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My Doctor Said I Should Drink a Lot! Recommendations for Fluid Intake in Patients with Chronic Kidney Disease

Ulrich O. Wenzel, Lee A. Hebert, Rolf A.K. Stahl and Ingo Krenz
CJASN March 2006, 1 (2) 344-346; DOI: https://doi.org/10.2215/CJN.01140905
Ulrich O. Wenzel
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Lee A. Hebert
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Rolf A.K. Stahl
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Ingo Krenz
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    Table 1.

    Relationship between solute and water intake in those with normal or impaired kidney concentrating ability

    Urine concentrating capacityNormalImpaired
    Urine osmolality (mOsmol/kg)1200600
    Solute excretion (mOsmol)800800
    Water needed = urine volume (ml)6701340
    Water balance (food + oxidation − water loss; ml)200200
    Drinking (ml)4701140
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    Table 2.

    Conditions associated with high water intake: Those in which high water intake is indicated or not indicateda

    ConditionComment
    Conditions for which high fluid intake is indicated to prevent disease
        urolithiasisGenerally, fluid intake should achieve a urine volume of 2.0 to 3.0 L/d
    Conditions for which high fluid intake is recommended because of underlying disease
        salt-wasting nephropathy (medullary cystic disease, other causes of chronic interstitial kidney disease)Very rare disease; high salt intake (e.g., >400 mM/d NaCl) may be required to avoid hypotension; because these patients cannot appropriately concentrate the urine, high fluid intake (e.g., >4 L/d) may be needed
        central and nephrogenic diabetes insipidus (genetic or acquired, e.g., lithium nephrotoxicity)These patients often cannot raise urine to levels isosmotic with plasma; often large water intakes (e.g., >5 L/d) are needed to maintain water balance and a normal plasma osmolality
    Conditions for which high fluid intake is not recommended
        inappropriately high NaCl intake (′salt gluttony′) in the patient with CKDThe high NaCl intake “drives” the fluid intake; 24-h urine collection for creatinine (to assess completeness of the collection) and NaCl (to assess NaCl intake) will detect this condition; the appropriate management is to decrease salt intake
        primary polydipsia because of the mistaken belief that high fluid intake is good for the kidneyThis practice should be discouraged
    • ↵a CKD, chronic kidney disease.

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Clinical Journal of the American Society of Nephrology
Vol. 1, Issue 2
March 2006
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My Doctor Said I Should Drink a Lot! Recommendations for Fluid Intake in Patients with Chronic Kidney Disease
Ulrich O. Wenzel, Lee A. Hebert, Rolf A.K. Stahl, Ingo Krenz
CJASN Mar 2006, 1 (2) 344-346; DOI: 10.2215/CJN.01140905

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My Doctor Said I Should Drink a Lot! Recommendations for Fluid Intake in Patients with Chronic Kidney Disease
Ulrich O. Wenzel, Lee A. Hebert, Rolf A.K. Stahl, Ingo Krenz
CJASN Mar 2006, 1 (2) 344-346; DOI: 10.2215/CJN.01140905
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