With late stages of chronic kidney disease (CKD) or end-stage kidney disease (ESKD), a fluid restriction may be necessary to prevent fluid from building up in your body. In the National Kidney Foundation’s Hot Topics in Kidney Health, former dialysis patient and kidney transplant recipient Anthony Reed, and nurse practitioner Catherine Wells discuss restricting fluid as a kidney patient, including when it is necessary, and tips for maintainance.* 

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Why are fluid restrictions important?

One of the main responsibilities of the kidneys is to balance the fluid in your body and remove any excess. Unfortunately, when your kidneys are badly damaged, fluid can build up in the body and around vital organs. Some symptoms of fluid buildup are:

• Edema (swelling) in the feet, ankles, wrists, and face
• Shortness of breath
• Cramping
• Headache
• High blood pressure

Who should restrict fluids? 

Fluid restrictions are commonly recommended at CKD stages 4 or 5 and on dialysis. If you have certain heart conditions, like congestive heart failure (CHF), you may need to follow a fluid restriction sooner. 

“It’s different for everyone,” said Wells. “Some people lose filtering abilities when kidney function fails, but still make a lot of urine. Others lose both the filtering function and ability to remove extra water. Everyone’s fluid prescription will look different because it should be based on the amount of kidney function you have and how that kidney function is working.”

Will fluid prescriptions change?

Fluid restrictions are often needed with CKD; however, different treatments can change fluid needs. This includes:

• Hemodialysis (HD) treatment warrants a fluid restriction to manage blood pressure, cramping, and stress on the heart during treatments. 
• Peritoneal dialysis (PD) treatments often do not require a fluid restriction, but you may need to monitor sugar intake more closely. 
• Kidney transplants will generally lead to an increase in fluid needs, especially when transitioning from a fluid restriction. 

What are some tips for following a fluid restriction?

If you’re on hemodialysis, fluid management is critical to maintain your health and prevent cramping during your treatments. Wells and Anthony discuss six ways to support a fluid restriction: 

• Discuss your fluid needs with your healthcare team. Learn what may cause them to change with your healthcare team. For example, sweating, vomiting, and/or diarrhea will cause you to lose more fluid, and your need for fluids may be greater. 
• Limit your salt (sodium) intake. Eating too much salt leads to more thirst. 
• Know your target weight in the context of dialysis. Your target weight is your weight without additional fluid, which is also the weight you leave with at the end of dialysis. If you gain too much fluid between treatments, it can be difficult to meet your target weight. 
• Take medications as prescribed. Medications, such as diuretics, help to maintain a proper fluid balance. 
• Avoid skipping dialysis treatments. Missing sessions can lead to excess waste and fluid building up. Re-schedule treatments ahead of time when you have plans at your original time. 
• Create new habits to reduce your fluid intake. For example, you can use mouthwash or hard candies to help reduce thirst when a craving hits. 

“Learn upfront to budget (fluid for hemodialysis) and learn that if you mess up once, then that’s a lesson, not a failure,” said Anthony. “That’s with anything in life. If you learn from it, then it’s a lesson and you go on and move on.”

*The Dos and Don’ts of Fluid Management for Kidney Disease. (2023, March 31). National Kidney Foundation. https://www.kidney.org/newsletter/dos-and-don-ts-fluid-management-kidney-disease