CKD: Is It Good for You to Drink Excessive Fluid

Although adequate fluid intake is an essential requirement for survival, excessive fluid intake can increase morbidity and mortality in stage 5 CKD patients.
One of the main functions of the kidney is to balance fluid in the body and with kidney failure, the commonest problem is being able to get rid of excess water. Excess water in the body is called fluid overload. It causes high blood pressure and may eventually contribute to heart disease.
If the water content of the body reaches very high levels, the accumulating fluid causes the body to swell - starting at the ankles, due to gravity - and spreading up the body. Eventually, if not treated, the excess fluid will settle in the lungs, causing a life-threatening condition called pulmonary oedema.
As the kidneys become less able to keep the body's fluid level balanced, you will have to watch how much you drink. Some patients have greater restrictions than others, but it's essential for most kidney patients to regulate their fluid intake.
Fluids include all beverages, foods that melt (ice, popsicles, ice cream, gelatin), and soup. Although it is interesting to note that almost all foods contain some fluid (meat is approximately 50% fluid, while the fruits/vegetables are approximately 90% fluid) and contribute an estimated 800-1,000 cc of fluid daily, this amount is offset by insensible fluid losses estimated at 1,000 cc/day through evaporation (skin, respiration) and stool.
Because adequate nutrition is key to improved health outcomes, dialysis patients who gain too much fluid between treatments should never be advised to eat less, but rather to drink less. Strategies to assist patients in decreasing fluid intake include:
· Avoiding salt and salty foods
· Maintaining blood sugar control (for people with diabetes)
· Using mouth sprays or mouthwash to relieve dryness
· Chewing gum
· Sucking on a lemon wedge or sour hard candy
· Freezing allowed fruit (e.g., grapes)
· Consuming ice (in measured amounts), popsicles
· Using a measuring cup to check the volume of household cups and glasses
· Keeping a fluid intake chart
· Filling a water pitcher with daily fluid allowance (and discarding amounts equal to other beverages consumed during the day to keep track of fluid intake)
· Using smaller cups/glasses
· Drinking from thirst rather than from habit.

Having been encouraged to drink more in earlier stages of CKD, patients new to dialysis often report difficulty adjusting to fluid restrictions. Although fluid intake is usually unlimited in predialysis patients, Wenzel and colleagues (Clin J Am Soc Nephrol. 2006;1:344-346) suggest that patients not be advised to increase fluid intake above normal requirements except in certain conditions (i.e., urolithiasis, salt-wasting nephropathy, diabetes insipidus).