Understanding Fluid Balance and Target Weight

Fluid balance is a big concern when your kidneys can no longer regulate fluids. Adhering to your fluid restriction is a difficult task, no doubt about it. And yet, following your fluid restriction is very important and can help you to avoid irreparable health hazards.

Impact of Excess Fluid

Excess fluid can cause swelling of feet, hands and face, as well as high blood pressure.  It can also cause fluid to collect in the lungs, producing difficulty breathing and fatigue. Long term non-adherence to your fluid restriction can cause the heart to lose its elasticity (like a worn out rubber band). When this happens, it cannot do its job of pumping blood throughout the body. This damage to the body carries with it the increased risk of hospitalization and death.

How Much Fluid?

Individuals may have different fluid restrictions based on their specific condition, but for most dialysis patients, the fluid restriction is 1000 ml which is equal to 4 cups or 32 fluid ounces. If you have chronic kidney disease (CKD) stages 1-4, your restriction may be different, as determined by your doctor. Regardless of how much your restriction is, one thing is for sure. If you do not measure your liquids, you will not know how much fluid you are taking in. You could be drinking in excess of your fluid restriction without realizing it. Measuring your liquids is key to adhering to your fluid restriction.

What Counts as Fluid?

A fluid is anything that you can drink, including water, coffee, tea, juice, milk, supplements, broth and soda. Ice, gelatin, and sherbet are also considered as liquids because they melt at room temperature. One cup of ice melts to 1/2 cup of water. Sucking on ice to quench thirst, although may not seem like much, can still add up in your daily liquid intake.

Dealing with Thirst

Some ways to help combat the feeling of a dry or tacky mouth are:

• eat frozen grapes or blueberries
• keep your mouth feeling fresh with mouthwash or minty gum
• avoid caffeinated beverages
• fill a mist bottle with lemon water and mist mouth
• use smaller glasses
• try a mouth rinse that helps treat dry mouth

Minty and sour flavors tend to decrease thirst while sugary and salty flavors will increase thirst. Maintaining blood sugars within range, if you have diabetes, and avoiding salty or processed foods will also help to decrease thirst.

Target Weight

Target weight is the weight that the doctor has prescribed for you to weigh when you have completed your dialysis treatment. Knowing your target weight is very important. Your target weight may change as you gain or lose real weight, but it won’t fluctuate from day to day. Ask your dialysis technician for your target weight if you are not sure. This will insure that when you weigh yourself before and after your treatment, you know if you are carrying excess fluid. Generally speaking, if you come in to treatment 2.5 kg above your target weight, this may mean that you are coming into your treatments with fluid excess.  Ask your doctor about individualized fluid weight goals. And when you have completed your treatment, if you do have excess fluid (1 kg or above your target weight) the  way to get back to your target weight is to drink less fluid in between your next treatment.

Being in excess of your target weight is like being overdrawn at the bank. You need to pay that money back sooner or later to get back to even. Just like you would spend less money to balance your account, drink less fluid in between treatments to reach your target weight. And, just like being constantly overdrawn at the bank, constantly being in excess of your target weight carries heavy penalties. So stay within your fluid budget to help avoid penalties on your health.

Reference

Excessive Fluid Intake Can be Harmful, Debra Blair, MPH, RD, CSR; Renal and Urology News; June 2009. http://www.renalandurologynews.com/nutrition/excessive-fluid-intake-can-be-harmful/article/139815/