My nephrologist insists I need to restrict my fluid intake to 64 oz. daily since I am stage 3 CKD. Yet, other nephrologists do not agree. What is your opinion and why do you feel that way?
Thank you in aedvance.
Dear guest
I am trusting that my conversion table is correct and that your quote of 64 oz is equivalent to around 1890 ml/day … so, let’s assume that is right … and if so, that is a fairly ‘average’ fluid intake for a normal sized human …
But, that said, I know nothing of you, your size, your BMI, your age, your cardiac status, your body habitus, your underlying renal disease, your blood pressure, your diabetic status, your serum albumin … all these and, i am afraid, more … would influence a doctors’ assessment of a recommended daily fluid intake.
So … you can see, I can’t pass a sensible judgement/comment with the Knowledge I have.
Broadly, I do not subscribe to recommendations of fluid restriction or excess for most patients with CKD3 … rather, most can/should drink as their physiological demands dictate - ie: drink as you feel comfortable … don’t over-push it, but drink to need/desire …
But, that said …
What if you have cardiac disease: that may demand fluid restriction … and often to less than the quoted 64 oz (coupled with salt restriction).
What if you are a salt-waster and need excess fluid … or are bipolar on lithium … that may need a higher fluid/salt intake.
Or nephrotic …
Or diabetic …
What all this boils down to is that fluid intake for a CKD3, while for many it can and/or should be free … must (in given circumstances) be scripted according to the underlying clinical status.
Yours, I do not know. Your doctor knows you best. He/she will presumably have reasons why 64 oz has been chosen as you limit.
Just ask why. If you are un-nerved by or unhappy with the restriction … just ask why.
If you doctor cannot explain the advice he/she gives, well, to your understanding and satisfaction … then seek another opinion. That is always your right.
Hi John,
I asked this person to contact you. Her high blood pressure has been controlled for 20 years with meds, and she does not have diabetes. She lives in AZ, where it is very hot and dry. She can fill in more details for you if she is willing. I’m just concerned about damage from dehydration. And, I want to understand all of this better for the next book! 
Ah … what you didnt say is that you live in Arizona … I have this now from Dori.
You get hot there … much like we do where I come from in Australia … so your fluid intake may need heat-adjustment +++.
It would be unwise of me to suggest a value for the volume you should drink, but I have a relaxed view about fluid consumption.
My creed on fluids goes something like this … and, remember, this may NOT apply to you as I do not know your heart, your kidney disease … anything about you …
But, that clearly understood, I say to my patients - drink as your body, your thirst, your need, your environment all combine to tell you. I do not restrict patients (unless they have a stuffed heart and are at risk on that score). I tell my patients to drink as they wish.
The BEST way to ensure volume stability is to weigh, daily, naked, in the morning, after you have passed your overnight urine. If at that time you are comfy in your own skin, not unduly short of breath, have no detectable ankle swelling and are not unduly thirsty … then you are likely in reasonably stable fluid balance. Take that nudie weight as your base ‘ideal weight’ … remembering that weight is a good reflection of your fluid status … just as it is for dialysis patients.
Keep an eye, day to day on your base weight -same circumstances (moring weight, after bladder emptying, nude etc etc …) and if you are holding weight, you are likley doing pretty much what you ought to be with you fluids.
Dont get too hung up on it. Drink to comfort. Measuring is for the birds … again, I say that on the understanding that I have said that but have no knowledge of your clinical condition. If you have a dicky heart … that changes the ball game. Ditto for some other ‘co-morbidities’. But, if you have relatively uncomplicated stage 3 CKD … drink as your body signals you to and enjoy being you.
Thank you, Dr. Agar and Dori. I agree that measuring is for the birds, but find if I don’t weight and measure food (not what I originally asked about), I gain weight. It seems I just can’t get away from the numbers.
I think, in the main, that that is an apt description for ‘measuring’. I think some do get too hung up on numbers and measuring - failing to ‘listen to’ or ‘feel’ their own physiology in the process. Try to learn to gauge your food and fluid intake - over time - without the measuring and weighing … you’ll get the hang of it … and, if you can, it will give you a freedom that ‘numbers’ never will. Common sense is a good ‘measure’ in medicine (and dialysis too) … but sometimes it is thrown out or forgotten in the scramble to conform to numbers.