While staying hydrated to beat the heat during the harsh summer months may be the obvious advice for most people, frequently consuming too much water can induce a host of problems — from sudden weight gain to breathing difficulties — in people with kidney diseases which require them to undergo dialysis. Hence regulating fluid intake in summer is crucial for kidney health.
Maintaining kidney health in summer
The main function of the kidneys is to maintain fluid balance in the body, according to Dr Sujeeth Reddy, a nephrologist at the Asian Institute of Nephrology and Urology, Hyderabad. “But in persons with renal diseases like chronic kidney disease (CKD) — a condition in which the kidneys are unable to filter blood and excrete fluids properly — the overconsumption leads to fluid overload,” he adds.
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Dr Sushma Rani Raju, nephrologist, Sakra World Hospital, Bengaluru, says fluid restriction is crucial in those undergoing dialysis as their kidney function is compromised. “Only during dialysis, the extra volume of water consumed gets filtered out,” she adds. “Between two dialysis sessions, the weight gain shouldn’t be more than 5% of their body weight.”
Dr Raju recommends some tips that persons on dialysis should follow during the summer months:
- Take small sips of water whenever you feel thirsty, instead of consuming a large quantity in bulk.
- Suck on ice whenever you feel hot or thirsty.
- Rinse your mouth with ice-cold water whenever you get the urge to drink water and spit it out. Repeat twice. The third time, allow yourself a sip of the water.
- Black grapes can be kept in the freezer until they get solidified. Take a small bite of this frozen fruit whenever you feel thirsty.
- Do not overdo this because certain fruits are rich in potassium — check with a doctor about what is permitted.
More tips to tackle thirst
♦ Stay indoors: Dr Aravind C, senior consultant nephrologist and transplant physician, Trustwell Hospitals, Bengaluru, says that for people on dialysis and for everyone else, the most important tip to follow to maintain kidney health during the summer is to stay indoors during the hottest times of the day.
“Irrespective of the kidney functioning capacity, what we recommend for everyone overall is staying indoors and avoiding prolonged exposure to the sun, especially in the peak afternoon times: between 3pm and 4pm,” says Dr Reddy. “Make sure you stay in a relatively cold temperature, where your core body temperature does not worsen.”
♦ Monitor salt intake: A sodium-rich diet can hamper your kidney function — more salt can make you feel thirsty, leading to more water consumption which will make it harder to remove excess liquid through dialysis.
“People on dialysis already have restrictions on salt intake,” says Dr Reddy. “Hence restricting salt intake further during the summer becomes very important. Dehydration coupled with a high salt intake can trigger formation of kidney stones.”
♦ Eat healthy: According to Dr Aravind, certain infections that can worsen kidney diseases due to dehydration — like diarrhoeal disease (loose motions) — are more common in the summer.
“This can cause worsening of kidney disease due to dehydration,” says Dr Aravind, adding that people with normal kidney function have a functional renal reserve (kidney function reserve) which can withstand such infections.
To prevent infections, Dr Aravind recommends avoiding eating street food — which may be unhygienic — in the summer.
♦ Monitor fluid intake: “Normally, the water limit for a person on dialysis is one litre per day, but this is not a hard-and-fast rule,” says Dr Raju. “It depends on the person’s urine output. Upon initiation of the dialysis itself, we make them develop a habit of measuring their urine output and liquid intake.”
Dr Aravind says that persons on dialysis must increase their fluid intake by 500ml per day in the summer months of March, April and May (in India).
“I advise buying a digital weighing scale to check body weight daily,” he says. “An increase in body weight by 1kg or 2kg within a day or two means fluid accumulation and the need to step down on water intake.” He adds that those taking medicines like diuretics (that increase the amount of urine) may need to consult a doctor about dosing adjustments.
Signs of excess fluid intake
Dr Raju says excess fluid intake among those on dialysis can potentially cause the following:
- Swelling in the legs (caused by fluid accumulation in the legs)
- Breathing difficulties or shortness of breath (caused by fluid accumulation in the lungs)
- A choking sensation or dry cough at night which makes one sit up
Dr Arvind says that consumption of excess water while on dialysis results in sudden weight gain over a day or two — an early sign of fluid overload.
According to Dr Raju, some common effects of overconsumption of water in those on dialysis include:
During dialysis
- A drop in blood pressure
- Cramping
Post-dialysis
- Fatigue
- Lethargy
“If excess water is consumed before dialysis, it gets accumulated elsewhere in the body,” says Dr Raju.
Takeaways
During the summer months, regulating fluid intake becomes even more important for persons undergoing dialysis. Doctors suggest some simple tips to beat the summer heat, including staying indoors during the hottest times of the day and monitoring the salt intake.
