Picture of man crawling in desert with an empty glass of water. Fluid restriction on dialysis. Dialysis Dietitian.

Fluid Restriction On Dialysis

Being on a fluid restriction is tough no matter what time of year it is, but it’s especially challenging in the hotter summer months.

So, why do dialysis patients need to limit how much they drink in the fist place? How can you make sure you’re drinking enough, but not too much?

We’ll cover these questions along with summer survival tips on how to better manage fluid restriction on dialysis.

Why Your Fluid Intake Matters

In the earlier stages of chronic kidney disease (CKD) you usually do not need to limit your fluid intake. However, as your kidney failure progresses, your kidneys lose the ability to properly balance fluid in the body and you may notice a decrease in the amount of urine you are able to produce.

Once your kidneys are no longer able to properly remove extra fluid, that fluid starts accumulating in the body. This causes what we call “fluid overload”. Symptoms of fluid overload include:

  • Swelling (edema) in your hands, wrists, feet, face, ankles, and abdomen.
  • Headaches and low energy levels.
  • Shortness of breath. Sometimes this extra fluid can accumulate in your lungs making it difficult to breathe.
  • High blood pressure due to the heart having to pump all the extra fluid in your blood stream. This puts you at risk for a stroke.
  • Over time an increase in the size of your heart due to the extra workload which can eventually lead to congestive heart failure.

Can’t dialysis just remove the extra fluid? Good question. Dialysis can definitely help, especially if you are doing more frequent or daily dialysis such as peritoneal dialysis. But, it does not compare to the amount of fluid that can be removed by healthy kidneys which are working 24/7.

In Hemodialysis, typically you are only being dialyzed three times a week for a few hours. Your body can only handle a certain amount of fluid being removed in such a short period of time.

Having to remove a lot of fluid in one treatment can cause your blood pressure to drop during dialysis which can cause headaches and uncomfortable cramping. No bueno!

Thirst Quenching Diet Tips

How can I drink less when I’m so thirsty? This is definitely the challenging part, but there are things you can do to help relieve your thirst without consuming a bunch of fluid.

The absolute number one thing you can do which makes a HUGE difference is limiting your salt/sodium intake. This is key! The more salt you consume, the more fluid your body will retain and the thirstier you will be which leads you to want to drink more. A vicious cycle.

Instead, you can keep your total sodium intake to under 2000mg a day by really paying attention to the foods, condiments, and sauces you use as well as reading your food labels.

Ditch The Salt

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Picture of Low Sodium Diet spelled out with salt crystals on a blue background. Fluid restriction on dialysis.

Eating a low sodium diet starts with first getting rid of the salt shaker. Just a teaspoon of salt contains 2300 mg of sodium, which takes you over your daily allowance and doesn’t leave you with much else to eat.

Herb and spice up your diet instead, using fresh or dried herbs and seasonings that don’t contain salt. You can add so much flavor to a dish just by adding fresh garlic, onion powder, chilies or chili powder, smoked paprika, lemon/lime juice, black pepper….the list goes on.

Swap the typical high sodium sauces like soy sauce and fish sauce with coconut aminos instead. My favorite brand can be found HERE*. If you like hot sauce like I do, try a lower sodium version which contains 40 mg sodium per serving vs. 140 mg (>>my fav*).

Look for Low Sodium or Unsalted on your food labels. A food is considered low sodium if it contains =/< 140 mg sodium per serving.

Fun Fact: Miso is a traditional Japanese seasoning (paste) made from fermented soy. Just using a small amount can add so much flavor! Miso does contain a lot of sodium, however it has been found not to have the same cardiovascular effects (such as raising blood pressure) as other high sodium foods (1). You still need to limit this seasoning to help control your thirst.

Bye-Bye Ultra Processed

Start evaluating all the packaged, bottled and prepared food and snacks you buy in addition to the foods you order when you eat out or get take-out.

You may not even realize how much sodium you are consuming just with your breakfast cereal (1 cup Corn Flakes=204 mg sodium) or the two slices of bread you use for your sandwich (~250-300 mg sodium). And that’s before you add on the mayo, mustard, processed meat and throw in a bag of chips. Holy sodium fest!

Decreasing your intake of ultra processed foods and fast foods will greatly help you reduce your sodium intake.

