How much fluid do you take off during Dialysis?

This is simple question that carries a truckload of baggage.

The question is really: How much fluid do you need to take off during dialysis? I try to arrange things so that I don’t need to take off more than about 2.5 – 2.6 litres in 3 hours (or about 0.8 Litres an hour). That’s about the limit my body can take without acting up later (making me feel weak or nauseous while my body redistributes the fluid evenly).

That 2.5 litres consists of about 1.3 – 1.4 litres that my body has built up since my last run, plus an allowance for food and drink I have through the run (around 1 litre), plus about 200mls to flush my blood out of the lines and into me.

The key variable here is the amount of fluid I put on between runs: 1.3 – 1.4 litres. That doesn’t mean that I can only drink that much. The body naturally evaporates up to a litre a day through perspiration and aspiration. And I like to kick things along a little too, by going to the gym or on a run. I easily sweat off half a litre this way.

But there are traps.

The first is salt. Salt is the dialysis devil. It absorbs body water into the blood and makes you hellish thirsty. So you drink more – more than you body needs or can get rid of. I am sure you know the symptoms: swollen ankles and extremities; shortness of breath (because your lungs have fluid in them and can’t breathe properly); increased blood pressure; stress because you know you shouldn’t drink; difficulty sleeping.

The second is alcohol. Not only because it has nowhere to go and so just sits in your blood and tissue, but because it is insidious. A little sip, then another. Your head is light and easy, and you forget how much you’ve had.

The third for me is Chinese food. Not only is it often salty (not to mention the occasional MSG), but I like to sip Chinese tea with it. And again, I get carried away. Before I know it I had the day’s supply of water in a single meal.

Too much fluid matters in a couple of ways, one short-term, the other long term.

In the short term, you have to get it off during dialysis. Taking off a lot of fluid (believe it or not, I know some people that arrive for dialysis carrying six to eight kilos of excess fluid!) can be hard and uncomfortable: fluctuating blood pressure, dizziness, jiggly legs, difficulty staying in one position, nausea, and so on). And it’s just as hard and uncomfortable for at least the rest of the day.

In the long term (which can be distressingly short), having more fluid on board than is natural puts pressure on your heart. Lots of pressure. It is a documented fact that us BigD club members rarely die from kidney-related problems. Mostly, predominantly, it’s heart failure.

So watching our salt, getting regular exercise and staying within our ideal fluid zone give us more than simply a good run. It’s step one to a healthy heart and a long (or at least longer) life.

18 thoughts on “How much fluid do you take off during Dialysis?

  1. The body has to go thru a huge reajustment when fluid is removed, so 0.8-1.0 litres loss per 3 hours depends on heart/vessel condition & symptoms of fluid overload, as to how the person responds. Accumulation of fluid & the 2 days between dx is so tricky for fluid balance! Thirst is one of the worst symptoms for us dx patients. So.. I’ve found sips of good water with a little sea salt, helps cellular fluid distribution. This salt dissolves, unlike table salt, which collects in the body. Other tips for keeping fluid where it should be: a good protein level, fish oils, ( for cell wall integrity) and Vitamin B6, with all the B’s. Also, keep active, to help pump the lymph to remove some fluid. You can loose a goodly amount of fluid by sweating via exercise. I’ve found that foot detox baths are fabulous for helping between dialysis . This does not replace dialysis, but helps my overall health & energy. Still learning & staying positive 🙂


  2. Im a bit concerned about your sea salt advice here, I mentioned this to my nurses / medical staff and they nearly fell over. Sodium is always sodium, whatever form it apears in.


  3. Hello I’m currently doing peritoneal dialysis for about 2 weeks my creatin level was 5.3 when I started. I’m a 38 year old male in fairly good health except my kidneys. It happened because of my blood pressure ever since I got sick they got my blood pressure under control. I’ve not felt sick but they told me I gotta do dialysis so can I have my kidney function return doing peritoneal dialysis? Its what I’m hoping. Is it possible or likely? I ask because the dialysis has made no difference in how I feel, but getting my blood pressure under control has made me feel so much better. My creatinin level went from 9 to 5.3 since they got my blood pressure under control. I haven’t done dialysis long enough to know if it might make my kidney function improve enough to get off dialysis without a transplant yet but the VA is taking good care of me. Can my kidney function return enough to get off dialysis without a transplant? I personally feel that it will. Should I have hope of that or just plan on the transplant? sincerely Dan Alexander


    • Hi Dan. It is more likely that the dialysis has helped get your blood pressure under control, reduced your creatinine level and made you feel better. Not knowing the reason for your kidney failure, I can’t comment on how likely your kidney function will return of its own accord. Regards, Greg


  4. I do 3 sessions a week, each 3.5 hours. I drink after I checked my weight and so my UF target every session is about 0.5litres plus 0.7litres I get while session and blood reinfusion. With this I have sessions without cramps, headache or blood pressure crises. And I minimize the risk of heart damage. Its a question of self discipline. We have it in our own hands how we tolerate our dialysis treatment.


