{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:21:59Z","timestamp":1787732519784,"version":"build-2784847793"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Dietary management of hyperkalaemia in chronic kidney disease has traditionally focused on potassium restriction. However, contemporary renal nutrition practice increasingly requires dietitians to balance biochemical safety with nutritional adequacy, dietary quality, treatment burden, and patient wellbeing. Limited empirical evidence has examined how renal dietitians reason through these competing priorities in routine practice.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore how renal dietitians approach dietary hyperkalaemia management in chronic kidney disease and to examine the professional reasoning underpinning dietary decision\u2010making.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This qualitative study integrated free\u2010text responses from an international online survey of renal dietitians with semi\u2010structured interviews. Survey free\u2010text responses provided breadth across practice settings, while interviews enabled more detailed exploration of clinical reasoning. Data from 203 survey respondents and eight interview participants were analysed consequently using reflexive thematic analysis to examine how dietitians prioritised, sequenced, and adapted dietary interventions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Dietitians described dietary hyperkalaemia management as a staged but flexible process of professional reasoning. Four interrelated themes were identified: consideration of non\u2010dietary contributors before dietary restriction; prioritisation of potassium additives and highly processed foods; preservation of nutritional adequacy as a central boundary condition; and selective restriction of potassium\u2010rich whole foods only when clinically indicated. Dietary restriction was not described as an automatic response to elevated serum potassium, but as one possible component of a broader reasoning process shaped by biochemical trends, nutritional status, clinical urgency, patient preferences, and psychosocial context. These findings informed development of the Prioritisation and Reasoning in the Management of Elevated Potassium in Chronic Kidney Disease model, known as PRIME\u2010K.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Renal dietitians reported using flexible professional judgement to manage hyperkalaemia while minimising unnecessary dietary burden and protecting nutritional adequacy. The PRIME\u2010K model offers a practice\u2010informed representation of professional reasoning in dietary hyperkalaemia management and may support dietetic education, reflective practice, and the development of more context\u2010sensitive approaches to dietary care in chronic kidney disease.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jhn.70314","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T12:44:21Z","timestamp":1784292261000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Professional Reasoning in Dietary Hyperkalaemia Management in Chronic Kidney Disease: Development of the PRIME\u2010K Model"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1962-525X","authenticated-orcid":false,"given":"Andrew","family":"Morris","sequence":"first","affiliation":[{"name":"Research Centre for Healthcare and Community Transformation Coventry University Coventry UK"},{"name":"Dietetics Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way Worcester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5935-7328","authenticated-orcid":false,"given":"Kelly","family":"Lambert","sequence":"additional","affiliation":[{"name":"School of Medical, Indigenous and Health Sciences University of Wollongong Wollongong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.132"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.09.018"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2016.02.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2020.07.001"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2020.01.025"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.03.008"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.10.003"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2022.12.003"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.12820"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(26)00297-7"},{"key":"e_1_2_10_17_1","volume-title":"Qualitative Inquiry and Research Design: Choosing Among Five Approaches","author":"Creswell J. 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