Fluid Restriction in CKD

Some people living with CKD — or CHF, or hyponatremi — have to limit fluid intake. Restricting your fluid intake can be a pain, especially during the hot summer months. So, let’s talk about why we do it and some different ways to make it easier.

Why Did my Doctor Order a Fluid Restriction on Me?

There are many causes for your doctor to order a fluid restriction. 

• Heart Failure

• Kidney Disease

• Liver Damage

• SIADH (or low sodium in the blood or other reasons)

Even among kidney or heart patients, different people may have a different fluid restriction. Some people may have to limit fluid to 2,000 milliliters daily and some may have to limit it to 1,500 milliliters.

A tall glass of water has about 16 ounces or 500 milliliters of water!

When a person with kidney disease is on dialysis, their fluid restriction may change from month to month depending upon:

• Medication changes

• Physical activity or sweating a lot

• Missing dialysis treatments

• Changes in your dialysis treatments (a shorter run time or fewer treatments per week)

• Drinking much more or much less than what your doctor has ordered

What Happens if I Drink Too Much Water?

Drinking too much fluid — more than what your doctor has ordered — can cause some pretty serious problems like:

• Swelling in the hands, feet, and face

• Shortness of breath

• Weakness

• Headaches

• Nausea

• Seizures

You should talk to your doctor if you are experiencing any of these issues. But, I assume that you’re here because you have already seen your doctor and they told you to limit your fluids?

When I worked in dialysis, almost all of my patients were on a fluid restriction. So, I got good at finding ways to stay refreshed without drinking a lot of extra fluid. This is because I didn’t want my patients to have to deal with ultrafiltration — the process of having extra fluid taken off by the dialysis machine.

This procedure, while safe and often necessary, can cause some unpleasant side effects. When a large amount of fluid is removed quickly from the body, a person may have headaches, muscle cramping, and lightheadedness. Since these side effects can be avoided by limiting fluid intake before and after dialysis, my patients usually chose to do that.

What to Know About Sticking to a Fluid Restriction

It’s important to remember that all fluids that are liquid at room temperature contribute to total fluid intake. This means that things that will melt and become a liquid in the heat still count.

• Jello

• Ice cream

• Milkshakes

• Smoothies

• Popsicles

These foods still contribute to total fluid intake for the day and should be included in your daily fluid recording, along with other fluids that you drink like coffee, milk, tea, juice, and water.

My Favorite Tips and Tricks for Sticking to a Fluid Restriction

These are the tips and tricks that my patients, coworkers, and I have found to be most useful when faced with a thirsty patient on a fluid restriction.

1. Limit the salt. Salty fries or a salt-rimmed margarita can cause the body to hold onto water and can increase thirst. So, by limiting intake of highly salty foods, thirst can be decreased.

Snacking on frozen berries can keep you cool and regular!

1. Munch on frozen fruit. Kidney friendly fruits like berries and pineapple chunks can be kept frozen to munch on when you need to cool down. My dialysis patients always loved this option, because the fiber from the fruit can help with constipation!

1. Suck on ice. Ice has about 10% less fluid when compared to a comparable amount of water. So, instead of drinking an 8 ounce glass of water, you can suck on a slightly larger glass of ice. Ice is more refreshing than water and tends to last longer. So, even though you still have to limit the amount of ice that you eat, you can stay cooler for longer if you choose ice over water.

1. Fill up a jug with water to meet your total fluid “allowance” for the day. You can either drink only from that jug, or if you have a different drink — like coffee! — you can pour out that amount of water from the jug. So, if you have a 12 oz mug of coffee, pour 12 oz of water into the sink — or on your plants! This way you also know how much fluid you have left to drink for the day.

Even though a fluid “restriction” sounds very limiting, it is important to remember to get the amount of fluid that your doctor has ordered in a day. Dehydrating yourself can cause problems too.

It's important for me to note here that if your doctor has not told you to limit your fluids, you should not. Some people with CKD need plenty of fluid, while some people need very little.

If you have any questions or concerns about your fluid restriction, you should talk to your healthcare team. Your doctors, nurses, dietitians, social workers, and technicians want to help you however we can. And if you have any other questions about kidney nutrition, just drop me a comment below!