DIETARY POTASSIUM COUNSELING PRACTICES AMONG DIETITIANS IN BRAZILIAN DIALYSIS UNITS: RESULTS FROM A NATIONAL SURVEY

 

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https://storage.unitedwebnetwork.com/files/1099/ab7e996167052eacc94d72e8e9983636.pdf
DIETARY POTASSIUM COUNSELING PRACTICES AMONG DIETITIANS IN BRAZILIAN DIALYSIS UNITS: RESULTS FROM A NATIONAL SURVEY

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Fabiana
Nerbass
Fabiana Nerbass fabiana.nerbass@gmail.com Fundação Pró-Rim Nephrology Joinville Brazil * Brazil Brazil
Aline Antunes alineantunes00@gmail.com UNESP Nephrology Botucatu Brazil -
Lilian Cuppari licuppari@uol.com.br UNIFESP Nephrology São Paulo Brazil -
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Nutrition is a cornerstone of dialysis care, influencing clinical outcomes, quality of life, and the management of metabolic complications such as hyperkalemia. Dietary counseling recommendations for potassium management have evolved in recent years. Current evidence supports assessing non-dietary causes, prioritizing the restriction of inorganic potassium from additives, and promoting diet quality through adequate intake of fruits, vegetables, and legumes. However, it remains unclear whether these updated recommendations have been incorporated into dietitians’ counseling practices.


We conducted a national cross-sectional online survey targeting dietitians working in Brazilian dialysis units. The questionnaire was shared on social media platforms and in dietitian messaging groups during September 2025. It included demographic information, counseling practices, and interventions related to metabolic disturbances, particularly hyperkalemia.

A total of 232 dietitians from 260 dialysis units (29% of all Brazilian units) complete the survey. Seventy-five percent reported having specialized training in renal nutrition, and 40% have been working in dialysis for more than 5 years. The median number of patients per dietitian was 190 (IQR: 92–206). When asked when they provide counseling about potassium intake, 32% report doing so only in the occurrence of hyperkalemia, while 68% provide preventive advice regardless of serum potassium concentration. This practice is more common among those without renal nutrition training (79% vs. 66%; p=0.04) and among those with less than 5 years of dialysis experience (76% vs. 60%; p=0.007). Consideration of non-dietary causes of hyperkalemia is more frequent among dietitians with renal nutrition training (96% vs. 89%; p=0.03). In the presence of elevated serum potassium, 76% encourage increasing fruit and vegetable intake when low, and 99% investigate other dietary sources of potassium, including legumes and nuts (72%), dairy (31%), and meats (26%). Eighty percent assess the intake of ultra-processed foods, more frequently among dietitians with renal nutrition training (83% vs. 70%; p=0.02).

Overall, Brazilian dietitians’ counseling practices align with current recommendations for serum potassium management, particularly among those with specialized training, underscoring the importance of ongoing professional education.


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