Fluid Balance in Kidney Disease

About this guide
This leaflet is intended to provide you advice on restricting your fluid intake if you have kidney disease and have been told by your clinical team that you should limit the amount of fluid you drink.

This leaflet is for people who are not on dialysis. If you are on haemodialysis, please ask your renal team for the leaflets on fluid balance when on dialysis.

Why do I need to limit how much I drink?
One of the functions of your kidneys is to control the amount of water in your body. This is known as ‘fluid balance’. In some kidney conditions, getting rid of excess fluid can become a problem. If you have too much fluid in your body you may experience the following symptoms;

• breathlessness due to fluid on your lungs (pulmonary oedema)
• swelling of your ankles and sometimes legs (oedema)
• high blood pressure
• puffy eyes
• headaches

Your daily fluid intake (allowance) on the ward
If you are an inpatient, the clinical team will let you know how much fluid you should have every day. Please note that everyone’s fluid allowance is different.

My daily fluid allowance is ……………………………..mls a day

How is my fluid intake monitored?
The clinical team will monitor the amount of fluid you have each day and record it on your fluid balance chart. We encourage you to record how much fluid you have through the day on your own fluid balance chart. This will help you to keep track on how much you are drinking.

When monitoring your fluid intake, your allowance will include tea, coffee, cold drinks and fluid rich food, such as gravy, soup and ice-cream. As a guide:

• 1 average cup/mug = 150mls/200mls
• 1 average glass = 200mls
• 1 scoop ice-cream = 30mls
• 1 carton yoghurt = 100mls
• 1 bowl of cereal with milk (or pudding with sauce, such as custard) = 100mls
• 1 ladle of soup = 100mls
• 1 ice cube = 10mls

Your clinical team will weigh you each day and will record your weight in your charts. They can use the measurements of your weight to assess how much fluid you are losing.

One litre of fluid weighs 1kg, so your weight will go down by 1kg for every litre of excess fluid your body gets rid of.

Following a fluid allowance at home
Your clinical team may advise that you would benefit from restricting your fluid intake at home. The list of volumes above will help you monitor how much fluid you have consumed. It may help to record how much fluid you have consumed per day so you can compare it against your allowance. 

Tips on managing your fluid allowance
Taking a lot of salt in your food will make you thirsty and make it difficult for you to stick to your fluid allowance.

You can cut your salt intake by;

• Not adding salt to food
• Eating less salty foods
• Avoiding processed food
• Using herbs and spices to add flavour

You should avoid salt replacement products such as ‘LoSalt’ because they contain a high amount of potassium.

Further information in reducing your salt intake is available from the dietitian.

You can reduce the amount of fluid you drink by:

• Using small cups or filling cups only half-full
• Taking small sips rather than big gulps
• Measuring your total fluid allowance into a jug at the start of each day.
• Every time you have a drink, take that amount of volume away from the jug, so that you know what you have left to drink
• Letting family and friends know that you can only drink a certain amount each day, so that they are not tempted to give you extra fluids
• Spreading your allowance evenly throughout the day;
• Sucking small ice cubes (an average ice cubes is 10-20mls, so 10 ice cubes = a small cup)
• Having sweets such as mints, boiled sweets or chewing gum instead of a drink, or if your mouth feels dry. Remember to continue to look after your dental health when eating sweets for a dry mouth.

It is important to try and keep to your recommended fluid allowance as best as you can as it has been calculated to keep you in the best condition of health.

Where can I get further information?
Further information on following fluid allowances is available from the following Kidney Kitchen | Kidney Care UK website.

Worcestershire Acute Hospitals NHS Trust
Nutrition & Dietetic Department
Covering the Alexandra Hospital, Redditch, Worcestershire Royal Hospital and Kidderminster Hospital
Tel: 01905 760 136
Email: [email protected]

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.