How can I reduce puffy eyes with stage 3 Chronic Kidney Disease (CKD)?

Managing Puffy Eyes in Stage 3 Chronic Kidney Disease

Reduce sodium intake to less than 2.3 g/day (100 mmol/day) to improve volume control and reduce fluid retention causing periorbital edema. 1

Understanding the Cause

Puffy eyes in stage 3 CKD result from fluid retention and volume overload, which manifests as peripheral edema including periorbital swelling. 2 This occurs because your kidneys cannot efficiently regulate sodium and water balance, leading to extracellular fluid accumulation. 1

Primary Intervention: Sodium Restriction

• Limit sodium intake to less than 2.3 g per day (equivalent to less than 1 teaspoon of salt) to reduce blood pressure and achieve better volume control. 1
• Replace processed and canned foods with fresh foods, as processed foods contain hidden sodium. 1
• Read food labels and choose items with less than 140 mg sodium or 5% daily value per serving. 1
• Avoid adding salt at the table and use fresh herbs and spices for flavoring instead. 1
• Reduce fast food consumption, as these are typically very high in sodium. 1

Blood Pressure Management

• Target blood pressure ≤130/80 mmHg using ACE inhibitors or ARBs if you have albuminuria to reduce proteinuria and improve volume status. 3
• Proper blood pressure control directly reduces fluid retention and associated symptoms like puffy eyes. 1, 2

Fluid Management Considerations

While sodium restriction is the primary intervention, if you have oliguria (reduced urine output), fluid restriction may be necessary. 1 However, this is typically not required in stage 3 CKD unless specifically advised by your nephrologist. 1

Monitoring and Follow-up

• Weigh yourself daily at the same time to detect fluid accumulation early—sudden weight gain indicates fluid retention. 2
• Monitor for other signs of volume overload including leg swelling, shortness of breath, or increased blood pressure. 2
• Have your kidney function (eGFR and albuminuria) checked every 3 months to assess disease trajectory. 1, 3

Medications to Avoid

• Completely avoid NSAIDs (ibuprofen, naproxen) as these worsen fluid retention and can cause acute kidney injury. 3
• Check with your doctor before taking any over-the-counter medications, as antacids and laxatives can contain significant sodium. 1

Important Caveats

Sodium restriction must be introduced gradually if you are accustomed to high-sodium intake, as abrupt severe restriction can reduce appetite and lead to malnutrition. 1 Most patients adapt to lower sodium intake within a few weeks and no longer miss the salt. 1

If puffy eyes persist despite sodium restriction and blood pressure control, this may indicate worsening kidney function or inadequate diuretic therapy, requiring nephrology consultation. 3