Fluid Matters: Every Drop Counts

Do you know how much water is in the human body? Approximately 60 percent! That is a lot, and we need water for our bodies to work properly. But when kidneys do not work, excess fluid is not removed from the body efficiently. For many patients there is very little urine output, if at all.

Healthy kidneys work 24 hours a day to eliminate excess liquids and waste. With end stage kidney disease (ESKD), when the kidneys no longer work, elimination of fluid only takes place during dialysis treatments. Therefore excess liquids build up in your body until the next dialysis treatment. Not adhering to a fluid restriction puts a burden on your blood vessels and your heart. Your tissues are stretching out from this increased volume until they lose their elasticity.

What can happen when too much fluid weight is gained?

• Shortness of breath from little exertion
• Weakened heart
• High blood pressure
• Swelling of feet, hands and face
• Water in the lungs
• Increased risk of hospitalization and death

All of these effects decrease your mobility and independence. To maintain fluid balance, a limit on liquid intake is required. The exact amount is determined by your doctor and dietitian. If a limit of 1000 ml is prescribed, this is equal to 4 cups, or 32 ounces daily.

It is best to measure fluids to know exactly how much you are drinking. It is not a good practice to “estimate” how much you drink. If you do not measure your liquids, there is a risk that you will underestimate how much you are drinking, which may lead to getting too much fluid.  In other words, it’s easy to drink more than you think you are drinking if you don’t measure your fluid intake.

What counts as fluid? Anything that is liquid at room temperature, including gelatin, soup, ice, a liquid nutritional supplements and anything that you can drink.  All of these items need to be counted within your fluid restriction.

Some ideas to decrease your fluid intake and help control thirst:

• Freeze grapes or blueberries and eat a few to quench thirst
• Keep your mouth feeling fresh with mouthwash or gum
• Mist your mouth with a small spray bottle of lemon-flavored water
• Use smaller cups or glasses
• Take pills with applesauce instead of water
• Follow a low-sodium diet.  High sodium or salt intake increases thirst
• If you have diabetes, monitor your blood sugars.  High blood sugars may make you feel thirsty

For a person on hemodialysis the only way to remove excess liquid from the body is to have scheduled dialysis treatments. When a large amount of fluid is gained, an extra treatment may be required.  Sticking to your fluid restriction helps avoid harm to your body and gives you more quality time when you are not at dialysis.  Your heart will thank you.  And so will your dialysis team!