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The Importance of Removing Excess Fluid

Healthy kidneys pull extra fluid out of your body and send it away in your urine. If you have kidney failure at end stage renal disease (ESRD), you can manage your fluid levels by doing dialysis treatments as prescribed and following a kidney-friendly diet. With chronic kidney disease (CKD), it’s important to your health to manage your fluid intake by staying on track with treatment. If fluid is not controlled and builds up too much between dialysis sessions, you may experience fluid overload—also called “hypervolemia.” This condition isn’t just uncomfortable, it’s a serious health risk.


Why is excess fluid a health risk?

Retaining extra fluid does more than make you feel bloated and uncomfortable. It can also make your blood pressure go up, causing your heart to work harder to pump blood. Over time, your heart may get weaker and not work as well, which could eventually lead to heart failure.

The effects on your heart of having high blood pressure caused by excess fluid are similar to repeatedly overinflating and deflating a balloon. Repeated stress on your heart muscle can cause it to get less elastic and weaker.

What are the signs of fluid overload?

The most common fluid overload symptoms are:

  • Headaches and low energy
  • Swelling in your face, waist, hands and feet
  • Trouble breathing
  • Heart damage
  • High blood pressure that may lead to a stroke

How much fluid gets removed during dialysis?

Your weight when you don’t have excess fluid is called your dry weight or target weight. Your care team will use some medical tests to calculate what yours should be. When you’re at your dry weight, your blood pressure should be in your normal range, and you shouldn’t have symptoms of fluid overload.

Your weight before dialysis helps your care team know how much fluid needs to be removed during your dialysis treatment. Each liter of fluid weighs a little more than 2 pounds. You’ll get back on the scale again after your session to see how much fluid was removed. If you have excess fluid or fluid overload, your care team may prescribe extra dialysis to get back to healthier fluid levels. 

4 ways you can control fluids to avoid fluid overload

  1. Manage your fluid intake. Your care team will tell you how much fluid you should have each day. Remember fluid isn’t just what you’re drinking—it can be in food too. Work with your renal dietitian to learn how much fluid is right for you.
  2. Cut back on salt. When you eat salty foods, you’ll get thirsty. Even if you manage your fluids perfectly, salt causes the body to hold onto water. Your renal dietitian can give you tips for using herbs and spices to add bold flavor to your favorite foods.
  3. Track your weight. Get on the scale at the same time every day and record your weight and let your nurse know about any big changes. A significant weight change may be from excess fluid. Your care team will monitor your weight and make adjustments to your dialysis treatment or diet if necessary.

  4. Stick to your dialysis schedule. During each treatment, excess fluid is removed from your body, along with unwanted waste and toxins. If you miss a treatment, your fluid levels will increase until you go for dialysis. And if you end treatment early, even by 5 minutes, less fluid will be removed. So it’s important to complete every dialysis session exactly as prescribed.

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