Clinical dietitian, pre-PhD-student
Kenneth Mærsk Christensen
Internal Medicine Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark and department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| Projekt styring | ||
| Projekt status | Open | |
| Data indsamlingsdatoer | ||
| Start | 01.04.2025 | |
| Slut | 31.03.2028 | |
Hyperkalaemia in Chronic Kidney Disease: Investigating the Role of Potassium Content of Ultra-Processed Foods
Short summary
Chronic kidney disease (CKD) is a progressive condition and a significant health burden globally. Among its complications, hyperkalaemia is well-recognized, requiring a multimodal approach, including dietary modifications. Patients are advised to reduce consumption of fruits, vegetables, nuts, and legumes, which are generally beneficial for CKD. Less attention has been given to investigating the role of potassium additives in contributing to hyperkalaemia
Rationale
The classification and management of Cronic Kidney Disease (CKD) are defined by The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), identifying abnormalities in kidney structure or function persisting for more than 3 months. CKD progression is marked by decreased glomerular filtration rate and albuminuria, which defines the stage of kidney damage. Individuals with CKD face a spectrum of nutritional disorders, including undernutrition, protein-energy wasting, and electrolyte imbalances. The progression of CKD increases the risk of hyperkalaemia (plasma potassium levels >5.0 mmol per litre), associated with heightened risk of morbidity and mortality, as well as cardiac dysrhythmias. Other symptoms includes palpitations, nausea, muscle pain, weakness, paralysis and paraesthesia. Treatment of hyperkalaemia is therefore essential in CKD management. Nutritional therapy in early CKD stages emphasizes high intake of fruits and vegetables for their favourable effects on blood pressure, lipid profiles, and fibre content, while limiting dairy and meat consumption to improve lipid profile and slow down the onset of kidney failure. However, the emergence of hyperkalaemia necessitates dietary modifications through comprehensive dietary assessments using dietary recalls to identify primary sources of potassium. Intake of fruits, vegetables, legumes and nuts are recommend as these products have potential benefits to CKD management. Unfortunately, potassium is prevalent in high amount in these products and therefore, patients are recommended to lower the consumption of these products when experiencing hyperkalaemia. The impact of nutritional therapy extends beyond physiological outcomes, influencing quality of life and everyday life, particularly at home and in social gatherings. Many additives found in processed foods are potassium-based, and demonstrates to have a greater absorption by the gastrointestinal tract compared to naturally potassium sources. Ultra-processed foods characterized as ready-to-eat or heat formulations, are notable for their high energy density, elevated levels of sugar, salt, total fat/saturated fat and additives, alongside low levels of dietary fibre and essential micronutrients. The amount of potassium in ultra-processed food, surpass fresh food by up to three times higher. Consequently, there is a growing imperative to explore strategies to mitigate the risks associated with potassium additives in ultra-processed foods while optimizing the intake of whole foods among individuals with CKD. However, data regarding the frequency of ultra-processed food consumption and the potassium content of these products among CKD patients with CKD remain scarce. Therefore, this study aims to address these gaps by assessing the consumption patterns of ultra-processed foods and their potassium content among individuals with CKD, while investigating the potential impacts of dietary modification on their everyday lives. Within this PhD-protocol, the following questions will be addressed: 1. What is the frequency of potassium additives in ultra-processed foods? 2. What is the quantification of consumption of ultra-processed food among patients with CKD in the Region of Southern Denmark? 3. What is the potential potassium consumption from ultra-processed foods among patients with CKD? 4. How is everyday life experienced when lowering ultra-processed food among patients with CKD?
Description of the cohort
This PhD project involves four studies: 1) a cross-sectional study of ultra-processed foods in supermarkets, 2) a cross-sectional survey among patients undergoing haemodialysis and their consumption of ultra-processed food, 3) an analysis of the content of food additives, and 4) an explorative qualitative study based on semi-structured interviews and/or focus group interviews. In both studies 2 and 4, participants are from the five haemodialysis units in the Region of Southern Denmark.
Data and biological material
Study 1: Data from label analysis of ultra-processed products (potassium additives). Study 2: Questionnaires with binary variables (different food consumptions and Resonium prescription), nominal variables (gender, education level, income, number of years on dialysis, and ethnic group), and continuous variables (age, height, and weight). Study 3: Food samples (100-200 food items) will be analyzed at the Danish Veterinary and Food Administration. The total amount of potassium will be analysed. Study 4: Semi-structured interviews on patient perspectives regarding the considerations they encounter when reducing ultra-processed food and increasing the intake of whole foods.