How much water should I drink ?

[Pianohome]

I am CKD 3 and my dr told me to limit my drinks to 1.5L a day. I said that was too little as I take fibre for constipation. So he said 2L.

I see in your replies they often say “Drink plenty of water “.

I am still very very constipated. Should I ignore my Dr and drink lots more?

I’d like to change my Dr but it’s not easy in UK on NHS.

Thanks

Pianohome

[purple-1974]

Fluid restrictions are only needed if on dialysis, at stage 3 you shouldn’t need to be, but I would listen to your doctor and take his advice, as on here we aren’t doctors. They could be restricting your water for something other than your kidney issues, drinking too much water can put increased pressure on your heart, if you are constipated obviously you need to go back to them and see what underlying cause is causing you to have this problem, it could be simply tweaking your diet, to include fibre rich foods.

[userotc]

Essentially your doctor's indicated 1.5-2l/day albeit with a prompt from you and that seems about right in general terms. But, we are all different, so a naturopathic nutritionist specialising in renal disease may be worthwhile for that and other things.

As you may note on a separate post from me in today's HU, I rate reduced water intake as a possible cause for my mum's drop in kidney function in the past few months after increasing excellently with higher amounts. But there are other possible reasons for her.

[Pianohome]

Thank you for your replies. I am on a plant based diet with loads of fruit and veg and every laxative there is. Also the plain fibre, ispaghula husk. I think the only thing left for me to try is to increase my water intake.

[Waise]

As far as I know fluid restricted in the following cases:1- You have a body fluid retention (total fluid out much less than total fluid intake) due to many reasons such as macro-albuminurea, diastolic heart failure, kidney failure,...etc .

2- You have very low serum albumin due to either liver disfunction, heart failure, kidney problem less than normal urine.

3- You have very enlarged prostate result in urine retention and for any reason you can't go for surgery to remove/reduce prostate size.

4- You have electrolyte imbalance with excess fluid such as Sodium.

Plz check with your doctor before doing something wrong from your mind may further deteriorate your health.

You have the right to take 2nd medical opinion from another more senior consultant.

[RickHow]

This is an age old discussion on here and throughout the internet. My kidney doctor also says not to drink in excess. Yes you will get what are lower Creatinine and therefore better egfr numbers. BUT this is not an accurate reflection of true kidney function. Why? Think of it simply that the kidney is a filter. One of its "jobs" it to filter Creatinine (and a million other things) out of your body. Now if you drink more you will be forcing more fluids through your kidney. Sort of like flushing. With that more creatinine will leave your body. But is your kidney really working any better or worse? Think of a coffee filter. Fill it with coffee grounds (your creatinine). The more water your pour through those grounds/filter, the more will be flushed out of it. It is much like when you get a cholesterol test. The doctor will ask you to not eat or drink for a number of hours. To reflect a true measurement of cholesterol in your system. If you drank a lot of water before the test, you would not get an accurate measurement. NOW there are good reasons to drink water in appropriate amounts. If you drank too little, then not enough would pass through the kidney to remove EXCESS wastes from the body AND the blood vessels to the kidney narrow also restricting flow. My kindey doctor, and my general practitioner tell me not to even measure how much I drink, but to much more simply just watch my urine color. If I am properly hydrated then my urine will be a light yellow, clear, color, like light straw. If I am drinking too much, it will be almost clear in color. Not harmful, but not necessary. If it is darker than straw (I am not drinking enough and this is "bad" for the kidney and body in general. They say this usually requires about 50 to 60 ounces per day, but not all out once but rather spread throughout the day. Coffee and tea DO count, but not to go much above 2 or 3 cups a day due to it being too much caffine.

[Willowdene]

RickHow very good advice as always colour of urine a good indicator,

[Pianohome in reply to Willowdene]

Thanks Rick. My urine has been brown but I don’t know if that is due to senna staining it.

[RickHow in reply to Pianohome]

Senna can cause urine color change (usually to orange or reddish color) bit it is not common. There can be other causes of this color urine too. UTI, Kidney stones, on and on. Have your doctor do a simple urine test to be sure it is not something more serious. I take 2 senna tablets each morning and 2 at bedtime. I'm lucky it has not affected my urine color. I get severe constipation from cancer medications. In my case my doctors recommend that I take the senna only tablets in the morning, and at night take a combination tablet(s) of senna with stool softener. If you want to test for yourself if it is being caused by the senna, simply don't take it for a day or day and 1/2. You urine should return to "normal" coloration. If not. get a simple urine test. You can even purchase urine test strips to test it yourself at home. You just dip the "stick" into the urine for 2 or 3 seconds, remove, wait 30 to 90 seconds, and color coded results will show you if something is not "normal".

[Pianohome in reply to RickHow]

Thanks RickI got some sticks. Individually wrapped so they’ll keep.

Everything normal except Leukocytes which were TRACE which is normal for me. pH was 7.0. I’m on two sodium bicarbonate caps otherwise I’m acid and painful wees.

Thanks for your suggestion.

Pianohome

[RickHow in reply to Pianohome]

Trace leukocytes is something to keep an eye on. Anything above "5" could be a UTI or the starting of a UTI. Your ph of 7 is perfect. If lower then it is an indication your urine is acidic, if above it means you urine is alkaline. So all in all it sounds as if your urine is fine, except the color. As I say, try 2 days without senna and see if it changes more normal color, and drink appropriate amounts of water to stay hydrated.

[Pianohome in reply to RickHow]

I'm on Amoxycillin at the moment for a bad cough, query lung cancer.

[RickHow]

Keep us posted. I have stage 4 cancer. Found in 2017. Lost a kidney. Now I have tumors in pelvis (3), had my femur replaced, had rods put in my back (fusion) due to 2 vertebrae destroyed by cancer, spot on lung, spot on adrenal gland, spot on spleen. I assume you had a CT scan or more appropriately an MRI of lung. I tell you all this to let you know the advances in cancer, and prolonging a near normal life are amazing with more new treatments monthly. So don't let the news devastate you. No, it is not good, but here I am 5 years later, living a decent life, "full" of tumors and one thing I have learned the most is acceptance. Don't sit around wasting whatever number of days or years that are left, wasting time waiting for the inevitable. Live each day as normally as possible, enjoy them, don't feel sorry for yourself as it fixes nothing. Don't waste time looking for searching wild "fixes" from the internet (eat this, eat that, take this supplement, on and on and on. Cancer is in charge if you have it. Why waste a moment trying "dr. google" or "internet" fixes. Be assured if they worked as great as they sound, the world would know, the medical community would know, and they would be normal accepted treatments. Cancer drug manufacturers would be making and selling them by the millions. Immunotherapy drugs are the present and the future.

[Pianohome in reply to RickHow]

I am booked for a CT thorax this Thursday. I also have long Covid which is putting me in bed much of the time. The chest x ray was in preparation for the long Covid clinic which isn’t until November but they saw an abnormality on it.