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.