When I was initially diagnosed with kidney failure my nephrologist asked if I drank Diet Coke. I said yes, and indicated that I frequently drank a dozen cans a day while working. He told me that Coke is the only soft drink that actually adds potassium as part of their recipe. And, since all colas are mode from cola beans, they are also very high in phosphorus.

I also love Italian food, potatoes, fresh fruit and vegetables, seafood, etc. All of these items also contain potassium, some at very high levels.

While dialyzing in-center a fellow patient told me how to tell what foods are high in potassium and phosphorus – if it grows, it’s high in potassium. If it tastes good it’s high in phosphorus.

Luckily, there is plenty of information online about the potassium and phosphorus levels of almost any food you can name. Here is one that I used frequently:

https://www.med.umich.edu/1libr/Nutrition/PotassiumHandout.pdf

https://www.med.umich.edu/1libr/Nephrology/Nutrition/UMHS_HighPhosphorusFoods.pdf

So, the bad news – I now know what foods are high in potassium and phosphorus, what can I do if I love these foods?

Dialysis removes potassium and a small amount of phosphorus. Never miss a treatment. By dialyzing six days a week at home, I have the ability to be much more flexible with my diet, and foods that contain potassium and phosphorus.

Meal planning goes a long way in allowing me to eat more potassium. When I crave a food high in potassium I eat them four to six hours before I dialyze, and the high potassium gets taken out of my blood almost as quickly as it enters it. Since I dialyze at 6:00 PM each evening after my wife returns home from work, I eat these types of food for lunch.

When I crave a high potassium food for dinner and know I won’t be dialyzing until 24 hours later, I used a prescription potassium binder called Kayexecelate. I only do this once or twice a month, but it provides me with just enough freedom to adhere very closely to my low potassium diet. My potassium level in my last monthly lab work was 4.5, well within the guidelines for the range of safe potassium blood levels. This works for me, but the use of Kayexcelate like this must be discussed with your nephrologist before using it in this way.

The most important thing to remember about potassium, both high and low levels are very dangerous for your heart.

Phosphorus is a different story. Even with daily dialysis, I still need to use a prescription phosphorus binder every time I eat. I have used Renegal in the past, and now use Renvella. These drugs can be very expensive, but without them you endanger your health.

Once on a two-day vacation with my wife, I forgot to pack Renagel. I stopped at a local pharmacy and purchased TUMS Ultra 1000 antacid tablets, and took them with each meal. These can be a used in an emergency to lower your blood phosphorus. But, in my case, use for more than a day or two also raised my calcium levels too high. Like any drugs, use of antacids as a phosphorus binder needs to be discussed with your nephrologist before any such changes.

I vary the amount of phosphorus binder I take with each meal, based on the amount of phosphorus in my meal. With a normal meal I use four 800Mg Renvella tablets. With a high phosphorus meal I will take seven Renvella tablets. After asking my nephrologist about the side effects of too much binder, he replied constipation. So, there is a balancing act with changes in dosage. My last phosphorus blood level was 4.5, also well within the guidelines for the range of safe phosphorus blood levels.

I am not providing medical advice. If you are considering any of the changes I have described, you must discuss them with your nephrologist prior to making them. But for me, sometimes “cheating” on my diet with foods higher in potassium or phosphorus allows me to closely adhere to a diet low in them the rest of the time.

With Thanksgiving only a couple of more days away, I know I will be enjoying a nice helping of mashed potatoes and gravy and my potassium level on Friday will still be normal.