Why fluid restriction?

  • The answer to the question is that the person suffering from kidney disease is unable to balance the fluid electrolyte balance as healthy individuals.
  • So to keep up the balance the volume of fluid in the body should be watched through dialysis procedure 
  • It helps and makes it easier for patient to cope up with the illness 
  • The fluid restriction is usually recommended for individual who are recommended for dialysis sessions 
  • Particularly If the sessions long for 3 days / week and if urine production or urine output  is decreased 
  • For at home dialysis sessions minimal flushes are recommended
  • Patient should at least maintain to limit 32 ounces of water per day 

What happens if the patient follows fluid restriction?

  • The patient may end up with severe symptoms which can be sometimes life threatening too 
  • The reason behind is due to poor functioning of the kidneys they don’t tend to filter the blood efficiently  leading to fluid overload 
  • They may experience shortness of breath,swelling or edema of feet,hands and elevated blood pressure ,poor nutrition,Lung infections,heart failure or muscle spasms ,reduced blood proteins , proteinuria 
  • Due to rise in blood pressure patient experience nausea, vomiting,weakness,dizziness,muscle cramps etc

What are the factors determining the fluid restriction?

  • Dialysis alone doesn’t determine the fluid restriction to be done 
  • The factors vary person to person based on their age,weight,urine output and edema ,food habits (consuming more fluids or sodium containing food)
  • Also depends on the stage of kidney disease so that specific recommendations are included for every individual.

How do we know?

  • To determine the exact amount of appropriate fluid intake ,there is a noticed weight gain of 1-2 kgs in between the treatment sessions is considered good 
  • If patient has more than 2 kgs then the fluid is insufficiently removed 
  • If patient weight drops to  less than then there is an excessive removal of fluid
  • In Hemodialysis the weight gain is recorded as mentioned earlier before and after the sessions ,where as in peritoneal dialysis it should be checked daily

How is the fluid intake calculated?

The units of calculation includes milliliters or cubic centimeters

  • 30ml is equal to 1 oz
  • On 1500 ml fluid restriction which is equal to 50 oz or 6 and ½ cups 
  • The fluids are calculated for everything we consume 
  • As healthy individuals requires 8 glasses of water per day to maintain fluid balance so filters approximately 20-25/day after which about 2 liters of urine is lost per day 
  • In case of kidney patients this doesn’t happen and leads to build up and causes potential harm to health 
  • Patients on peritoneal dialysis will have daily dialysis sessions unlike hemodialysis where it last for 3 days /week 
  • So the fluid intake is not as much limited 

How do patients need to manage to quench thirst?

  • Patients should avoid eating spicy and sodium or salty foods in their diet
  • Should include sugar free candies or frozen grapes to reduce the thirst
  • Using lemon wedges,mints,breath spray or regular mouthwash can quench thirst 
  • Try freezing the liquid or water ,juices can relieve thirst
  • Staying cool and hydrated every possible without much into sun
  • Maintain glucose levels in case of diabetic as increased thirst is  one of the common symptom 
  • Sipping on small amounts of water is recommended

What fluid counts?

  • Anything that turns liquid at room temperature is considered to include when calculating
  • For example ice, ice cream,soups,jellos, protein shakes,milk,sorbets etc 
  • Consuming high fluid containing fruits such as watermelon or muskmelon or grapes should be considered to a certain point because these too is restricted in serving sizes 

As mentioned above for 

Chronic Kidney disease 

Stage 1 & 2

  • Around 64 ounces or 8 glasses per day of fluid is recommended

Stage 3,4 & 5

  • Patients who are not on dialysis need to limit the fluid intake 
  • Consulting doctor and your Dietician will help
  • Check for signs and symptoms which means fluid overload or hypervolemia

Kidney failure 

  • Patients on dialysis need to limit the intake in how much the fluid is consumed every day 
  • Generally recommended was 32 ounces /day
  • If the patient urinates 32 Ounces + total volume equal to the amount of urination in 24 hours 

For instance:

  • 1 cup or 8 ounces of urinate  / day 

means 40 ounces of fluid intake daily +8 ounces / day 

  For decrease in urine output evaluation is done for every 1 day for 3 months 

To conclude : The kidney disease patient should have 1 liter/ day, that is i;e 4 cups ×250 ml.

Frequently asked questions?

Is fluid restriction needed in renal patients?

Yes of course, the fluid restriction is needed in advanced stage renal patients and who are on dialysis have sessions for 3 days per week and with decreased urine output .

What IV fluid is best for renal failure patients?

Lactated ringers solution,
0.9% saline are considered as the best IV fluid choices for renal failure patients 
The mainstay of Dextrose containing fluids is due to its increasing  risk of abscess formation
Plasmalyte is not indicated  

What conditions require fluid restriction?

Renal disease conditions such as end stage renal disease, chronic Kidney disease,kidney failure,dialysis patients ,Inherited disorders who have hard time maintenance on fluid electrolyte balance do require fluid restriction 

Can you give lasix in renal patients

Lasix and other diuretics are often used in patients with End Stage Renal Diseases(ESRD) and who are on dialysis routine .
They are used to remove the swelling caused by the accumulation of fluid in the body 
Lasix should be avoided when patient is on ACE inhibitors or ARBs because there is a risk of severe hypotension

How do you treat fluid retention in renal patients

There are plenty of ways to manage the fluid retention in renal patients .
Initially including with a prescription of a diuretic or water pill which increases urine production and helps to aid in effective filtration done by kidneys 
Dialysis is another way of treating the fluid retention which reduces the fluid retention and it’s further complications

What is the main cause of renal fluid loss?

There are two probable reasons for the renal fluid loss .Firstly ,due to severe diarrhea, vomiting,blood loss, or high fever.
Secondly  ,Lack of a hormone known as antidiuretic hormone (ADH) can cause the kidneys to get rid of too much fluid

What are signs of electrolyte imbalance

confusion
dizziness
delirium
fatigue
muscle spasms
vomiting
headaches
Weakness
Irregular heart beat
Coma 
Seizures 
nausea

What is a fluid balance chart?

The fluid balance chart is used to assess the surgical patients hydration level or status 
It is a non invasive tool  used to check the fluid balance 
The nurse or the expert relies on it and prescribes the fluids according to it as a part of fluid management therapy in renal disease patients.

How does kidney disease affect fluid volume?

Too much volume of fluid is known as hypervolemia  
Hypervolemia is common among people with chronic kidney disease (CKD) and renal failure, because their kidneys aren’t working enough to remove excess fluid like healthy individual kidneys do 
When you have too much excess fluid, it can cause serious health issues such as swelling, high blood pressure, heart problems and even more  complications . And it can be potentially risk to the individuals life leading to death

What is the 4 2 1 rule for fluid replacement?

For fluid replacement the requirements are calculated by using the 4,2,1 rule 
That means 
4 ml/kg/hr for the first 10kg
2ml/kg/hr for the second 10kg and 
1ml/kg/hr for the third 10 kg ,with a maximum of 100 ml/hr maintenance.

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