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How much water should a person on dialysis drink a day?

For people with kidney failure undergoing dialysis, fluid intake is an important consideration. Dialysis removes excess fluid and waste from the blood, so dialysis patients need to be mindful of how much fluid they consume between treatments.

Quick Answer

The general recommendation is for dialysis patients to limit fluid intake to around 32-40 ounces (1-1.2 liters) per day. However, the optimal amount can vary based on factors like the type of dialysis, urine output, and other medical conditions. Patients should discuss their fluid allowance with their healthcare team.

Why fluid intake matters for dialysis patients

Healthy kidneys filter excess fluid and waste products from the blood. When the kidneys are no longer working effectively, dialysis takes over this function. During dialysis treatments, a machine filters the blood and removes extra fluid. This helps prevent fluid from building up between treatments.

If a dialysis patient consumes more fluid than recommended, fluid can accumulate. Too much fluid between treatments is called fluid overload. This leads to increased blood pressure, swelling, shortness of breath, and heart problems. It also makes dialysis treatments less effective.

Consuming the right amount of fluids helps prevent fluid overload and allows dialysis to work optimally. Monitoring fluid intake and restricting consumption is crucial for dialysis patients.

Recommended daily fluid intake

Most dialysis patients are advised to limit their fluid intake to around 32-40 ounces per day. This equals approximately:

  • 1 liter = 33.8 ounces
  • 1.2 liters = 40.6 ounces

These recommendations can vary based on the individual. Factors that influence appropriate fluid intake include:

  • Type of dialysis: Allowances are stricter for hemodialysis (3 sessions per week) versus peritoneal dialysis (daily at-home treatments).
  • Urine output: Patients with some remaining kidney function and urine production can drink more.
  • Other medical conditions: Limits may be lower for patients with heart failure or high blood pressure.
  • Climate and physical activity: Limits may be adjusted based on sweat losses.

Typical daily fluid allowance by dialysis type

Dialysis Type Typical Fluid Allowance
In-center hemodialysis (3 sessions per week) 32-40 ounces daily
Short daily hemodialysis (5-7 sessions per week) 40-48 ounces daily
Peritoneal dialysis (daily exchanges) 48-64 ounces daily

Monitoring fluid intake

To stay within their recommended fluid limit, dialysis patients need to monitor and measure fluid intake. Tips include:

  • Weighing yourself daily to check for fluid retention.
  • Measuring liquids with a marked cup or bottle.
  • Logging all fluids consumed in a journal.
  • Limiting fluid intake later in the day as limits approach.
  • Setting reminders to avoid excess consumption.

All beverages and foods with high fluid content contribute to total fluid intake. Things to measure and track include:

  • Water
  • Coffee, tea, soda
  • Milk, juice
  • Soup, broths
  • Gelatin, ice cream, popsicles
  • Gravies and sauces
  • Fruits and vegetables

Careful monitoring ensures fluid limits are not exceeded between dialysis treatments.

Distributing fluid intake

It’s best to spread fluid consumption evenly throughout the day. Guzzling a large volume all at once puts strain on the cardiovascular system. Tips for distribution include:

  • Drinking 8 ounces with each meal.
  • Allowing 1-2 hours between drinking episodes.
  • Avoiding large fluid intake within 2-3 hours before bedtime.
  • Consuming more earlier and less later in the day.
  • Setting a kitchen timer as a reminder to drink at regular intervals.

Allowed and prohibited fluids

For dialysis patients, some beverages are better choices than others. Here are some dos and don’ts:


  • Water
  • Clear juices like apple, cranberry, grape – limit 4 ounces daily
  • Fresh lemon/lime juice
  • Herbal tea, limit caffeine
  • Nonfat or 1% milk – limit 4-8 ounces daily
  • Homemade broth strained of fat and salt


  • Soda/pop
  • Coconut water
  • Caffeinated drinks
  • Alcohol
  • Prune juice, other fruit juices
  • Regular coffee and tea
  • Milkshakes, commercial smoothies
  • Foods containing hidden fluids like gelatin

Check with your care team about allowances for other drinks not mentioned here.

Tips for dealing with thirst

It can be challenging to limit fluid intake when feeling thirsty. Helpful tips include:

  • Sucking on ice chips or popsicles for temporary relief.
  • Chewing sugar-free gum to stimulate saliva production.
  • Rinsing mouth with water without swallowing.
  • Sucking on hard candy or lemon wedges.
  • Distracting yourself with activities.
  • Setting small achievable fluid intake goals.
  • Rewarding success and getting support from loved ones.

Risks of excessive fluid intake

Consuming too much fluid between dialysis sessions has serious risks including:

  • Fluid overload – Excess fluid remains in tissues causing swelling, high blood pressure, congestive heart failure.
  • Blood pressure issues – Increased fluid leads to hypertension, placing strain on heart and vessels.
  • Heart problems – Fluid buildup makes heart work harder, leading to complications.
  • Shortness of breath – Fluid in lungs causes breathing difficulties.
  • Less effective dialysis – Excess fluid makes dialysis less efficient in removing wastes.

Careful fluid restriction is essential to avoid these complications between treatments.

When to call your care provider

Notify your dialysis care team right away if you experience:

  • Sudden weight gain of 2-3 pounds or more between treatments
  • Swelling of hands, face, abdomen, ankles
  • Rapid heartbeat or palpitations
  • Chest pain, difficulty breathing, coughing
  • Dizziness, confusion, weakness
  • Nausea, vomiting, diarrhea
  • Significantly increased thirst

These may indicate fluid overload and a need to reevaluate your fluid limits. Frequent monitoring and communication with your providers is key.

The takeaway

For people undergoing dialysis, limiting fluid intake is critical. Consuming more than the recommended 32-40 ounces per day can lead to dangerous fluid overload.

Carefully monitoring and measuring intake, spreading consumption throughout the day, and choosing appropriate beverages helps dialysis patients stay within their fluid limits. Thirst can be managed through substitutions like ice chips or hard candy.

Excessive intake can cause swelling, high blood pressure, heart issues, and breathing problems. Notify your care team immediately if these complications develop between treatments.

With diligent tracking of fluid consumption, risks can be minimized. Work closely with your healthcare providers to determine the optimal daily fluid allowance based on your treatment plan and health status.