Response:

Kidneys perform vital functions, including regulating body fluid and eliminating excess substances. When kidney function declines, the ability to excrete water is limited, and patients may experience symptoms such as swollen legs, facial swelling, shortness of breath, high blood pressure, muscle cramps, and headaches.

Not all kidney patients need to restrict water intake from the outset. Most patients only require strict fluid control when the disease progresses to stage 4-5, or when they show signs of low urine output, edema, or heart failure. If not yet on dialysis, a patient's water intake should depend on the disease stage and daily urine output. Drinking too much water can lead to fluid retention, swelling, high blood pressure, and even pulmonary edema or heart failure if the kidneys cannot excrete it quickly enough.

The general recommendation for healthy individuals without chronic kidney disease is 2-2,5 liters of water daily. It is unclear what stage your disease is in, but if you have early-stage kidney failure, no edema, and still have normal urine output, your water intake can range from 1,5-2 liters daily. This includes filtered water, soup, milk, and water from fruits. You should divide your water intake throughout the day, avoiding large amounts at once.

The amount of water pre-dialysis kidney patients should drink depends on the disease stage and daily urine output. *Image created by AI*

If you show signs of low urine output, swollen legs, facial swelling, shortness of breath, or high blood pressure, your water intake must be strictly limited according to the rule: 24-hour urine output + a maximum of 500 ml (insensible water loss). For example, if you only urinate about 800 ml daily, your total water intake should be around 1,3 liters per day to avoid stressing the kidneys and causing edema. In cases of severe edema, water intake needs to be restricted even further.

It is crucial to pay attention to signs indicating excessive water intake, such as rapidly increasing swelling, sudden weight gain, shortness of breath when lying down, and high blood pressure. If these symptoms appear, patients should reduce their water intake and seek early medical attention to strictly control fluid consumption. Kidney patients should not force themselves to drink as much water as healthy individuals, nor should they rigidly follow the 2-2,5 liters per day recommendation. Patients should adjust their water intake flexibly according to their disease status, weather conditions, activity level, and especially the treating doctor's instructions.

Pre-dialysis kidney patients must pay special attention to monitoring their daily urine output to adjust their water intake appropriately, especially if low urine output or edema occurs. Rapid weight gain over a short period can indicate fluid retention in the body and requires early management.

Patients with chronic kidney disease should not self-medicate, especially with pain relievers, anti-inflammatory drugs, or traditional Vietnamese herbal remedies of unknown origin, as these can accelerate kidney function decline. They should eat a low-salt diet to manage fluid retention and blood pressure, and not arbitrarily restrict or increase protein intake without a doctor's order.

Regularly monitor blood pressure and attend follow-up appointments to assess kidney function and adjust lifestyle appropriately for each disease stage. During hot weather, fever, or diarrhea, dehydration can occur more rapidly; patients should consult a nephrologist before changing their water intake. Maintain gentle exercise, get enough sleep, and avoid alcohol, beer, coffee, and carbonated soft drinks to protect kidney function and slow disease progression.

Dr. Ho Tan Thong

Head of Nephrology - Dialysis Unit

Tam Anh General Clinic, District 7