Hyperkalemia is a common complication of kidney disease and incidence increases as kidney function declines. Renin-angiotensin system blockade, which improves renal and cardiovascular outcomes, increases the risk of hyperkalemia. Unfortunately, hyperkalemia often leads to discontinuation of these medications, which can increase adverse outcomes. Treatment of chronic hyperkalemia includes diet and pharmacologic interventions. However, the association of dietary potassium intake with serum potassium levels is weak and does not consider important internal and external balance factors that affect serum levels.