    • The most it’s taken off me is 2000 ml uf but now it averages about 600 ml in an 8 hr session but I pee pretty regular I think they told me I gotta do it for eight hours every day though undoing it at home paratneal dialysis plus I drink about 32 ozs of water every night while I’m doing it I believe my kidneys will recover doing my treatment also my blood pressure has stabilized


      • Also I don’t have any swelling in my extremities even if I miss my treatment for a couple days or problems with blood pressure I haven’t went more than 2 days without doing it for eight hours though. T my doctor told me that in order for my kidneys to have a chance of recovering I have to do it every day so I’ve been trying really hard to stick to that


  5. I got my renal failure from high blood pressure and my creatin level went from 9 to 5.3 before I started doing dialysis I hadn’t had my creatin level checked since starting my dialysis as I’ve only been about 2 weeks though. When I got on medication for high blood pressure is when my creatin level went down before my dialysis started thank u for commenting I’m gonna have a positive outlook on this and believe my kidney function will return although I’m preparing to get on the transplant list soon cuse my dr said I need a transplant


  6. Can someone answer for me? If A patient will receive hemodialysis for 2.5 hours. The amount of fluid removed per hour is 1.4 liters. The total amount removed, in liters, will be much?


    • a fluid removal of 1.4 liters per hour is VERY much. I couldnt stand it, i’d get cramps and my blood pressure would fall. I have about 1.4 liters in 3.5 hours. I think 2.5 hours of dialysis is not enough to remove the waste off the blood (3 times per week? )


  7. Hi. I am 38 and I have been on dialysis since last 4 years. I often have 4 to 5 and very recently almost 6 liters of excess fluid. I get 2 sessions of hemodialysis per week. I am from Pakistan and financial constraint is preventing me from getting 3 dialysis per week. If I would have got 3 dailysis per week, my fluid would be around 2 and 3 liters. I want to know, is it possible to get a machine with WRO system at home and dialyze at home?


  8. I am a young 91 yr old man who has had systolic kidneys for over 30+ years. 4.5 +- creatinine level. last April (2015) my kidneys finally gave out and after a week in E.R. and another week in rehab. now on dialysis 3 times a week for 3 hours. My last check-up showed my creatinine at 5.9., a little improvement.

    I do not think the doctors think I am a candidate for transplant at my age, but I am completely frustrated and depressed having to take the treatments. I played tennis up to one year ago. If it was for the not love family, I really do not know how long I could tolerate. Do you, or anyone, have suggestions?

    Many thanks


    • Young 91 year-olds are just as entitled to be frustrated and depressed as the rest of us. And you are in exalted company. I’m sad to say these feelings never go away entirely, no matter how long you are on dialysis.

      But the big plus of dialysis – if you are getting enough – is that you get your active, healthy life back between sessions. That is a huge gift, considering the alternative. If you walked or ran, played tennis or wrestled bears before dialysis, there’s no reason why you can’t do the same after you go on dialysis (maybe smaller bears…).

      Your body will need a few weeks to get used to the new routine, but if the dialysis is right, then you will be too.

      Of course, I’m talking physically here. Recovering mentally is a different thing altogether. And you are not alone in how you feel Jack. Others have gone so far as to philosophise about it, probing the seven stages of the grief cycle we are all intimate with: Shock, Denial, Anger, Bargaining, Depression, Testing and eventually Acceptance.

      But there is a world of difference between theory and practice. I am certain that while many of us BigD veterans have finally reached acceptance, that doesn’t mean we have finished with our old friends Anger and Depression. They are just under the surface, ready to emerge on weak days.

      About a year ago I walked around our dialysis unit with my phone set on video and asked a range of people, young and old, what it was what like to be on dialysis. Everyone, in one form or another said that in their head they were grateful, and accepted that they needed dialysis, but in their heart they still resented the time and hassle. Amen.

      But as you say, there are other things in our life besides dialysis. Like family and sport, and for me add personal projects, history, travel, Mandarin, writing, tech and biotech. So much happening in the world. It’s a great ride, and who knows what tomorrow will bring?

      And what’s the price of a ticket on this ride? Dialysis? – Pretty steep! But worth it.


  9. My father-in-law receives dialysis 3 times a week. He used to flush about 7 lbs on Monday and 3-4 on Wed. and Fridays. Now, he is releasing 8 or more lbs of fluid each of the 3 days. Will this amount keep increasing?


    • Hi Debbie. The amount of fluid that has to be removed is related directly to how much your father drinks between sessions. 8lbs is a lot of fluid to remove over a single run. Some people think this amount is OK, but it’s not just having to take it off (which can be very tiring), it is also the huge strain that much fluid puts on his heart between each dialysis run. The fact is that most people on dialysis don’t die from kidney failure; most die from heart disease caused by this fluid rollercoaster gradually wearing out the heart. As much as you can, work with your father to help him reduce his fluid intake (reducing salt will help the most). Talk to his dialysis unit manager to arrange for him to see the dietitian. A simple change in fluid intake will do wonders for how well he feels.
      Good luck! Greg


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