The kidneys are excretory organs that remove metabolic wastes and excess fluids. They also maintain the acid-base and electrolyte balance in the body. When kidney function deteriorates due to disease or damage, fluids and wastes build up in the body, leading to complications including anemia, edema or fluid retention, high blood pressure and congestive heart failure. Therefore patients on dialysis must limit their daily fluid intake to avoid further health problems. The recommended fluid amount depends on the health of the individual. Education on managing kidney disease is important for both patients and their families.
Step 1
Suggest that the dialysis patient consult a dietitian regarding the limits of fluid intake and how to stay within the prescribed fluid allowance. Warn the patient of the consequences if fluid intake is not managed; these include serious complications such as swelling or edema in the legs, arms, torso and face and fluid buildup around the lungs and heart.
Step 2
Instruct the patient on practical fluid measurements, such as 1 liter is equal to 1,000 milliliters or 4 cups. Also ensure that the patient is aware of what food sources contain fluids. These include obvious fluids such as water, juice, soda, tea, coffee, shakes and soups as well as not so obvious sources including jello, porridge, ice, gravy, sauces, pudding, yogurt, watermelon and frozen desserts. Advise the patient that all of these fluids count toward the daily allowance for maintaining kidney health.
Step 3
Calculate the daily fluid allowance for the dialysis patient by determining the amount of urine passed in a 24-hour period. Advise the patient that most individuals on dialysis are restricted to approximately 700 to 1,000 ml of fluid plus the amount of urine output per day. For example, if the patient has a urine output of 500 ml per day, the total allowed daily fluid allowance would be 500 plus 700, for a total of 1,200 ml a day. Advise the patient to report any symptoms of thirst, loss of weight or low blood pressure to a doctor; these may indicate that not enough fluids are being ingested.
Tips and Warnings
- Ensure that the patient's family os also present at all education sessions and appointments, as they will most likely cook for and provide food and fluids to the patient. Educational reading material for the family and patient to take home is important.
- It is important to monitor the patient's progress and question them on their daily fluid measurements and recordings. Ask the patient if they are strictly following the daily fluid allowance or simply estimating what they can drink and eat. A meal plan is important to stay within the guidelines.
