Abstract: SA-PO1077
EvoKe-HD: A Pilot Randomized Trial of Targeted Potassium Counselling in Patients on Hemodialysis
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bernier-Jean, Amelie, Universite de Montreal, Montreal, Quebec, Canada
- Papineau, Roxanne, Institut Universitaire de Cardiologie et de Pneumologie de Quebec - Universite Laval, Québec City, Quebec, Canada
- Dawson, Jessica, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Goupil, Remi, Universite de Montreal, Montreal, Quebec, Canada
- Madore, Francois, Universite de Montreal, Montreal, Quebec, Canada
- Jaure, Allison, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- Clase, Catherine M., McMaster University, Hamilton, Ontario, Canada
Background
Standard potassium restriction in hemodialysis often leads to broad avoidance of potassium-rich foods, including fruits and vegetables. Emerging evidence suggests dietary potassium’s effect on serum potassium may depend on source, processing, and fiber content. EvoKe-HD evaluated targeted potassium counselling to avoid potassium additives and reduce selected potassium sources while preserving whole fruits and vegetables.
Methods
EvoKe-HD was a pragmatic, single-center, two-arm, 1:1 randomized pilot feasibility trial in adults receiving thrice-weekly maintenance hemodialysis with ≥2 pre-dialysis serum potassium values ≥5.2 mmol/L in the past 3 months. For 3 months, participants received monthly individualized targeted potassium counselling, including avoidance of high-risk potassium additives and selection of at least two additional dietary potassium sources to reduce from a predefined list, based on dietary habits, nutritional priorities, and potential contribution to serum potassium, or standard counselling using the local hemodialysis nutrition guide.
The primary feasibility outcome was the proportion of eligible patients who enrolled and completed the study. Dietary intake was assessed using ASA24-Canada2018 recalls. Understanding and acceptability were self-reported using 7-point Likert scales. Preliminary efficacy was assessed using post-randomization mid-week pre-dialysis serum potassium in a linear mixed-effects model adjusted for time, sex, and baseline potassium.
Results
We screened 196 patients; 91 met serum potassium criteria and 57 were eligible. Fifty were randomized (age 64±16 years; 36 male), and 48 (84%; 95% CI 72 to 93) completed the 3-month visit, meeting the high-feasibility target (>40%). Good/very good understanding (≥6/7) was reported by 21/26 (81%) in the intervention versus 17/24 (71%) in the control group; dietary changes were acceptable to 19/26 (73%) versus 14/24 (58%). Canadian Food Guide fruit/vegetable servings decreased in controls (-1.14/day, IQR -2.45 to 0.17) but were broadly preserved with intervention (+0.19/day, IQR -0.99 to 1.52). Mean follow-up serum potassium was similar between groups (adjusted difference 0.14 mmol/L; 95% CI -0.14 to 0.42).
Conclusion
Targeted potassium counselling was feasible and acceptable, did not increase serum potassium, and may help preserve fruit and vegetable intake compared with standard potassium restriction.
Acknowledgment
We thank the study participants, trial dietitian, and patient partners for their contributions to EvoKe-HD.
Funding
- Government Support – Non-U.S.