For dialysis patients, fluid intake is an important consideration. Dialysis removes excess fluid from the body, so dialysis patients must be careful not to drink more fluid than their kidneys can handle. Most nephrologists recommend that dialysis patients limit their fluid intake to around 32-48 ounces per day. However, the optimal fluid intake can vary based on individual factors.
Quick answers
- The recommended fluid intake for dialysis patients is typically 32-48 oz per day.
- Fluid intake needs to be balanced against urine output for dialysis patients.
- Most fluids count towards the daily fluid limit, including water, juice, soup, ice, gelatin, etc.
- Monitoring daily weight gains and losses can help dialysis patients stick to their fluid limit.
- Blood pressure, edema, and thirst are important indicators of fluid status.
Why do dialysis patients need to limit fluid intake?
Kidney failure prevents the kidneys from properly filtering fluid and waste from the blood. For people on dialysis, excess fluid tends to accumulate between treatments. This extra fluid can lead to complications like high blood pressure, swelling (edema), shortness of breath, and congestive heart failure.
Dialysis removes extra fluid from the body, but treatment sessions are not continuous. Limiting fluid intake helps prevent excessive fluid from building up. Balancing fluid removal with fluid intake helps maintain a steady, healthy fluid status.
Fluid overload
If dialysis patients regularly drink more than their kidneys can handle, fluid can accumulate in the body. This leads to fluid overload, which strains the heart and blood vessels. Signs of fluid overload include:
- High blood pressure
- Swollen ankles, legs, hands, or face
- Sudden weight gain between treatments
- Congested lungs or shortness of breath
- Stiffness or fullness in the abdomen
- Increased need for blood pressure medications
Thirst
Excessive thirst or dry mouth is another reason dialysis patients need to watch their fluid intake. Damaged kidneys cannot properly regulate thirst. Many dialysis patients feel thirsty even when they are fluid overloaded. Drinking when thirsty can easily lead to taking in too much fluid.
What is the ideal fluid intake for dialysis patients?
Most nephrologists recommend a daily fluid intake of 32-48 oz for dialysis patients. However, the optimal amount depends on the individual patient’s urine output, body size, and other factors.
Urine output
Patients with some remaining kidney function can put out a certain amount of urine per day. This urine output needs to be balanced with fluid intake. For example:
- If urine output is 1000 ml/day, fluid intake should not exceed 1000 ml plus the usual 32-48 oz per day.
- If urine output is low at around 500 ml/day, fluid intake should be lower as well.
Body size
Larger patients may need more fluid than smaller patients. Men also tend to need more fluid than women. Severely obese patients can tolerate up to 64 oz per day if needed.
Climate and physical activity
Hot weather and strenuous exercise cause fluid losses through sweat. Dialysis patients who sweat a lot may need slightly more fluid intake to avoid dehydration. However, extra fluid for activity should be limited.
Other medical conditions
Some conditions like congestive heart failure require stricter fluid restriction. In these cases, nephrologists may advise intake lower than 32 oz per day. Ultimately the ideal fluid intake depends on the patient’s unique situation.
Tips for limiting fluid intake
Sticking to a 32-48 oz fluid restriction takes diligence. Here are some tips for dialysis patients to limit fluids:
- Track intake: Measure daily fluid intake with a graduated container.
- Monitor weight: Weigh yourself daily to catch excess fluid gains.
- Spread out intake: Distribute fluid allowance throughout the day.
- Sip small amounts: Avoid gulping or chugging large volumes.
- Swallow pills with food: Use applesauce or pudding to swallow pills instead of fluid.
- Suck on ice: Ice chips or popsicles can relieve thirst with minimal fluid intake.
- Choose low-sodium foods: Avoid items like chips and canned soups which trigger thirst.
- Watch the scale: Weigh yourself before and after exercise to replace only sweat losses.
What liquids count towards fluid intake?
