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Today’s Dietitian Talks With Ryan Woolley, MSPH, RDN, From the American Kidney Fund About the Connections Between Heart Disease, Kidney Disease, and Hyperkalemia

Ryan Woolley, MSPH, RDN, is the director of public education at the American Kidney Fund (AKF). She’s an experienced public health professional and an RD nutritionist with an extensive background in both public health research and program evaluation. In her role at AKF, she provides strategic oversight in developing and managing evidence-based kidney disease education programs and resources. She oversees formative research, contributes to proposal development, leads project implementation, and manages outcomes evaluations.

Today’s Dietitian (TD): February is American Heart Month, which is a month dedicated to raising awareness of the importance of a healthy heart and encouraging healthful habits that help reduce the risk of heart disease. Why is Heart Month important to the AKF? What‘s the connection between heart disease and kidney disease?

Woolley: The heart and kidneys can greatly impact each other—heart disease can cause kidney disease and vice versa. When one organ isn’t working, it puts undue stress on the other. For example, if the kidneys aren’t functioning properly, they may not filter extra fluids and toxins from the bloodstream as effectively. A buildup of either can then damage your veins or organs, including your heart. Or if you have heart disease, your heart may not circulate oxygen-rich blood as effectively and the kidneys have to work harder to perform their functions, ultimately damaging them and leading to kidney disease.

The newly defined cardiovascular-kidney-metabolic syndrome recognizes this connection as a systemic disorder that includes heart disease, kidney disease, diabetes, and obesity. In addition, heart disease is the number one cause of death among people receiving dialysis treatments.

TD: Why is that?

Woolley: There are several reasons. Many people on dialysis already struggle with heart problems because long-term kidney damage can cause heart disease. Furthermore, many people on dialysis also struggle with high blood pressure, which means the force of your blood in your blood vessels is too strong and can damage your heart or kidneys. People on dialysis are also at an increased risk of stroke, which happens when the supply of blood to the brain is either reduced or blocked.

The kidneys control the delicate balance of electrolytes in the body, including sodium, calcium, phosphorus, and potassium. With potassium, for example, the kidneys ensure there’s enough potassium in the body for the muscles to contract as needed (including the heart), but not so much potassium that it causes hyperkalemia—a condition in which the person’s blood has too much potassium—which can be dangerous and even cause death. Hyperkalemia is common in people with chronic kidney disease (CKD), which can put them at risk for heart disease or heart failure.

TD: What do patients need to know about hyperkalemia and how it’s treated?

Woolley: Hyperkalemia is often asymptomatic, but symptoms can show as fatigue and weakness, palpitations, and muscle cramps. Hyperkalemia is defined by high blood potassium (K+) levels, generally accepted as serum K+>5.5 mEq/L in adults. It’s important to keep potassium within a healthy range as elevated or reduced potassium levels can be life threatening, causing cardiac arrhythmia or cardiac arrest.

Hyperkalemia can be managed by reducing potassium intake through dietary changes and promoting potassium excretion with medications. Dietitians can help patients create a custom food plan and start a daily log of potassium intake. Patients with CKD should aim for less than 3,000 mg of potassium each day. Potassium can also be managed through medications. Loop diuretics promote excretion of potassium in the urine, and sodium bicarbonate may be recommended to help with metabolic acidosis.

Patients may also need to stop taking medications that can increase their potassium levels, including renin-angiotensin-aldosterone system (RAAS) inhibitors like angiotensin-converting enzyme or angiotensin receptor blockers, which can be prescribed to manage hypertension and certain kinds of heart failure. Potassium binders can also be recommended and may help a person stay on their RAAS inhibitor, which may offer heart healthy benefits. Potassium binders usually come in a powder form that gets mixed with water and taken daily. These agents bind potassium ions in the large intestine and prevent absorption into the blood. Potassium binders can allow patients more freedom with their food choices and enjoy heart-healthy fruits and vegetables that may be higher in potassium like spinach, avocados, and tomatoes.

Each person’s potassium needs will be unique to them but working with a doctor and/or dietitian can help them to understand what level of potassium they need to be at a healthy level and what food they need to eat or avoid to maintain that level.

TD: What resources does AKF have for dietitians to help them work with clients who need to manage their kidney disease or hyperkalemia?

Woolley: The American Kidney Fund’s Beyond Bananas campaign provides patients and professionals with a number of evidence-based resources to help them learn more about high potassium and kidney disease. AKF offers several downloadable guides, including a potassium food tracker, a potassium food guide, a low- vs high-potassium foods guide, and a food label and potassium guide. All of these—and more—can be found in our potassium resources for health professionals hub or on our Beyond Bananas website. In addition, one of the best AKF resources available to dietitians is the professional portal of our Kidney Kitchen website: Kidney Kitchen Pro. Kidney Kitchen Pro provides dietitians, other allied health professionals, and clinicians support in helping patients successfully navigate the challenges of kidney-friendly eating and nutrition. Developed with strategic guidance from AKF’s Dietitian Advisory Group, a diverse collaboration of 10 expert renal dietitians, Kidney Kitchen Pro provides customizable resources and makes it easy to collect and share a week-long meal plan featuring recipes from Kidney Kitchen.