Kidney Diet Tips

Holiday Fluid Management (Part One)

Stream of water going into a glass

It’s the holiday season, the time to celebrate our traditions, even if things are different this year due to the COVID-19 pandemic. These celebrations may include a variety of foods and drinks that can tempt you beyond your usual diet and fluid limits. Your renal dietitian will most likely work with you on holiday fluid management. They may remind you to be careful with high fluid gains and to avoid salty foods. There are a lot of delicious kidney-friendly recipes for the holidays and tips to help with fluid control. But, do you know how much you should drink between treatments? Do you know the meaning of abbreviations like TW, IDWG or UFR? Read on to learn about better holiday fluid management and how much fluid is actually safe for dialysis patients to gain between treatments. This is Part One of a two-part blog post.

Target Weight (TW)

During your first or second week of dialysis treatments, your team will decide on a target weight (TW) and the doctor will sign as an order. Target weight is a term set by the Centers for Medicare &Medicaid Services (CMS). It is the weight your doctor orders as the post-dialysis weight that you can safely and reasonably achieve. In other words, TW is the ideal weight to reach once all the fluid weight you gained in between treatments has been removed. At TW, patients have an acceptable blood pressure level, no visible edema or swelling, no lung sounds related to fluid, and no shortness of breath at the end of the dialysis treatment.

If you have extra fluid in your body (edema), it might take a few more treatments before an accurate TW order is decided. This TW can be changed frequently as extra fluid is being removed each dialysis treatment. If help is needed, you can ask your dietitian about good nutrition, fluid and sodium goals, and recipes and tips to help you manage fluid balance.

Interdialytic Weight Gain (IDWG)

Interdialytic weight gain (IDWG) is the fluid weight a patient gains in between hemodialysis treatments. For example, you dialyzed on Monday and your post weight (ideally your TW) is 70 kg. At the next treatment on Wednesday, you weigh 72 kg before treatment. This is your pre-dialysis weight. The difference of 2 kg is your IDWG. Your team will plan on removing those 2 kg. Studies have shown that gaining over 5% of the TW can be harmful to a patient’s health (1).

Fluid Intake

How much should a dialysis patient drink? This depends on many factors, some of these being body size, amount of urine output, if any, and how much fluid removal is tolerated. Fluid limits generally range from 32 to 40 ounces daily, but must be individualized for each person. Most research indicates that IDWG should be no more than 3% to 4% of the TW (1). For example, if you weigh 70 kg, the goal for fluid weight gains between treatments is 2.1 to 2.8 kg. Higher levels are associated with high blood pressure, poor control of blood pressure and increase in size of heart walls (2).

Increasing your knowledge of fluid balance and applying fluid control tips from your healthcare team can help in managing holiday fluids.

Look for Holiday Fluid Management: Part Two coming in December.

Additional Kidney Diet Resources

Visit and explore these diet and nutrition resources:

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Matilde Ladnier RD, LD

Matilde Ladnier RD, LD

Matilde is an adventurer who loves to cook, try new foods, travel (especially to her home country Peru) and play tennis. She has over twenty years of experience working with CKD patients and enjoys educating anyone who is willing to learn.