Managing fluids for ESRD patients is critical to outcomes, treatment tolerance, and cardiovascular health.
Fluid balance is important for comfort during dialysis and avoiding excess waste in the body. Additionally, excess fluid can lead to complications such as increased blood pressure, swelling, and difficulty breathing. It is important to remember that fluid intake is not limited to only what a person drinks, but includes any foods that can become liquid at a different temperature (i.e. ice, jello, sherbet, soup, popsicles, melon, sauce, and gravy). Typically it is recommended that a patient gain no more than three percent (3%) of their body weight between treatments, or approximately two to three (2-3) kilograms.
A patient's estimated dry weight (EDW) should be routinely evaluated based on their dialysis outcomes, fluid gains between treatment, and tolerance both during and between dialysis treatments. Dietary restrictions, especially fluid and sodium intake, should be routinely reviewed with patients to ensure understanding and to identify any symptoms related to fluid imbalance. EDW should be reassessed by clinical staff as necessary to meet the patient's needs and desired outcomes with as little complications as possible. Medications such as pain medications or non-steroidal anti-inflammatories that can interfere with fluid removal should be evaluated as well to determine possible side effects that may influence fluid removal goals. These goals are evaluated during state survey and certification review under management of volume status, as can be seen on the Measures Assessment Tool (MAT).
Nutrition in ESRD must focus on maintaining an appropriate weight and fluid balance, sufficient protein intake (albumin), prevention of renal osteodystrophy by way of monitoring mineral metabolism, and reducing the risk of cardiovascular complications. Renal dietitians are the team leaders in assisting patients and providers in understanding the renal diet and the complexity of patient needs.