor other electrolytes that may be altered by the potassium binder. | C Weak | ||
| 5.2.4 For children who are eating, avoid foods containing potassium additives in the first instance. | D Weak | ||
| 5.2.5 If hyperkalemia persists, decrease potassium intake by reducing high potassium foods, particularly those with a low nutritional value. | D weak | ||
| 5.2.6 Advise parents and caregivers on food preparation techniques that reduce the potassium content. | C Weak | ||
| 5.2.7 The daily use of an oral potassium binder to control serum potassium level may be considered when hyperkalemia cannot be corrected without compromising diet quality, or when dietary compliance is poor. | D Weak | ||
| 6 | Management of hypokalemia in children with CKD2–5D | 6.1 Severe, life-threatening hypokalemia requires prompt medical intervention, usually requiring intravenous potassium infusion. | X Strong |
| 6.2 In a child with persistent hypokalemia, increase the dietary potassium intake, targeting foods with high nutritional quality, to maintain serum potassium within normal range. | D Weak | ||
| 6.3 If applicable, review and adjust potassium lowering medications and the dialysis prescription. | C Moderate |