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Kidney Diet Tips

Archive for Fluid Control

June 24, 2014

Hemodialysis and fluid intake: How much to drink?

iStock_000013019978Small-Water-IcePeople on in-center hemodialysis usually have dialysis treatments three times a week. The amount of fluid they can have is limited since the kidneys lose the ability to remove excess fluid from the body. Too much fluid can increase blood pressure, make the heart to work harder, and may cause shortness of breath.

To determine how much fluid to consume each day several things are considered, starting with urine output. Many hemodialysis patients no longer urinate due to complete kidney failure. In this case, liquids are usually limited to 32 ounces or 1000 ml each day. This amount will result in a daily fluid weight gain of 1 kilogram, or 2.2 pounds. Some hemodialysis patients still urinate due to residual renal function. For them, the fluid intake is usually more liberal. All obvious liquids like coffee, tea, juice and water plus items that are liquid at room temperature like ice, sorbet and gelatin count as part of a person’s fluid allowance.

How much liquid can dialysis patients consume each day if they still make urine? To find out, a 24-hour urine collection is measured. The measured volume is added to 1000 ml (1 liter or approximately 32 ounces) fluid allowance. For example, if the 24-hour urine collection is 500 ml, the fluid restriction is 1500 ml per day instead of 1000 ml. This is approximately 48 ounces or 6 cups of liquid each day. Residual renal function can decrease over time and fluid goals may change as a result. For people on home hemodialysis the treatments are usually more frequent—5 to 6 days a week. Fluid is removed more often so the daily allowance is greater. Dialysis patients are advised to weigh themselves daily to help keep track of weight and fluid balance.

July 24, 2013

How to deal with thirst when it’s hot

July and August are two of the most challenging months for people following a limited fluid allowance. When the weather heats up, you may find yourself getting thirsty. In addition, a diet high in sodium will increase thirst.

Here are some suggestions for dealing with thirst while adhering to your fluid restriction on the dialysis diet. Read more…

March 16, 2011

Is watermelon safe for a kidney diet?

This week a question came up about watermelon in the dialysis diet. Some patients are told to avoid watermelon while others are told it’s ok to include. Why the mixed messages? It has to do with 3 issues—portion size, potassium and fluid.

  • Portion: The typical portion is a wedge of watermelon—equal to about 3 cups. For a dialysis diet that includes limited potassium and fluid, a wedge of watermelon contributes too much potassium and fluid. Most dietitians advise limiting watermelon to a 1 cup serving. Instead of cutting a wedge, cut the watermelon into bite-size pieces and measure into a cup.
  • Potassium: Knowing how many fruits and vegetables to eat and the best portion size is essential to controlling potassium intake. A wedge of watermelon contributes 560 mg potassium but a smaller 1 cup serving contains only 180 mg potassium. Since a one cup portion of watermelon is smaller than a typical portion, try measuring your servings until you can successfully guesstimate a 1 cup portion. You can also cut your portion into small triangular pieces as sometime seen when watermelon is placed on a salad bar or used as a garnish. Most other melons are much higher in potassium compared to watermelon. For this reason watermelon is usually the only melon included in a low potassium diet plan.
  • Fluid: It’s easy to exceed your fluid goals if you don’t count watermelon as part of your fluid intake. That’s because watermelon is 92% fluid and has little fiber. A wedge of watermelon has close to 3 cups of fluid!  For dialysis patients on a fluid restriction, watermelon is limited to 1 cup and may be counted as a replacement for fluid if water weight gains are a concern.

Nutritionally, watermelon is a good source of vitamin C, beta carotene and lycopene, a phytochemical with antioxidant activity that may protect against cancer. As mentioned, when consumed in small portions it is also low in potassium, and naturally very low in phosphorus and sodium.

Once available only during summer months, watermelon is now available year round in most large markets. Consider adding watermelon to your favorite fresh fruit salad. Make summer salsa with watermelon as a replacement for tomato. For a special refreshing watermelon treat, try Watermelon Cooler from the DaVita.com kidney-diet recipe collection.

 

Kidney diet resources from DaVita.com

October 21, 2008

Diet Analysis Tools and Correct Totals for Potassium and Phosphorus

People with chronic kidney disease (CKD) and those on dialysis need to be aware of how much protein, potassium, sodium, phosphorus and calcium they consume. Since phosphorus and potassium are not required on food labels, food manufacturers may not analyze and provide data on these nutrients. Many online diet analysis tools provide only the available nutrient data. When values are missing, these tools calculate a zero value. Consequently, a person using the tool may assume they are eating less potassium or phosphorus than they actually consume.

