Fluid and Sodium Restriction for Hemodialysis Patients

I’m Thirsty!! Why do I need to restrict Sodium and fluids?

The kidneys are vital to many body functions; most importantly they regulate water fluid levels and help remove waste products from the blood. When your kidneys are not healthy, extra fluid and sodium can build up in your body. This can lead to complications such as:

• Edema: swelling in your legs, hands and face
• Heart failure: excess fluid in the bloodstream can overwork your heart   making it enlarged and weak
• Shortness of breath: fluid can build up in the lungs, making it difficult to breathe
• Elevated blood pressures
• Cramping and blood pressure drops during dialysis

Many hemodialysis patients urinate very little or not at all, and therefore fluid and sodium restriction between treatments is extremely important. Hemodialysis removes fluid as the blood is filtered through the dialysis machine. However, it's not as effective as healthy kidneys that work 24 hours a day, seven days a week, and there is a limit on how much fluid can be safely removed during a dialysis session. If you exceed your fluid allowance, sometimes an extra dialysis session or longer dialysis time may be required to remove all the extra fluid.

How much fluid and sodium can I have daily?

Fluid restrictions vary for dialysis patients, so your kidney doctor, nurse practitioner, and dietitian will assess your individual requirements. Most people on hemodialysis will need to limit fluid intake to about four to five 8 oz cups each day. Factors in determining the amount of the restriction include weight gain between treatments, urine output, and swelling. The goal for an average sized hemodialysis patient is to keep fluid weight gain at or below 1 kilogram or 2.2 pounds each day. This equals a 2 kg (4.4 pounds) of fluid weight gain when there are 2 days between treatments and 3 kg (6.6 pounds) fluid weight gain when there are 3 days between treatments.

Sodium restrictions are recommended along with a fluid restriction.  A sodium restriction of less than 2g of sodium per day is typically recommended. A good control of sodium intake can lessen thirst and make fluid restrictions easier to comply.  

What counts as a fluid?

Fluid includes anything that is liquid at room temperature or melts at room temperature, such as: water, tea/coffee, milk, soft drinks, juice, popsicles, ice, ice cream, sherbet, gelatin, soups, liquid creamer, alcohol, water, or beverages used for taking medicine.

What are some high Sodium foods I should limit?

Salt and salt seasonings: bouillon cubes and granules, meat tenderizer, table salt, flavored salts, including garlic, celery and onion salt.
Sauces: such as barbecue sauce, marinades, Ketchup, Steak sauce, and Teriyaki sauce.
Salty Snack foods: such as corn chips, potato chips, Pumpkin seeds, salted popcorn or crackers.
Convenience foods: canned chili, dry soup mixes, frozen dinners entrees, Chinese food, frozen prepared foods, ramen noodles
Cured foods: bacon, relishes, sauerkraut, sausage, salty pork, pickles, ham and lunchmeats.

What are some tips to help restrict dietary sodium?

• Read food labels to see how much sodium content is in your food; hidden sodium can be found in foods that don’t even taste salty.
• Limit the amount of processed, frozen and canned foods in your diet.
• Watch out for beverages that contain added sodium.
• Try substituting fresh herbs and other spices to flavor foods.
• Be cautious when eating in restaurants; request condiments and dressings on the side and avoid cured meats and soup.
• Be aware of high sodium convenience foods and instead prepare your own foods and freeze them for a later meal.
• Ask your renal dietician before using any salt substitute. Certain substitutes contain potassium, which most dialysis patient should avoid.

What are some tips to help restrict dietary sodium?

• Use smaller glasses for drinking.
• Drink small portions during the day, rather than large ones all at once.
•  Use sour candy or gum to moisten your mouth.
•  Add fresh lemon or lemon juice to water or ice. The sour taste will help quench your thirst.
• Try swishing your mouth with mouthwash when you are thirsty. Do not swallow it!
• Use ice cubes instead of liquids. One-cup of ice is equal to a ½ cup of water/juice and will last longer.
• Freeze 20 grapes and eat throughout the day as one of your fruit servings.
• Add Fresh mint. The flavor of mint added to salads, beverages or other dishes cools and refreshes your mouth similar to a mint-flavored gum.
• Try to take your medications with mealtime liquids
• Maintain good blood sugar control (for patients with diabetes)
• Drink only when you are thirsty rather than from habit

If you are having trouble restricting sodium and/or keeping your fluid gains at the recommended limits between treatments, talk to your Kidney Doctor, Nurse practitioner, Dietitian, and Nurse. We will absolutely try to help.

Resources:

National Kidney Foundation. Sodium and your CKD diet: How to spice up your cooking. Retrieved July 24, 2017 from https://www.kidney.org/atoz/content/sodiumckd

Stewart, L. Fluid restrictions in Kidney disease. Retrieved July 26, 2017 from https://www.nutritioncaresystems.com/fluid-restrictions-and-kidney-disease

Wright, J and Cavanaugh, K. (2010, June 14). Dietary Sodium in Chronic Kidney Disease: A Comprehensive Approach. US National Library of Medicine National Institute of Health. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921029/

Davita. Sodium and Chronic Kidney Disease. Retrieved July 26, 2017 from https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/sodium-and-chronic-kidney-disease/e/5310

Registered Dieticians, Dept. of Veterans Affairs. (2005, December). Tips to Control your fluid intake.Retrieved July 26, 2017 from https://www.pittsburgh.va.gov/Dialysis/docs/TipstoControlFluidIntake.pdf

Coleman, S. (2007, June 15) How much fluid weight does a dialysis patient gain between treatments? [Web blog post] Retrieved July 26, 2017 from http://blogs.davita.com/kidney-diet-tips/how-much-fluid-weight-does-a-dialysis-patient-gain-between-treatments/