Nephrol Dial Transplant (2001) 16: 1538-1542
© 2001 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Advising dialysis patients to restrict fluid intake without restricting sodium intake is not based on evidence and is a waste of time
Department of Renal Medicine, Southmead Hospital, Bristol, UK
Introduction
Advice on the restriction of fluid intake is a cornerstone of management of patients with kidney failure. Doctors ‘prescribe’ fluid restrictions on ward rounds for patients with acute renal failure. Nurses on the dialysis unit, backed up by dieticians and psychologists, exhort patients to drink less, telling those with large inter-dialytic weight gains that they are putting themselves at risk of heart failure and death. Written information for patients invariably emphasizes the importance of fluid restriction, as do textbooks of renal medicine and dialysis. Here, I argue that much of the effort expended persuading patients to drink less is misdirected.
There is no doubt that fluid intake is the most important determinant of weight gain between one session of haemodialysis and the next, particularly in patients with minimal residual urine output. Small amounts of water can be lost in the form of sweat but these losses generally amount to not
Do patients with high inter-dialytic weight gain have a higher risk of death?
The relationship between water intake and ECF volume depends on sodium intake
Where does the extra fluid accumulate in haemodialysis patients?
What governs fluid intake in dialysis patients?
What is the impact of dialysate sodium?
How else may sodium overload influence blood pressure?
What might the dangers be of ‘allowing’ free fluid intake in dialysis patients?
Where is the catch?
Conclusions
Acknowledgments
Notes
References
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