Peritoneal Dialysis and Fluid Goals

Peritoneal dialysis (PD) patients are usually able to have a less restrictive meal plan than those on hemodialysis (HD). This is due to doing treatments daily. Frequent treatments allow toxins and fluid to be removed more often compared to HD treatments. Fluid goals for PD patients may not be the same as the goals for HD patients.

What is fluid?

Fluid consists of anything you drink. This means all beverages including the small amounts of water you take to swallow your pills. It also includes foods that are liquid at room temperature like ice pops, sherbet, gelatin and ice.

Determining fluid intake

To determine how much fluid you are currently having:

• Place an empty pitcher near a sink.
• Each time you drink, fill up a glass with the same amount of tap water as the fluid you drank.
• Pour the tap water into the pitcher. Remember to include those foods that are liquid at room temperature. For example, if you drank 1/2 cup coffee, add 1/2 cup tap water into the pitcher. If you like to eat ice chips, you’ll have to measure out the same amount of ice you’ve consumed and let it melt. Then add that same amount of tap water to the pitcher.
• After 24 hours, you can measure the tap water in the pitcher to determine how much fluid was consumed.
• Do this for a few days to get an average fluid intake.

How much fluid?

In general, our PD meal plan begins with 1 liter of fluid (32 fluid ounces or 4 cups) and is adjusted based on residual kidney function (production of urine). PD patients work closely with their healthcare team to determine their fluid goals. It is adjusted by several factors:

• Ultrafiltration = the amount of fluid that is removed by treatment
• Fluid loss from urination, perspiration and respiration
• Current fluid status (dehydrated or overhydrated)

Fluid status

Often times, PD patients are given a very generous fluid goal to increase their fluid intake to prevent dehydration. Signs of dehydration may include:

• dry mouth
• feeling light headed
• cramping
• nausea
• low blood pressure
• diarrhea.

When too much fluid is being retained, PD patients can work with their healthcare team and use a dialysate solution with a higher concentration of glucose. This will remove more fluid. However, the higher concentration is of concern because it contains more sugar. It may lead to higher blood sugars and weight gain over time if used often. Signs of fluid overload may include:

• edema or swelling in the feet, ankles, wrists and face
• shortness of breath or difficulty breathing
• higher blood pressure or weight gain.

This excess fluid may lead to heart problems.

Fluid intake is often influenced by your sodium intake. For information on how to decrease your sodium intake, see “Spice Up Your Life without Salt“. Creating  the best fluid goal for your individual needs can be complex. Speak with your registered dietitian for a meal and fluid plan to meet your specific needs.

To learn more about the meal plan differences between PD and HD, read the Kidney Diet Tips blog post “A Dialysis Diet to Match Your Treatment Type“. One difference to note is the fluid intake goals.

Click here for additional kidney diet tools and resources from DaVita.

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.