Water, Water Everywhere, and Not a Drop to Drink

By Katy Wilkens, MS, RD
Water is life. Without it, nothing would live on the planet. How hard is it then when your dialysis health care team tells you to limit your intake of water, and all fluids?
When kidneys fail, one of the common side effects is a decrease in making urine. Eventually, many people on dialysis stop making urine altogether. Since most dialysis patients dialyze 3 times a week, the common answer from your health care team to solve this problem is to ‘restrict your fluids’. A fluid is anything that is liquid at room temperature, for example beverages, soups, ice. Ice cream, or gelatin desserts.
Just exactly what does restricting fluids mean? For most people on dialysis, restricting fluid means limiting yourself to three or four 8-ounce cups of fluid a day. If you put out any urine, you may be able to have a little more. Ask your dialysis team how much fluid you may have each day.
Another way to look at fluid is to see how much fluid weight you gain between dialysis treatments. A good goal is 1.5-2 kilograms (3-4 lbs.) between dialysis treatments for most people. Check with your doctor about what amount of fluid weight gain is safe for you.
One issue for most people is just exactly what is a ‘cup’? We all have different size cups and drinking glasses at home, but a standard household measuring cup is 8 fluid oz. My favorite coffee mug holds 12 ounces, but when I pour it into my insulated travel mug, which looks twice as tall, it actually holds less. So, it’s a good idea to measure fluids to see how much liquid your drinking glasses, coffee cups, or mugs hold.
Measuring your cups and glasses just one time will help you to know how much fluid they hold. 
The secret to staying within your fluid allowance though, doesn’t have anything to do with willpower, or fluid. It has to do with salt.
Salt makes you thirsty. The more foods high in salt or sodium you eat, the thirstier you will be. It is hard, almost impossible to limit fluid when you eat foods that are high in sodium. So the real trick to keeping your fluid gains manageable, so that you don’t have cramping, blood pressure drops and feel badly during and after your treatment, is to limit your sodium intake to about 1,500 mg a day.


Tips to help control your fluid intake 

  • Measure your drinking cups, mugs and glasses to see how many ounces of fluid they really hold. Many sizes can be misleading.
  • Count anything that melts at room temperature as fluid; ice, popsicles, icecream, soup, and jello all count as fluid.
  • Use lemon wedges, hard sour candies, breath mints, thirst-quenching gum or breath spray to moisten your mouth.
  • Eat frozen fruits between meals instead of drinking fluids. Try frozen grapes, blueberries or strawberries.
  • Freeze fruit juice or lemonade in an ice cube tray and use it as part of your fluid. It will be softer and easier to chew than regular ice cubes.
  • Try using special dry-mouth toothpaste, mouth wash or artificial saliva.
  • Swallow your pills along with food from your meals or with soft food such as applesauce or oatmeal.
  • Try a cup of espresso or strong coffee after meals for the same “lift” without the large volume.
  • Check the package of ice cream bars, popsicles, soft drinks, beer, etc., and see how many ounces they contain.
  • Measure out part of your fluid allowances as ice cubes and store in a special container in your freezer. Ice is about half water by volume and it is often more satisfying than the same amount of water, because it stays in your mouth longer. Usually one ice cube tray holds about 2 cups of fluid.

Tips to help you limit your sodium intake, so you won’t feel thirsty

  • Choose “well balanced” foods. Food should have about the same amount of sodium as calories. If your microwaveable meal has about 600 calories, and about 600 mg of sodium, ( a ratio of about 1 to 1), that is a well-balanced food; compared to a can of soup, with 90 calories, and 900 milligrams of sodium, which is about 10 to 1 ratio.
  • Buy and cook ‘whole foods’ the way they come from nature, as much as possible. Highly processed foods in cans, frozen packaging and boxes are usually high in salt. The longer you can keep it, the more likely it is high in sodium.
  • Read labels. Every time you grocery shop, set yourself a goal of finding just one lower salt food to substitute for your regular choices. Just by reading labels, you can save over 400 mg of sodium in 2 tablespoons of salad dressing. 
  • Use fresh herbs to flavor your cooking. Every week, buy a bunch of parsley; put it in a cup of water on your kitchen counter. Every time you cook, grab a handful, chop it up and add to your food. Fresh herbs add amazing flavors to spaghetti sauce, soups, stews, and salads. Studies show people cut their use of sodium better when they use fresh herbs. If you have room, grown some in a pot on your deck, or a flowerbed in your yard, you will save money and add flavor.
  • Have about 3 ‘Go to’ recipes you can whip up quickly, with ingredients on hand. Keep a few Healthy Choice type lower sodium frozen meals in the freezer. Either of these choices is much better, healthier, and faster than eating out when you are crunched for time. 


Katy G. Wilkens is a registered dietitian and department head at Northwest Kidney Centers, Seattle WA. A recipient of the Susan Knapp Excellence in Education Award from the National Kidney Foundation Council on Renal Nutrition, she has a Master of Science degree in nutritional sciences from the University of Washington. See more of her recipes at www.nwkidney.org.