One of the most difficult characteristics of being on dialysis is fluid restriction. Being on dialysis often says you do not urinate (pee) as much as you used to, or you might not urinate at all. Moreover filtering our blood of waste and toxins, our kidneys also eliminate the extra fluid and water we consume each day.

When functioning properly, your kidneys filter 180 liters of blood daily. Our entire body’s blood supply is filtered roughly 20-25 times per day. During filtration, you generate  1 to 2 liters of urine every day.

What is fluid?

Knowing what counts as fluid is tougher than it may sound. A fluid is anything that turns to liquid at room temperature, not only water.

Examples of fluid:- 

Ice, Soups and stews, Pudding

Ice cream, sherbet, sorbet, popsicles, etc.

protein drinks

Protein drinks (Nepro, Novasource, Ensure, etc.)

All beverages (water, soda, tea, coffee, milk, non-dairy milk, etc.)

Some fruits that have an increased water content, such as watermelon and grapes, do not count toward your daily fluid amount, but you should restrict your daily servings of these fruits if you have fluid limitations.

Fluid and stages of kidney disease

Relying on your stage of chronic kidney disease, you may have various fluid recommendations.

Kidney disease stages 1-2

When you have kidney disease stages 1 and 2, it is crucial to drink enough water—around 64 ounces, or eight glasses every day. This will help keep your kidneys hydrated and functioning well.

Kidney disease stages 3, 4, and 5 (not on dialysis)

Once you reach the later stages of kidney disease—stages 3, 4, and 5 (not on dialysis)—you may need to restrict the amount of fluid you consume. Talk to your doctor and dietitian about how much fluid you should consume.

During these stages of kidney disease, you may suffer fluid retention (too much fluid buildup in your body).

Inform your doctor right away if you notice these signs of fluid retention:

1. Bulging in your feet and ankles
2. Problem with breathing or shortness of breath when walking short distances, such as one to three blocks
3. Trouble in  breathing or shortness of breath when walking up one flight of stairs
4. Difficulty breathing or briefness of breath when lying flat on your back. You may require one or more extra pillows to aid you breathe.

Kidney failure (on dialysis)

When you are on dialysis, you will be required to limit how much fluid you absorb each day. Your nephrologist and renal dietitian will tell you the exact  amount of fluid you should consume, but the general recommended quantity of fluid is 32 ounces per day. If you still urinate, you can have a slight more fluid—32 ounces plus the volume equal to the amount you urinate in 24 hours.

Your daily urine output may fall  over time. Your doctor and dietitian may inquire you to measure your urine output for one day every three months. Some people obtain their urine in a 20-ounce disposable cup. Before you get commenced, mark your cup or other container in half-cup increments to make measuring simpler. After you have obtained the urine over 24 hours, Jot down how much is in the cup or container and share that data with your doctor and dietitian.

Having more fluid in your body can be harmful because it results in an increase in blood volume. When your kidneys cannot manage  this extra volume of blood, you may experience difficulties, such as:

• Swelling (edema)
• Poor nutritional status
• Increased blood pressure
• Lung infections (i.e., fluid)
• Heart failure
• Difficulty in  breathing or briefness of breath
• Declined blood proteins, which could affect how productive your dialysis treatments are.

Q.1.  Can drinking extra water boost kidney function?

“While many claims about the advantages of increased water intake remain untested, a growing body of evidence indicates that increased water intake improves kidney function through the suppression of the antidiuretic hormone ( ADH).”

Q.2. Can drinking extra water lower creatinine levels?

Drinking more water could decrease the serum creatinine level, but does not change  kidney function. Forcing unnecessary water intake is not a good idea.

Role of weight gain because of swelling :-

For dialysis patients, there are two kinds of weight: dry weight and fluid weight.  

1. Dry weight applies to your weight when your blood pressure is controlled and there is no extra fluid in your body.
2.  Fluid weight is the weight you reach between dialysis treatments from the foods and fluids you consume.

Healthy kidneys eliminate excess fluid from the body when you eat or drink liquids. When kidneys do not function well, they do not make sufficient urine to remove the extra fluid from the body, resulting in fluid weight gain.

What are the symptoms of too much fluid?

Between your dialysis treatments, increasing too much fluid can cause:

• Increase in  blood pressure
• Briefness of breath
• Swelling

If you attain too much fluid between treatments, you may suffer the following symptoms during dialysis:

• Stomach Cramps
• Dizziness
• Headache
• Nausea

Anything that is liquid in state at room temperature is considered to be fluid. This comprises ice, gelatin, Popsicles and soup. Be cautious that you don’t consume foods elevated in sodium, or salt, because they will make you thirsty, and you are inclined to then consume more fluids.

What results in fluid weight gain?

If you are gaining too  much fluid weight, some detective work is required to uncover the reason. The following clues will assist you solve the case.

Are you utilizing salt or eating salty foods? These are criteria of salty foods you may be overindulging in:

1. Cured meats, such as ham, bacon, sausage, hot dogs or luncheon meats
2. Frozen dinners, canned soups or soup blends
3. Food in salt  , such as pickles, olives or sauerkraut
4. Bouillon cubes, soy sauce or steak seasoning
5. Foods covered  with salt, comprising crackers, popcorn, potato chips or pretzels
6. Foods from Junk food restaurants. 
7. Meat or poultry that has been “enhanced” or “infused” with a sodium phosphate solution. 
8. Salty sauces such as garlic salt, onion salt, celery salt, lemon pepper or monosodium glutamate (MSG)-based aroma enhancers

There are different ways that you might be adding extra  fluid to your body:

1. Chewing tobacco or snuff, which results in thirst
2. Drinking more than 32 ounces (1 quart) of fluid each day (or the amount specified by your doctor)
3. Not counting “hidden fluids” such as ice, soup, gelatin and Popsicles as part of your fluid quota.

So how do you lighten up to safeguard your kidneys and overall health? Here are paths to reduce your risk for kidney disease if you are overweight or obese:

1. Notice your Body Mass Index (BMI):  This number gives you an approximate and fair  idea of your total percent of body fat.

• Normal BMI is commonly between 18 and 25. A BMI between 25 to 30 is assumed  overweight, and greater than 30 is considered obese. 
• You may have a higher weight than  other people, but you may have a normal BMI. 
•  This appears if you have more body weight coming from muscle than coming from fat.  Having more muscle than fat is healthy .

1.  Eat a diet suggested by your doctor or dietician  in fruits and veggies.
2. Make lifestyle changes, such as doing exercise.
3. Maintain blood sugar if you have diabetes.

It’s great if you wish to lose weight, but don’t be “The Bad Diet Guru.” Ask for guidance from your healthcare team. If you do require to drop some pounds, it’s necessary  to talk about any weight loss program with your healthcare provider, particularly if you have any stage of kidney disease.

Summary

Additional fluid can be destructive to the body and difficult to get rid of when you have kidney disease and require dialysis. Now that the indications have been put together you can prevent excess fluid weight gain between dialysis treatments. By stopping high-sodium food and sources of hidden fluids, you are less apt to gain too much fluid weight between dialysis treatments.