How much is enough?

When a healthcare professional says “stay well hydrated” how much water are they expecting one to drink? I have comprimised kidney function and my most recent creatinine level was elevated at 1.2. I was hospitalized for low sodium levels and while I was in the hospital they were always encouraging me to drink more water. Then when the nephrologist made an appearance, he cautioned me not to drink too much water. How does one know which advise to follow?

To better determine how much water you need each day, divide your body weight in half. The answer is the approximate number of water ounces you should drink daily. You should drink half of your body weight in ounces.

Divide the ounces by 8 for the number of cups.

The “standard” 8 cups per day is based on a 120lb/54kg person.

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I drink a lot of coffee. Does that count? Lots of water in coffee.

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I wish. I argued that for years, but the purpose of plain water is to help detoxify your body.

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AH Shoot! I tried. Where’s that water jug?

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Adequate hydration helps sustain renal function, so if your kidneys are in decline, you should ensure you are getting enough fluids of any kind. However, in patients with extreme degrees of renal compromise, water restriction may be necessary to reduce edema and avoid breathlessness. At a creatinine of 1.2 you are quite far from declining to that point, and you can avoid dialysis, depending on how you feel, until you reach a creatinine of 8.0 or so.

Since sodium in the body will be diluted by any additional fluids you have on board, you will show low sodium levels if you are drinking or retaining too much fluid.

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Chronic Kidney Disease and water consumption. Here is a good site explaining the misconceptions. And here’s the conclusion of the article.
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Conclusion

Patients with CKD should not “push fluids.” Normal thirst-guided intake should determine water intake, unless there is a specific reason to increase fluid intake (Table 2). There is no evidence of a beneficial effect of a high fluid intake. Indeed, there is evidence that it could cause harm by promoting progression of kidney disease.

Here’s the source:
http://cjasn.asnjournals.org/content/1/2/344.full

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I often show a low sodium level even when it is evident I am low in fluid intake. My doctor has me taking a diuretic in addition to 3 other blood pressure medications. It probably doesn’t make sense, but sometimes I actually “crave” salt even though I have a problem with edema.

Thank you for this link. It does an excellent job of explaining a lot of the questions I have had since being diagnosed with kidney disease.

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Does this guideline for water consumption apply to what a person’s ideal weight is OR what they actually weigh at present? I am considered considerably overweight by my physician and if I use this guideline, I think I would be drinking a lot more than I do now.

Drink until your pee is mostly clear?
Yellow is still not drinking enough .
Dark yellow is dehydrated.

Completely non-medical approach. But simple enough to work for me.

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When patients with gradual renal decline experience dehydration, perhaps because of vomiting and diarrhea from the 'flu, their creatinine levels go way up, since the kidneys require normal hydration to preserve their function. The usual advice given to renal transplant patients, for example, is to avoid dehydration at all costs in order to preserve the life of the graft as long as possible.

But, once a certain point of renal failure has been reached, even normal amounts of fluid will produce edema and breathlessness. There are sophisticated devices to determine the true ‘dry weight’ of patients to measure whether they are carrying excess fluid, but since they aren’t normally available, it is mostly just educated guesswork to judge whether there is too much fluid on board the patient.

Some nephrologists advise patients to hydrate, others say just drink to meet the requirements of normal thirst and no more. But again, if your renal function is low enough, you may need to be careful about fluid consumption. Just watch for signs of edema. You can press a finger into your ankles and if the skin returns slowly to its normal shape, that can be an early sign of edema. The feet normally show edema first in a swelling which does not go away.

Ah, the tangled web doctors sometimes weave. Though diuretics often help with edema, The edema may be caused by something else, in which case it would dehydrate you and could cause salt cravings.

If you are on a calcium blocker BP med, they are notorious for causing edema that a diuretic won’t help.

Actual weight at present.

Question, how can we keep track our kidneys’ health? What blood tests or urine tests do we keep a close eye on? Creatinine, microalbumine, and eGFR are the ones I know. You?

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The main measures are GFR, creatinine level, and albuminuria, but any one of them will give an indication of renal health. Patients with declining renal function should also have their phosphorous levels checked, since dietary restriction of phosphorous intake can slow the decline.

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Totally agree, but coffee offers antioxidants that prevent inflammation and magnesium to regulate blood sugar. And you can safely down 400 milligrams of caffeine a day, the equivalent of four small cups of coffee or two tall dark roasts, without harming your health