Helping you live a better life on dialysis

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Controlling Fluids

When your kidneys don’t work, it is harder to keep the right fluid balance. Your body is less able to remove extra sodium - and if you eat too much sodium, you will get thirsty. Then when you drink, your body cannot get rid of the extra fluid.

Part of the job of dialysis is to take off extra fluid your kidneys do not remove anymore. This is important, because if you have too much fluid, you may have:

  • Swelling in your face, hands, and feet called edema (eh-dee´-ma)
  • Headaches and low energy
  • Trouble breathing from fluid in your lungs
  • Heart damage from stretching your heart with too much fluid
  • High blood pressure that can lead to a stroke

But peritoneal dialysis (PD) or in-center hemodialysis (HD) can’t do all of the fluid removal - you have to help too. Some people on PD and most people on in-center HD have some type of fluid limit. (Daily and nocturnal HD remove much more fluid, so using those treatments may mean that you don’t need a fluid limit.) How much fluid you can have each day will depend on how much urine you make.

What Are fluids?

A fluid is anything that is liquid or anything that would melt if left at room temperature. Some examples are:

  • Alcohol (drink only with your doctor’s permission)
  • Coffee and Tea and other hot beverages
  • Gelatin (Jell-O) (1/2 Cup = 1/2 Cup fluid = 4 ounces)
  • Gravy
  • Ice cream, sherbet, sorbet (1/2 Cup = 1/2 Cup fluid = 4 ounces)
  • Ice cubes, ice chips (1 Cup = 1/2 Cup fluid = 4 ounces)
  • Milk, liquid creamer
  • Nutritional supplements
  • Popsicles (1 twin stick = 1/4 Cup fluid = 2 ounces)
  • Vegetable and fruit juices
  • Soft drinks, lemonade, limeade
  • Soups
  • Syrup
  • Water for drinking and taking medicine

Hemodialysis And fluids

Limiting fluids will make in-center hemodialysis much easier on you. You will have fewer painful muscle cramps and be less likely to feel “washed out” after a treatment. Your dietitian will tell you how much fluid you may have each day. Many people on hemodialysis need to limit fluids to about 36 ounces a day.

Water is heavy! A liter of water weighs one kilo (2.2 lbs). With no kidney function, your fluid limit on in-center hemodialysis will be about 1 liter per day, or just under 32 ounces. Between dialysis treatments, you would be able to drink 2 liters and gain 2 kilos, or 4.4 lbs. If you weigh yourself at the same time each day, wearing the same clothes, you will know if you are on track. (If you make some urine - or do daily or nocturnal hemodialysis—you will be able to drink more fluids.)

Peritoneal Dialysis  And Fluids

Most people on peritoneal dialysis have some kidney function left - so they still make some urine. Over time, this kidney function (called residual kidney function) often drops. How much fluid you can have each day will depend on how much urine you make. So it is important to measure your kidney function to be sure you are getting enough dialysis.

If you are on peritoneal dialysis, ask your doctor about checking your kidney function to be sure you are getting enough peritoneal dialysis. If your kidney function drops, you may need more peritoneal dialysis - and/or less fluids. Be alert for signs of edema and tell your peritoneal dialysis nurse or doctor if you:

  • Have fluid build-up
  • Notice a lot of sudden weight gain
  • Use more 4.25 strength solution than you did before
  • Have headaches

Watch For The signs Of Edema

Edema (eh-dee´-ma) is fluid build-up in the body. If you have edema, you may notice that your shoes or your rings don’t fit. Your eyesight may change. It may be harder to breathe (some people have mistaken fluid in the lungs for asthma). If you have a lot of extra fluid, your ankles or legs may even dent when you press on them with a finger. This is called “pitting edema.”

Part of the job of dialysis is to take off extra fluids your kidneys don’t remove any more. This is important, because if you have too much fluid, you may have:

  • Headaches and low energy
  • Swelling in your face, hands, and feet (edema)
  • Trouble breathing from fluid in my lungs
  • Heart damage from stretching my heart with too much fluid
  • High blood pressure that can lead to a stroke

Tips On Limiting Fluids And Controlling Thirst

Here are some easy, proven ways to limit fluids and deal with thirst, without drinking too much. Which ones do you want to try?

  • Drink only when you are thirsty, and just enough to quench your thirst.
  • Be aware of all the fluids in your diet. A fluid is anything liquid at room temperature. This means ice cream or Jello®, soup, gravy, etc.
  • Drink from small cups or glasses.
  • Eat a piece of cold or frozen fruit.
  • Eat soups or cereal with a fork instead of a spoon to save fluids.
  • A little ice can quench thirst more than the same amount of liquid. Try freezing regular or diet ginger ale or apple juice into slushes or popsicles.
  • Rinse your mouth with cold water or swish mouthwash and spit it out.
  • Suck on a piece of regular or sugar-free hard candy, an ice cube, a lemon wedge, frozen grapes, or chew regular or sugar-free gum to stimulate saliva.
  • Suck on a piece of regular or sugar-free peppermint candy, which will help quench your thirst and keep your breath fresh!
  • Check with your doctor or pharmacist to see if any of your medications cause thirst or dry mouth.
  • Each day fill a jar with the water equal to your daily fluid limit. Each time you drink, you will pour that amount out of the jar. Your will be able to see how much you have left.
  • Spread out your fluids evenly throughout the day.
  • If you are gaining too much weight, measure all your fluids for a day or two so you will know just how much you have been drinking.
  • Avoid high-sodium or very sweet foods.

 

Content from Kidney School, a program of the Medical Education Institute, Inc.

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