If you were stranded on a desert island, you would feel thirsty sooner than you would feel hungry. We are told the healthy body normally needs up to eight glasses of water a day to maintain fluid balance. For people in the later stages of chronic kidney disease (CKD), these normal amounts of fluid can build up in the body and be dangerous.
Fluid control for those on hemodialysis
Fluid restriction can help you feel comfortable before, during and after your dialysis sessions. Even though dialysis gets rid of excess fluid and waste in the body, it’s not as effective as healthy kidneys that work 24 hours a day, seven days a week. Most people on hemodialysis get treatments three times a week for about three or more hours at a time. This means, in the days between your dialysis treatments, your body holds on to excess fluid and waste your kidneys cannot remove.
Going over your recommended fluid allowance can cause swelling and increase your blood pressure, which makes your heart work harder. Too much fluid can build up in the lungs, making it difficult to breathe.
Hemodialysis removes fluid as the blood is filtered through the dialysis machine. However, there is a limit on how much fluid can be safely removed during a dialysis session. If you exceed your fluid allowance, sometimes an extra dialysis session may be required to remove all the extra fluid.
Fluid control for those on peritoneal dialysis
People on peritoneal dialysis (PD) may not be as limited with their fluids as people on hemodialysis. This is because PD treatments are performed every day, unlike hemodialysis, which is done several times a week.
But patients on PD are encouraged to keep track of their fluid intake and the amount of fluid removed in their dialysis exchanges. Too much fluid can still lead to complications like swelling, high blood pressure and shortness of breath.
Determining fluid restriction
Fluid restriction may vary for each individual patient. Factors such as weight gain between treatments, urine output and swelling are considered. If you’re on hemodialysis, your weight is recorded before and after your dialysis session. Your nurse uses weight changes to help determine how much fluid to remove during dialysis. If you’re on PD, your nurse will have you record your weight every day. Sudden weight gain may mean you are drinking too much fluid. Your dietitian will coach you on individual goals for your fluid intake.
Complications of too much fluid
For dialysis patients, the complications of excess fluid are:
Exercise and fluid intake
Before you start an exercise program, let your doctor and healthcare team know. Exercise may change your fluid requirements, especially if you are exercising and perspiring heavily. Your dietitian can coach you on how much fluid to drink.
Tips for managing your thirst
Your dietitian—as well as fellow patients—can give you many helpful hints to manage your thirst. Here are some tips to get you started:
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