Evidence for Potassium Restriction in Hemodialysis

EvoKe-HD is a pilot randomized controlled trial to assess the feasibility and potential for efficacy of a novel dietary approach to hyperkalemia. Contrary to the traditional recommendations limiting the intake of high-potassium whole foods, such as fruits and vegetables, the investigators propose to switch the focus to foods containing potassium that is readily absorbed by the body (high bioavailability), such as potassium from additives, processed meats, milk, fruit juices and sugary drinks.

Inclusion Criteria: * ≥18 years or older * Receiving hemodialysis 3 times/week for ≥ 3 months * Has at least two pre-dialysis serum potassium levels ≥5.2 mmol/L on any analysis in the past 3 months OR the most recent pre-dialysis serum potassium value ≥ 4.6 mmol/L and is currently prescribed a potassium-binding agent at a regular frequency (defined as ≥ once per week). * Can speak and understand French or English * Has not missed more than 1 dialysis session in the previous 3 months. * Is capable of providing informed consent. Exclusion Criteria: * Is not expected to survive beyond 6 months * Does not control their dietary intake (e.g., residents of high-dependency nursing homes) * Significant cognitive impairment precluding understanding of the dietary recommendations.