The Thirst Games: finding your way with fluids

 The Thirst Games: 8 practical tips to manage fluid restrictions and dry mouth between sessions  because strict fluid limits and dry mouth can be tough to handle, but using simple, everyday tricks can help you manage your thirst without drinking extra liquids. [1, 2]

Dialysis gets rid of extra fluid from your blood, but you're not there every day, so you need to watch how much you consume. Usually, you're on a fluid restriction with a dialysis diet, and the exact amount you can have each day depends on your health what your care team suggests and the type of dialysis you're doing. Folks on home dialysis might have fewer fluid restrictions, while those doing in-center hemodialysis  usually have stricter limits on their fluid intake. (Peritoneal patients can have slightly less restrictions.) Talk to your kidney doctor or renal dietitian about how to handle your fluids and feel your best.

Why do I have dialysis fluid restrictions?

Limiting fluids will help you feel better and stay healthier. Once you’re on dialysis, you may urinate very little—or not at all. Any extra fluid must be removed by dialysis, and consuming too much fluid may cause buildup between dialysis sessions, resulting in the following:

Headaches and low energy

Swelling in your face, hands and feet (edema)

Trouble breathing from fluid in your lungs

Heart damage from stretching your heart with too much fluid

High blood pressure that can lead to a stroke

(Source:Fresenius Kidney Care Fluid Mgmt Guide)

Less salt = less thirst = feeling better:

Consuming less salt will help you:

Control your thirst.

Avoid swelling in ankles, fingers, waist, or under eyes.

Keep your heart stronger.

Breathe easier.

Learn how to cut salt and sodium without sacrificing flavor.

Source:Find simple ways to limit salt

How fluid affects your weight:

Excess fluid in your body shows up on the scale. Therefore, your body weight can be an important indicator of how well your treatments and fluid management are working together. Your dietitian will teach you how to monitor fluid gains and track what you’re drinking to help you feel your best.

Measure and track your liquids:

People on a dialysis fluid restriction diet should typically limit fluids to 32 oz or less each day. Your doctor or nephrologist (kidney doctor) will discuss your specific fluid requirements. To help you monitor your fluid intake, write down how much you’re drinking or eating throughout the day. It may also help to think about your day to plan what you’re going to drink and when. For instance, if you have a special occasion in the evening, consume less fluid throughout the day. Source:Fresenius kidney care.com

8 tips for dialysis patients on fluid restriction:

Controlling how much you drink isn't always easy. Try these ideas for managing your fluid intake

ice

1. 1.Eat a piece of cold or frozen fruit, like grapes, strawberries, or blueberries.
2. 2.Freeze your favorite beverage in a bottle and sip as the fluid melts.
3. 3.Suck on a piece of sugar-free hard candy or chew sugar-free gum.
4. 4.Drink from small cups or glasses.
5. 5.Rinse your mouth with mouthwash.
6. 6.Avoid "fluid traps"—situations where you may drink out of boredom or habit. 
7. 7.Count to 100 and try to wait for a fluid craving to pass.
8. 8.Stay cool during hotter months with a misting fan and proper clothes. Source: Fresenius Kidney Care Fluid Mgmt Guide

For more official tips and tricks on how to budget your daily intake, check out the National Kidney Foundation Fluid Management Tips or the Fresenius Kidney Care Fluid Management Guide.

Fluids aren’t just what you drink:

Defining Fluids Beyond Beverages:

• While water, tea and anything you’re drinking out of a cup are obviously fluids, there are also some foods that contain enough liquid to be considered fluids and should be limited accordingly.

• Soup

• Ice cream, sherbet, sorbet

• Nutritional drinks

• Gelatin (Jell-O®)

• Ice cubes, ice chips

Tip: Foods that melt or are liquid at room temperature are considered fluids. Source: Fresenius Kidney Care Fluid Mgmt Guide

Foods That Contain (But Don't Always Count as) Liquid [1]

Many solid foods (like fruits and vegetables) are naturally made mostly of water. However, their water content is often handled differently: [1, 2, 3]

• Foods to restrict or carefully measure: Foods like watermelon naturally contain so much water that they can eat into your fluid allowance and must be counted. [1, 2]
• Exempt or limited foods: Many kidney-friendly fruits (e.g., apples, pears, berries) contain water but are usually not added to your daily fluid tally, though their portion sizes should still be limited. [1, 2]

Note:To ensure you stay safely within your fluid and electrolyte limits, always consult with your renal dietitian to get a tailored daily plan. You can find a professional and get helpful resources through the Academy of Nutrition and Dietetics or National Kidney Foundation databases. [1, 2, 3, 4, 5]

Many purified and electrolyte-enhanced bottled water brands explicitly list added sodium (often in the form of sodium chloride or sodium bicarbonate) as an ingredient. These brands add trace amounts to balance the water profile and improve flavor after the purification process. 

Common brands that contain added sodium include:

• Dasani: Adds magnesium sulfate, potassium chloride, and table salt (sodium chloride).
• SmartWater (Glaceau): Adds calcium chloride, magnesium chloride, and potassium bicarbonate.
• Limit my soup Nestle Pure Life: Includes calcium chloride, sodium bicarbonate, and magnesium sulfate.
• Essentia: Features trace added electrolytes, including sodium bicarbonate.
• Core Hydration: Purified water balanced with electrolytes, including sodium bicarbonate and sodium chloride. [1, 2, 3, 4]

Note: Bottled waters that have "sodium free" labels can still legally contain up to 5mg of sodium per serving, which is generally considered dietarily insignificant. Always check the "Ingredients" or "Nutrition Facts" label on the bottle for exact added amounts. [1]

My personal take on this topic:

I'm so lucky I can still pee a lot. So, I don't hold onto much fluid between treatments. I never take that fact for granted. It actually makes me a little nervous sometimes because I worry about getting dehydrated.

But my kidney doctor says it's because I'm getting rid of it myself. I trust her as a great doctor, so I just let that thought go and believe her. I mean, she's the expert, and she's been doing this longer than I've even had this diagnosis.

I gotta say, I measure (okay, sometimes I just eyeball it) and track how much I drink. I literally write it down in a notebook the night before so I can just follow my notes when I wake up. It's less thinking and remembering, and I don't know about you, but my brain's a bit fuzzy first thing in the morning.

I don't use much sodium in my diet, if any. I keep it low by cooking most of my meals fresh and from scratch. I eat more fresh produce and proteins so that there's nothing added. I read labels and research the prepackaged products I do use, and if possible, I check the labels on my condiments.

By the way, if you buy and drink bottled water, check the label because some brands have added sodium. See the list below:

You'd be surprised what has added sodium in it. Reading labels has opened my eyes to all the different kinds of added synthetics that are in products, even some of the ones labeled organic or natural.

I try to limit my soup intake since they use up a lot of my fluid allowance. But sometimes, when I haven't had much to drink, I'll have about 4-6 oz. Just enough to get a taste, but not too much. And I always remember to take a phosphorus binder with it.

I think I've rambled enough for one post! I'm done. I hope your day flies by so your weekend gets here soon.

Tina

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