Skip to content

Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Fluid

In short

Most people with kidney disease do not need a fluid limit until late stage 5 or dialysis, when they make much less urine and water has nowhere to go. Some people at stages 3–5 do need one, so ask your team (AKF). Then extra fluid causes swelling, high blood pressure, breathlessness and strain on the heart, and on hemodialysis gaining more than 3.5 % of your body weight between sessions is linked to death (Cabrera 2015). Your dialysis unit sets your allowance. Salt makes you thirsty, so cutting salt is one of the best ways to keep to it (DaVita).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Per day
Before dialysis no routine limit, unless your team sets one for swelling (AKF)
Hemodialysis about 1,000 mL (32 oz) plus the amount of urine you pass in 24 hours (AKF; DaVita); NKF says 1–2 L (NKF). The app starts at 1,500 mL, which assumes about 500 mL of urine
Home hemodialysis often more, because sessions are more frequent (DaVita)
Peritoneal dialysis 2–3 L, set for you from urine output and how much fluid the dialysis removes (DaVita); the app starts at 2,000 mL
  • 1,000 mL of fluid is about 1 kg (2.2 lb) of body weight (DaVita).
  • On hemodialysis, weight gain between sessions above 3.5 % of body weight (about 2.5 kg for a 70 kg person, or about 5.4 lb for 154 lb) is linked to heart problems and death (Cabrera 2015).
  • Eating less salt helps you reach your target ("dry") weight and control fluid (KDOQI 2020, statement 6.5.3; Sodium).

What counts as fluid

"A fluid is anything that turns to liquid at room temperature" (AKF):

  • all drinks: water, coffee, tea, milk and milk alternatives, juice, soda, nutrition drinks
  • soup and stew
  • ice and ice chips
  • ice cream, sherbet, sorbet and ice pops
  • gelatin desserts and pudding

The app counts fluid for foods that are drinks or liquid at room temperature, and on hemodialysis it totals fluid since your last session (Dialysis days). For frozen desserts it counts only the water in them: about 50 mL for ½ cup of sherbet and 40 mL for ½ cup of ice cream, less than their volume (120 mL). NKF and AKF count frozen desserts as fluid but do not say how much; counting the whole volume is the cautious way. Ask your unit which way to count, and if they count by volume, log the difference as water (NKF; AKF).

What to do

  • Ask your unit for your allowance in mL or ounces, and write it in the app.
  • Weigh yourself every morning (after the toilet, before breakfast) and write it down.
  • Cut salt: it is what makes you thirsty (Sodium).
  • Measure: fill a jug or marked bottle with your day's allowance and pour drinks from it.
  • Count ice, soup, sherbet and gelatin too.
  • Take pills with a small amount of water, as part of the allowance.
  • Treat lows with glucose tablets or gel: they add no fluid (Treating a low).

Taming thirst

Salt is the main driver of thirst, so cutting salt comes first (NIDDK; DaVita). High glucose makes you thirsty too: UK guidance notes that people on hemodialysis keep their weight gain between sessions under 2 kg more easily when their diabetes is well controlled (JBDS). Other tricks that help (AKF):

  • Drink from a small cup or glass, and sip slowly.
  • Chew sugar-free gum or suck a sugar-free sour candy or a lemon wedge to make saliva. (Sugar-free sweets do not treat a low.)
  • Freeze grapes or berries and eat them cold. Count their carbohydrate; they are not counted as fluid in the app.
  • Ask your team whether any of your medicines cause a dry mouth.
  • If you are very thirsty, check your glucose: a high reading is a reason to follow your plan for highs, not to drink more.

Treating a low on a fluid limit

A low is always treated first, whatever your fluid allowance. Four glucose tablets (4 g each, 16 g in all) or a tube of glucose gel give the 15 g you need and add no fluid at all (ADA Consumer Guide: Dex4); 4 oz of juice adds about 120 mL. Keep tablets at the bedside, in your bag and at the dialysis unit. If juice is all there is, drink it and count it later (Treating a low).

Examples

A hemodialysis day that fits 1,500 mL: 1 cup (237 mL) of coffee at breakfast, ½ cup of sherbet (120 mL counted by volume), ½ cup of gelatin (120 mL) and 1½ cups (355 mL) of water through the day, leaving about 670 mL for drinks with medicines and hot weather. See the hemodialysis menu.

In the app

Drinks and foods that are liquid at room temperature count toward your fluid total automatically. With your hemodialysis days set, the app also shows fluid, potassium and sodium since your last session against your allowance, so the long weekend gap is easy to see (architecture contract; Dialysis days; Targets and warnings).

Ask your care team

  1. What is my fluid allowance, and does it include food that is liquid?
  2. How much weight gain between sessions is too much for me?
  3. Should my allowance change when it is hot, or when I am ill?
  4. How much urine am I still making, and when will you measure it again?

Get help now if…

Call 911 (or your local emergency number)

You are very short of breath, cannot lie flat, have a frothy cough, or chest pain. These can be signs of fluid in the lungs (MedlinePlus).

Call your care team today

You gain more than your team's alarm weight, have new swelling, or miss a dialysis session. If you are very thirsty with glucose that stays high or with ketones, follow your sick-day plan and call your team (Sick days). Full list: Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.