By Melissa D. Pryer, LDN, RD, CNSD

Living with kidney disease can be challenging, and many lifestyle modifications are necessary for good disease control. These changes include limiting intake of certain foods and restricting fluids. Compliance with these guidelines is essential, and each person has an individualized diet plan and fluid restriction to meet their specific needs.

Two components of a renal diet plan that impact fluid balance are the restriction of sodium and fluid intake. The degree of these restrictions may vary based on many factors, such as volume of urine output, lab values, weight gain, and volume of fluid removed during dialysis. For most patients, weight gain should be no more than one to two pounds between dialysis treatments. If weight gain is excessive between dialysis treatments, too much fluid is being consumed. When excessive fluid is consumed, the patient may notice swelling in the feet and ankles, elevated blood pressure and fluid build-up around the lungs leading to shortness of breath. This fluid overload also causes the heart to work much harder and can lead to heart damage. In addition, excess fluid must be removed at the next dialysis treatment session, which can lead to muscle cramping, low blood pressure and fatigue. Since fluid overload can lead to complications, it is essential that every kidney disease patient know how much fluid they are allowed each day and adhere to that guideline.

It is difficult to address fluid intake without briefly discussing sodium intake. Most patients with kidney disease will need to restrict their sodium intake. If a patient consumes too much sodium, most likely, fluid intake will also be excessive, because eating foods high in sodium triggers the thirst mechanism. Excess sodium intake can also contribute to swelling and fluid retention. Each person’s sodium restriction will be different, so it is important to talk with your renal dietitian about your specific regimen.

In order to control fluid intake, it is important to understand what food items contribute to fluid intake. Any foods that are liquid at room temperature must be counted as a part of the daily fluid intake. Obvious examples of fluids include water, juices, tea, coffee, milk, sodas and lemonade. Other items that contribute to fluid intake that may not be so obvious are ice, popsicles, gelatin, ice cream, sauces, gravies and soups. It is also important to realize that many fruits and vegetables contain a substantial amount of water. Some examples include melons, grapes, apples, oranges, tomatoes, lettuce, celery and cucumbers. It is essential to understand the terminology used by the healthcare staff when they discuss fluid restriction. For example, one cup of fluid equals eight ounces, and four eight-ounce cups are equal to one quart. The healthcare staff may also discuss your fluid allowance in terms of “cc” or “ml”. One eight-ounce cup contains 240 cc or 240 mL. The healthcare provider will clarify any confusion or uncertainty that may exist when discussing fluid restriction.

Because you will become thirsty, it is important to understand how to satisfy your thirst without overindulging. Again, limiting intake of salt will help to combat thirst. It is also beneficial to have the pharmacist analyze your medication list to determine if thirst or dry mouth is a known side effect for any of your medications and, if necessary, suggest alternative medications without those side effects. Throughout the day, keep gum or hard candies available to help combat thirst. Two types of gum specifically designed to help combat thirst are Gatorgum® and Quench®. Tart items, such as lemon wedges and sour candies quickly satisfy thirst. To best utilize liquids you are allowed to consume, take medications with meals, unless your doctor instructs you differently. Remember to evenly distribute fluid allowance throughout the day to help minimize thirst. Many additional tips and suggestions for combating thirst and limiting fluid intake are available at the Web sites listed to the right. The renal dietitian at your doctor’s office or dialysis center can also provide you many additional suggestions tailored to fit your lifestyle.

Without question, controlling fluid intake is one of the most difficult aspects of managing renal disease, but is also one of the most important. Patients who stay within the guidelines determined by their doctor and/or dietitian have the best immediate and long-term results.

References:
www.ikidney.com
http://kidney.niddk.nih.gov
www.davita.com

Melissa D. Pryer, LDN, RD, CNSD, is a clinical dietitian specializing in Nutrition Support at Methodist Hospital in New Orleans.

The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.

This article originally appeared in the May 2005 issue of aakpRENALIFE, Vol. 20, No. 6.

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