Diet in Chronic Kidney Disease

Fluid intake

3. Fluid Intake
Why must patients with CKD take precautions regarding fluid intake?

The kidneys play a major role in maintaining the proper amount of water in the body by removing excess fluid as urine. In patients with CKD, as the kidney function worsens, the volume of urine usually decreases. Reduced urine output leads to fluid retention in the body causing puffiness of the face, swelling of the legs and hands and high blood pressure. Accumulation of fluid in the lungs (a condition called pulmonary congestion or edema) causes shortness of breath and difficulty in breathing. If this is not controlled, it can be life threatening.

What are the clues that suggest excess water in the body?

Excess water in the body is called fluid overload. Leg swelling (edema), ascites (accumulation of fluid in the abdominal cavity), shortness of breath, and weight gain in a short period are the clues that suggest fluid overload.

What precautions must CKD patients take to control fluid intake?

To avoid fluid overload or deficit, the volume of fluid should be recorded and followed as per the recommendation of the doctor. The volume o fluid permitted may vary for each CKD patient and is calculated on the basis of urine output and fluid status of each patient.

How much fluid is a chronic kidney disease patient advised to take?

• In patients without edema and with adequate urine output unrestricted water and fluid intake is permitted. It is a common misconception that patients with kidney disease should take large amounts of fluid to protect the kidney. The amount of fluid allowed is dependent on the clinical status and kidney function of the patient
• Patients with edema and reduced urine output are instructed to restric fluid intake. To reduce swelling, fluid intake in 24hours should be less than the volume of urine produced per day.
• In order to avoid fluid overload or deficit in patients without edema the allowable volume of fluid per day = urine volume of previous day plus 500 ml. The additional 500 ml of fluid approximately make up for the fluids lost through perspiration and breathing.

Why must CKD patients maintain a record of their daily weights?

Patients should keep a record of their daily weight to monitor fluid volume in the body and to detect fluid gain or loss. The body weigh remains constant when the instructions regarding fluid intake are followed strictly. Sudden weight gain indicates fluid overload due to increase in fluid intake. Weight gain warns the patients about the need for more meticulous fluid restriction. Weight loss usually occurs as a combined effect of restriction of fluid and a response to diuretics.

Useful Tips to Reduce Fluid Intake :

It is difficult to restrict fluid intake, but these tips will help you:

1. Weigh yourself at the same time every day and adjust fluid intake accordingly.
2. The doctor advises you on how much fluid consumption is permitted in a day. Calculate accordingly and take the measured volume of fluid everyday. Remember that fluid intake includes not only water but also tea, coffee, milk, juice, ice cream, cold drinks, soup, and other foods with a high water content such as watermelon, grapes, lettuce, tomatoes, celery, gravy, gelatin, and frozen treats like popsicles.
3. Reduce salty, spicy and fried food in your diet as they increase thirst, leading to a greater consumption of fluids.
4. Drink only when you are thirsty. Do not drink as a habit or because everyone is drinking.
5. When you are thirsty, take only a small amount of water or try ice. Take a small ice cube and suck it. Ice stays longer in the mouth than liquid, so it is more satisfying than the same amount of water. Do not forget to account for ice as consumed fluid. For easy calculation, freeze the allotted amount of water into an ice tray.
6. To take care of dryness of the mouth, one can gargle with water without drinking it. Dryness of mouth can be reduced by chewing gums, sucking hard candy, lemon wedge or mints and the use of mouthwash to moisten the mouth.
7. Always use a small sized cup and glass for your beverages to limit fluid intake.
8. Take medicines after meals when you are taking water to avoid extra water consumption for medicine.
9. A patient must keep himself busy with work. A patient who has little to occupy himself feels the desire to drink water more often.
10. High blood sugar in diabetic patients can increase thirst. A stringent control of blood sugar is essential to reduce thirst.
11. Since hot weather increases one’s thirst, any measure taken to live in cooler comfort is desirable and recommended.

How does one measure and consume the prescribed amount of fluid per day?

• Fill a container with water, equal to the exact amount of fluid prescribed by the doctor for daily intake.
• The patient must bear in mind that no more than that amount of fluid intake is permitted for the day.
• Each time the patient consumes a certain amount of fluid, the same amount of water should be removed from the water container and discarded.
• When the container has no more water, the patient will have consumed his quota of fluid for the day and should not drink anymore.
• It is advisable to distribute total fluid intake evenly throughout the day to avoid the need for additional fluid.
• Repeated daily, this method, if followed, effectively delivers the prescribed amount of fluid per day and prevents excessive fluid intake.