DaVita’s online meal planning tool for kidney diets, DaVita Diet Helper, includes a Nutrition Log where users can enter foods eaten and view nutrient values for calories, fat, saturated fat, cholesterol, carbohydrate, fiber, sugars, protein, sodium, potassium, phosphorus and calcium.

DaVita Diet Helper Online Meal Planning Tool

Each food in the database includes a complete nutrient profile, including potassium and phosphorus content. Users can be sure all the values are correct and potassium and phosphorus are not falsely low when using DaVita Diet Helper to analyze their daily food intake.

If you use another diet analysis tool be sure to check for accurate potassium and phosphorus values.

August 3, 2007

How much fluid can a person with chronic kidney disease on peritoneal dialysis (PD) consume?

Generally, peritoneal dialysis patients begin with a fluid restriction of 64 ounces or 2000 ml (2 liters) each day. This amount is then adjusted up or down based on how much fluid is removed during the peritoneal dialysis treatments or exchanges. Residual kidney function (residual renal function) also helps determine the fluid restriction. Read more…

July 24, 2007

Fluid calculation tips for dialysis patients following a fluid restriction

Iced Tea with Lemon

Iced Tea with LemonFollowing a dialysis diet fluid restriction is easier if a person has a plan to keep up with the amount of liquids consumed each day. Keeping a running list of fluids consumed is the best way for kidney patients to track fluid intake. These helpful steps will increase awareness of fluids consumed: Read more…

July 6, 2007

How much fluid can a person with chronic kidney disease on hemodialysis drink?

water bottle Fluid intake for hemodialysis patients is limited between dialysis treatments since the kidneys lose the ability to make urine and remove excess fluid from the body. Excess fluid can increase blood pressure, causes the heart to work harder, and can cause shortness of breath.

For hemodialysis patients who no longer urinate due to complete kidney failure, liquids are usually limited to 32 ounces or 1000 ml each day. Some hemodialysis patients have a small amount of residual kidney function (residual renal function) so their kidneys are able to remove some fluid still. For them, the fluid restriction may be increased. How much liquid can dialysis patients with residual kidney function consume?

To find out, a 24-hour urine collection is measured. That volume is added to the initial 1000 ml (1 liter) fluid restriction. For example, if the 24-hour urine collection is 480 ml, which is the same as 16 ounces, the fluid restriction is increased from 32 ounces to 48 ounces or 1500 ml per day. Dialysis patients are advised to weigh themselves daily to help keep track of weight and fluid balance.

June 15, 2007

How much fluid weight does a dialysis patient gain between treatments?

Scale The amount of fluid weight gained depends on how much fluid is consumed, how often a dialysis patient has the dialysis treatment (daily versus 3 times a week), and if their kidney is still able to remove water through urine. Some dialysis patients do not urinate at all and others still urinate because they have residual urine output.

Individual goals for weight gain between dialysis treatments must be determined by the nephrologists, and may vary based on small or large body size and other considerations.

The goal for an average sized hemodialysis patient is to keep fluid weight gain at or below 1 kilogram (kg) (2.2 pounds) each day. This equals a 2 kg (4.4 pounds) fluid weight gain when there are 2 days between treatments and 3 kg (6.6 pounds) fluid weight gain when there are 3 days between treatments.

Here is a guideline that can be used to determine how much fluid contributes to weight gain:

2 cups liquid = 16 ounces = 480 ml = 1 pound or 1/2 kilogram fluid weight

4 cups liquid = 32 ounces = 960 ml = 2 pounds or 1 kilogram fluid weight

June 15, 2007

Which foods count as fluid for those with kidney disease following a dialysis diet and fluid restriction?

Melting Ice Cream ConeMelting Ice Cream Cone Any food that is liquid or will melt at room temperature counts as fluid. These can be divided into visible fluids (includes anything a person drinks) and hidden fluids (foods that appear as solids, but are liquid at room temperature). For people with kidney disease following a prescribed fluid restriction, all the items below are counted as fluid:

Visible fluid

  • All beverages
  • Alcoholic drinks
  • Coffee, tea
  • Juice, juice drinks, lemonade
  • Milk, milk substitutes, liquid creamer
  • Nutrition drinks
  • Soup
  • Soft drinks
  • Sports drinks
  • Water

Hidden fluid

  • Gelatin
  • Gravy
  • Ice chips or cubes
  • Ice cream
  • Popsicle
  • Sherbet
  • Sorbet
  • Watermelon also contains lots of fluid

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