2021 has been one of the hottest years on record. Hemodialysis patients tend to come to treatments with fluid overload just to combat the hot weather conditions.
Fluid Control is covered in the initial nutritional assessment of new hemodialysis patients. A hemodialysis patient who can still produce a small amount of urine cannot have no more than 46 fluid ounces per day or 6 cups of fluid per day. A hemodialysis patient who does not produce any urine can have only 32 fluid ounces or 4 cups of fluid. per day.
Controlling fluid intake is very important for a comfortable dialysis treatment. A hemodialysis patient who follows a daily fluid restriction can have less swelling of the legs and ankles . Fluid control reduces muscle cramping during hemodialysis treatment. A hemodialysis patient who follows a daily fluid restriction of 32 fluid ounces to 48 fluid ounces will have more energy, better controlled blood pressure, and a reduced chance of death.
I instruct new hemodialysis patients to buy a 1 liter water bottle with the fluid ounce measurements on the side of the bottle. The 1 liter bottle is a three dimensional reminder of fluid intake. A purified water bottle is 16.9 fluid ounces and a small coffee cup is 6 fluid ounces. I display the typical purified water bottle or a small coffee cup when I teach hemodialysis patients or their families on fluid control. A hemodialysis patient can have two purified water bottles per day . Some patients like to drink coffee all day. The emphasis of fluid education is the selection of the coffee cup size. Hemodialysis patients should choose a coffee cup that is no more than 6 fluid ounces. Thirst or dry mouth can make it hard to limit fluid intake. Please follow these tips to help control fluid:
- Please do not buy or eat watermelon (high water content)
- Always order a small beverage with no ice (ice increases the beverage size when it melts down
- Avoid salty or spicy foods
- Take medications with applesauce or at meals instead of between meals
- Cut out the fast/restaurant foods (higher in sodium)
For any nutrition questions, please follow me at @karlasnutritiontips on Instagram

Karla Coffee Dunning
MA/RDN
Kidney Trails Guest Author