Why It’s Important to Control Fluids in a Hemodialysis Diet

We are continually told that if we want to have a healthy body, it is important to drink at least 8 glasses of water each day.  Drinking enough water day to day is important in maintaining our bodies fluid balance. We’re told it’s important if we want to enjoy good health. Everyone I know seems to have one or two favorite water bottles that they travel with daily, so it seems that Americans feel this advice important enough to follow faithfully.  So it seems completely at odds with good health to restrict what a person drinks each day, doesn't it?  However, for people in the later stages of Chronic Kidney Disease (CDK), this normally recommended amount of water per day can be unhealthy, and lead to dangerous complications. 

Restricting your fluids can help you to feel comfortable before, during, and after your dialysis treatment sessions.  Even though dialysis gets rid of excess fluid and waste in the body; it is not nearly as effective as healthy kidneys that are working properly 24 hours a day, 7 days a week.  Most people on hemodialysis go to treatment sessions three times a week.  This means, on the days in between the dialysis treatments, your body will hold onto any excess fluid and waste that your kidneys are unable to remove. If you exceed the fluid intake that has been recommended to you, it can cause swelling, and increase your blood pressure. This makes your heart have to work harder.  Too much fluid can also build up in your lungs, making it harder to breathe.

Hemodialysis removes fluid as the blood is filtered through the dialysis machine. There are limits however to how much fluid can be safely removed during one dialysis session. If you exceed your recommended amount of fluids, then an extra dialysis appointment might be required in order to remove all of the extra fluid.  

Fluid restrictions may vary with the individual patient. 

When determining how much fluid is safe for you to have each day, your healthcare provider takes several things into consideration.  Some of these are weight gain between your treatments, your urine output, and any swelling.  Weight changes between your treatment sessions will help to determine how much fluid to remove during dialysis.  Excess fluid can lead to serious complications in dialysis patients such as; High blood pressure, a sudden drop to low blood pressure during a dialysis treatment, shortness of breath,  fluid in the lungs, and heart problems. (heart problems can include a fast pulse, weakened heart muscles, enlarged heart).

The following are some fairly simple tips that I found for my patients.  I hope they might be helpful to you also. Many individuals  struggle to keep their fluid intake under control,  and  manage their thirst throughout  the day. At times I believe some people just really  miss their morning (pot of) coffee and drinking diet coke.  I have been trying out different things, hoping to replace old favorites with some new ones, at least for the time being. Here are a few things my patients are trying or have found helpful:

1) Use smaller glasses and cups for your beverages. 

2) Try to sip your beverage, making a smaller amount last longer. 

3) Try ice. Some patients say they find ice more satisfying than liquids. Try freezing the water you are allowed in an ice tray. Or, freeze approved fruit juices for a refreshing treat.

4) Take your medications with applesauce instead of a liquid.

5) Stay cool! Keeping cool will help in reducing your thirst. 

6)  If a dry mouth is bothering you, you can try mouthwash and brushing your teeth. Or, try sucking on a wedge of lemon or a lime. You could try a piece of hard candy also. 

7) If you are diabetic, maintain good blood glucose levels.  High blood glucose levels will increase your thirst.

8) Be aware of hidden fluids in your foods; those foods that have a high water content. Some are easier to spot such as watermelon, Jell-O, ice cream, sherbet, popsicles, and the juice pops you may decide to make. Just don't forget foods like soups, and gravy also have a higher water content; and, remember to count all the ice you are consuming!

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Video

This video from the American Kidney Fund explains in detail the importance of fluid management for people with CKD. The transcript follows.

Video Transcript

Maybe you've heard that old advice about how many glasses of water to drink per day.  Do you remember how many?  Eight glasses ,right?  While it's not clear who came up with that idea, if you're on dialysis you'll need to limit the amount of fluids you take in.  

That's because it's your kidneys job to take extra fluid out of your blood. And with kidney disease, your kidneys don't work as well as they should. Dialysis can remove some of the extra fluid in your body but not as much as healthy kidneys; and having too much fluid can make you feel tired have headaches and cause serious health problems such as a stroke.  

 So how can you make sure you're taking in the right amount of fluids talk to your doctor about what's right for you everyone is different after all but a good place to start is 32 ounces of fluids per day. That's about 4 cups.

Keep track of how much water, coffee, tea, juice, or any other beverages you're drinking try writing it down or using an app onyour phone if you have trouble remembering.

And it's not just drinks. many fruits and vegetables are mostly water such as melon cucumbers and tomatoes other foods like soup gelatin and ice cream have a lot of water in them too.  You'll need to count foods like these toward your daily fluid total.  

Talk to your doctor or dietitian about all of the specific foods you'll need to keep track of.  Here's some tips to help you limit the amount of fluids you take in:

·       Get smaller cups and glasses in your home

·       Stay cool if you get hot and sweaty. It can make you thirsty and want to drink more water.

·       Plan ahead if there's a special occasion in the evening where you'll want to drink.  Have less fluid during the day.

·       If you're feeling thirsty, here's some ways to cope, try chewing sugar-free gum rinse with the mouth full of water but spit it out.  Suck on a piece of ice or one of those reusable ice cubes.

Fluid restriction can be hard at first, but with these tips you can adjust to it.

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Resources  

‍DaVita Kidney Care

American Kidney Fund

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About the Author

Elizabeth Custer is a registered dietitian at Huntington Health and USC Arcadia.  She completed her Bachelor's Degree in clinical nutrition at University of California Davis, and dietetic internship at Sacramento State University.  She has worked in many settings including acute hospital, sub-acute, skilled nursing, psychiatric, outpatient, retirement, and convalescent facilities. As a registered dietitian, her primary role includes assessing patients, providing nutrition education, and implementing medical nutrition therapy for a variety of medical conditions, such as chronic kidney disease, cardiovascular disease, hyperlipidemia, diabetes, hypertension, and more. Her passion lies with direct patient care and her experience in clinical, food service, and managerial roles has allowed her to deliver high-quality, evidenced-based strategies to promote health, well-being, and manage nutrition-related diseases. Elizabeth presented her research paper on food insecurities among students at the California Association of Nutrition and Dietetics Annual Conference in 2018.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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