Almost all fluids eaten and drunk throughout the day count as part of the fluid allowance:
- Water
- Milk
- Juice
- Soup
- Coffee and tea
- Soda and other beverages
- Ice and ice pops
- Gelatin desserts like Jello
- Some high-moisture fruits like watermelon
Fluid content adds up fast, so dialysis patients have to account for all of these sources. Measuring cups can help tally up fluid from soups, cereals, gelatin, and other foods.
What doesn’t count as fluid?
Some items contain negligible fluid amounts:
- Most fruits and vegetables
- Cooked starches like rice and pasta
- Breads and crackers
- Meats
- Chips and pretzels
- Iceberg lettuce salad
- Sorbet and frozen yogurt
However, even these foods should be eaten in moderation to avoid provoking thirst.
Monitoring fluid status
Dialysis patients should monitor themselves between treatments for signs of fluid overload or dehydration. Useful indicators include:
- Blood pressure: Fluid overload causes hypertension. Low BP could signal dehydration.
- Thirst: Excessive thirst means fluid intake should be reduced.
- Weight: Sudden gains of 2-3 lbs could indicate excess fluid. Losses may signify dehydration.
- Edema: Swelling of the extremities is a clear sign of fluid overload.
- Dry mouth: Persistent dry mouth or mucous membranes point to inadequate fluid.
- Dizziness: Feeling lightheaded when standing up can be a red flag for dehydration.
- Cramping: Muscle cramps can also signal a fluid/electrolyte imbalance.
Monitoring these parameters helps guide adjustments to fluid intake as needed.
Risks of drinking too much
Exceeding the recommended fluid intake limit poses several health risks for dialysis patients. Potential consequences include:
- Edema: Excess fluid gets trapped in the tissues, causing visible swelling in the legs, arms, and face.
- High blood pressure: Extra fluid increases the volume of blood circulating through blood vessels, increasing pressure on artery walls.
- Shortness of breath: Fluid can build up in the lungs, causing congestion and breathing difficulty.
- Heart failure: Fluid overload places strain on the heart, potentially leading to congestive heart failure.
- Clotting: Sluggish blood flow from high fluid volumes raises the risk of clot formation.
In addition, consistently exceeding fluid limits makes dialysis treatments less effective. Removing large amounts of excess fluid during dialysis can cause dangerous drops in blood pressure.
Risks of drinking too little
Not drinking enough also poses risks for dialysis patients. Potential effects of inadequate fluid intake include:
- Dehydration: Fluid losses are not replaced, resulting in cellular dehydration.
- Electrolyte imbalance: Lack of fluid disrupts electrolytes like sodium, potassium, and phosphorus.
- Hypotension: Blood pressure drops due to decreased blood volume.
- Blood thickening: The blood becomes very concentrated and viscous.
- Organ damage: Dehydration causes cellular dysfunction in organs like the heart and brain.
- Hospitalization: Severe dehydration usually requires hospitalization to administer IV fluids.
Drinking inadequate amounts also diminishes the removal of wastes by dialysis. Toxic metabolites can build up between treatments.
What beverages help meet fluid needs?
Dialysis patients can select lower-volume beverages to help meet their fluid allowance each day. Some good choices include:
Water
Plain water is lowest in sodium and calories. Patients can measure out their water allowance in a pitcher or bottles.
Unsweetened tea/coffee
These provide fluid without extra sugar. Caffeine can help stimulate urine output.
Diluted juice
A small amount of juice diluted with water fits more fluid into a smaller volume.
Sparkling/mineral water
The carbonation can help quench thirst. Flavored seltzer waters add taste without calories.
Broth
Low-sodium broths offer hydration along with nutrients.
Popsicles
Frozen pops made from diluted juice or sports drinks provide small volumes of fluid.
Jello
One serving of sugar-free gelatin dessert contains about 1⁄4 cup fluid.
Low-fat milk
Milk offers hydration along with protein, calcium, and other nutrients.
Conclusion
Following proper fluid restrictions is crucial for dialysis patients. Consuming around 32-48 oz per day helps prevent complications related to fluid overload. Exact needs vary based on urine output, body size, climate, and other factors. Monitoring fluid status while limiting high-volume beverages allows dialysis patients to stay in fluid balance.