Start reading all your food labels. The first step is awareness. Once you are aware of how much you are consuming, then you can make a change to do something about it.

Sugar Makes You Thirsty?

You may have noticed after having a sugary dessert or drink that you feel thirsty afterwards. Similar to salt, when your blood sugar increases this pulls water out of your cells. When your cells lose water, this sends signals to your brain that you need more water which makes you thirsty.

This is just another reason to limit your overall sugar intake. Try to avoid sugary candies, soda, sports/energy drinks, sugary coffee drinks (hello Frappuccino!), and other foods with a lot of added sugar.

Get Your 5 A Day!

It’s true, both vegetables and fruit naturally have a higher water content than other foods. But, if you cut back on your processed and salty foods and make sure you are eating enough fruit and veggies each day, this can help quench your thirst without drinking a ton.

Try to fit in a produce with every meal. Whether it’s blueberries with your oatmeal (not the salty sugary instant kind), Salad with lunch, grapes for a snack, and steamed vegetables with dinner, you are on the right path!

How Much Fluid Is Enough?

The answer is very individual depending upon how much urine you are making and the time/frequency of dialysis.

In general, if you no longer make urine or very little, your daily target is 4 (8oz) cups a day or 1 liter. If you are still making urine, 6 (8oz) cups a day or around 1.5 liters would be your goal.

Sometimes you are able to drink more, but these are the typical guidelines. Ask your doctor or dietitian how much fluid you can drink in order to get a specific daily target for you.

Once you get a daily target, try to stick to it. Pay attention to your body. If you notice you are getting puffy around your face or ankles that is a sign you need to back off on the salt and how much you are drinking.

Another thing that you can do is weigh yourself daily. This can make you more aware and on it in regards to your fluid status. You gain water weight much faster than body weight.

Don’t wait until you become short of breath before you make a change to your fluid intake.

Measure Your Fluids

Measuring your fluids may seem like a no-brainer, but do you really know how much you are drinking a day? Do you keep track of all the little sips you have throughout the day? They really add up if you’re not paying attention.

Drink out of a glass or mug that is 8 oz. This may be a lot smaller than what you’re used to drinking from, but this is key to help you better stay on track.

Unfortunately, you have to also be mindful of not just what you are drinking but foods that also count as a liquid. A fluid is anything that melts at room temperature. A few examples are:

  • Soups and broths
  • Popsicles (1 usually contains around 3 oz)
  • Ice cream, sorbet, sherbet, frozen yogurt (1/2 cup=2 1/2 to 3 oz)
  • Snow cones, ice
  • Smoothies
  • Supplement drinks
  • Yogurt, pudding, custard (1/2 cup=3 oz)
  • Gelatin, Jello (1/2 cup=4 oz)

Tips To Control Thirst & Dry Mouth

There are many factors that can contribute to dry mouth including certain medications. Whatever the reason, it is not fun, especially when you are on a fluid restriction.

Pictures of products for dry mouth. Fluid restriction on dialysis. Dialysis Dietitian.
Products for dry mouth

There are gels, sprays, lozenges, mouthwash and toothpaste made specifically for dry mouth that you can try to see if you get any relief.

Besides all of the diet tips above, here are a few thirst quenching tips:

  • Squeeze lemon into your water.
  • Freeze grapes, berries, or pineapple and suck on one. Having something cold in your mouth can help.
  • Brush your teeth and tongue regularly and use non-alcohol mouthwash for dry mouth. Keeping it in the refrigerator can keep it nice and cold.
  • Chew sugar-free gum or suck on sugar-free hard candy.
  • Freeze your favorite beverage and sip on it as it melts.
  • You can try using a room humidifier to help moisten the air you breathe.
  • Controlling your blood sugar levels – especially if you have diabetes – will really help with your thirst.
  • Try out this sugar free lemonade with mint recipe >>Click HERE.

Be A Fluid Fighter

Instead of fighting the battle with your fluid restriction on dialysis, utilize all of these tips to help you take back control of your fluid status.

Not only can it help you survive the summer months, but well beyond. Your heart will thank you and you will thank yourself for having to deal with less swelling, breathing will be easier, you’ll be less thirsty, dialysis treatments will be more comfortable, and overall you will feel better with more energy!

So, stay cool and in control of your thirst my friends.

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