From the Guidelines
Not all dialysis patients are on fluid restriction, as the need for restriction varies based on individual factors such as residual kidney function, dialysis modality, and cardiovascular status. While fluid restriction is common for many dialysis patients, especially those on hemodialysis, patients with residual kidney function may have less strict fluid limitations compared to those with no urine output. Typically, hemodialysis patients are advised to limit fluid intake to 1000-1500 mL per day plus the volume of their urine output, as suggested by guidelines for hemodialysis adequacy 1. Peritoneal dialysis patients often have more liberal fluid allowances because they undergo daily treatments.
The restriction is necessary because dialysis patients cannot eliminate excess fluid normally, which can lead to fluid overload between treatments, causing hypertension, heart failure, pulmonary edema, and increased cardiovascular risk. Factors to consider when optimizing total body volume include dietary sodium and fluid restriction, especially in patients unable to maintain euvolemia/normotension with dialysis alone 1. Additionally, therapies such as restricting dietary sodium and water intake, use of diuretics in patients with residual kidney function (RKF), and optimization of peritoneal ultrafiltration volume and sodium removal can help optimize extracellular water and blood volume 1.
Key considerations for fluid restriction in dialysis patients include:
- Residual kidney function: Patients with RKF may have less strict fluid limitations.
- Dialysis modality: Hemodialysis patients may require stricter fluid restrictions compared to peritoneal dialysis patients.
- Cardiovascular status: Patients with heart failure or hypertension may require more stringent fluid restrictions.
- Individual factors: The nephrologist determines specific fluid restrictions based on the patient's dry weight, residual kidney function, cardiovascular status, and dialysis modality.
From the Research
Fluid Restriction in Dialysis Patients
- Not all dialysis patients are on fluid restriction, but it is a common requirement for many patients, especially those on hemodialysis 2.
- Fluid restriction is a major lifestyle change for patients with end-stage renal disease who are on hemodialysis, and educating patients about fluid management supports self-management of their prescribed fluid restrictions 2.
- The decision to impose fluid restrictions on a dialysis patient depends on various factors, including the type of dialysis, the patient's residual renal function, and their overall health status.
Types of Dialysis and Fluid Restriction
- Hemodialysis (HD) and peritoneal dialysis (PD) are two possible modalities for people with kidney failure commencing dialysis, and the benefits and harms of the two modalities remain uncertain 3.
- PD may be better tolerated than HD in some patients, with more stable blood pressure and no need for vascular access 4.
- However, the choice between HD and PD depends on individual patient factors, and fluid restriction may be necessary for patients on either type of dialysis.
Importance of Fluid Management
- Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients 4.
- Fluid management is critical for patients on dialysis, as excessive fluid intake can lead to complications such as hypertension, heart failure, and vascular disease 5.
- Educational interventions can help patients improve their knowledge of dietary and fluid management, thereby aiding in adherence to fluid restrictions 2.