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Your kidneys need fluids to function correctly. When sufficiently hydrated, you have enough fluids to create urine to carry waste products. You might have noticed that your urine darkens in color when you are thirsty. That is because it has become more concentrated.
Also, you require enough fluids to allow your blood to travel freely to your kidneys (and other organs). Severe dehydration on its own can cause kidney damage. This changes if you are in end-stage kidney disease, especially on dialysis.
For people who are on dialysis, water intake has to be significantly restricted because you cannot excrete enough water.
Drinking too much water can result in hyponatremia,¹ which is when the sodium in your blood becomes too diluted and below the normal level. Since sodium is responsible for fluid balance in the body, low sodium levels will allow extra water to enter the cells, causing them to swell.
Hyponatremia can also occur in people with kidney failure, those taking diuretics, elite athletes who are drinking and sweating, and people engaging in physical activity in extreme heat.
Therefore, if you have kidney disease, you should carefully balance your fluid needs to avoid disrupting the balance of your key minerals.
People are now questioning this piece of wisdom. Everybody is different, and their water needs will vary based on age, size, sex, climate, health condition, and physical activity. The Harvard School of Public Health² recommends 13 cups per day for men and 9 cups per day for women. But these recommendations are just rough guidance — you should listen to your body and talk to your doctor to determine the average amount of water you should consume daily.
If you are in the early stages of kidney disease, most studies³ have reported that moderately increasing water consumption across the day improves urine production, prevents stone recurrence, and slows the decline in renal functions.
However, a large-scale clinical trial⁴ reported that increasing water consumption in chronic kidney disease patients did not significantly slow the decline in kidney function after one year but did not cause any adverse effects.
On the other hand, if you are end-stage kidney disease, any fluid consumption should be limited.
Bear in mind that a lot of foods contain water. You should drink more water if your doctor advises you to, but most people should not force water consumption. If your urine is clear, then you are hydrated.
Plain water is the best way to hydrate. However, most of us don't want to drink just water all the time.
Furthermore, hot water is not palatable, and there is nothing better than a hot drink at certain times of the year. Thankfully, there are healthy options other than water.
You can also tweak water. Sparkling water is perfectly fine as long as you choose a brand that does not have added sodium or potassium. What you need to look out for are certain nutrients. Avoid sweetened beverages. Also, be careful with the amount of potassium you consume.
People with kidney disease, particularly late stages, are in danger of hyperkalemia, which occurs when you have too much potassium in your blood as your kidneys cannot get rid of the excess potassium. You will always need to consume potassium for your body to perform its normal functions, but you should take caution to prevent high potassium levels.
So, here are some things you should consider drinking if you have kidney disease or are at high risk.
Coffee, in moderation, is safe for people with kidney disease. Coffee was found⁵ to decrease the risk of diabetes, and since diabetes and kidney disease are closely linked, drinking coffee might help reduce the risk of kidney function impairment.
Some studies⁶ have found an association between drinking a moderate amount of coffee and improved glomerular filtration rate (eGFR) and kidney functions.
However, because coffee contains potassium, you should not drink more than three cups of it a day. This is also due to the high caffeine content, which can elevate your blood pressure, and as hypertension is both a symptom and a cause of kidney disease, you would need to ensure that your caffeine intake is limited. Perhaps you could always use decaf coffee or alternate between decaf and caffeinated coffee throughout your daily consumption.
Adding milk or creamers increases potassium content and calories, so enjoy your coffee black. You should also avoid flavored syrups, which often contain a lot of sugar.
However, some indication is that caffeine can worsen kidney function in older obese people with metabolic syndrome or diabetes. Talk to your doctor about whether it is safe for you to consume caffeinated beverages.
Green tea is lower in caffeine than coffee and full of antioxidants called polyphenols. It also has a lower concentration of soluble oxalate than black tea, so there is less risk of developing kidney stones. Additionally, some studies⁷ have shown that epigallocatechin-3-gallate, found in green tea, has a protective effect on your kidneys and reduces glucose toxicity in people with diabetes.
Green tea is generally considered the best tea for people with kidney disease, although you should still drink it in moderation due to its caffeine content.
Bananas, a classic smoothie ingredient, are very high in potassium and should be avoided if your doctor has told you to reduce your potassium intake.
However, if you stick to blueberries and mixed berries and use Greek yogurt as a base, you can make yourself a delicious smoothie that will also fill you up and give you energy. It's best to make your own smoothies so you can be in control of the ingredients.
You can also make smoothies with avocados, chopped greens, seeds, or whatever you want. Just make sure to keep your sugar, sodium, potassium, and phosphorus intake within moderate and balanced levels in the early stages of kidney disease, with further limiting in the case of end-stage kidney disease.
Infused water has become popular for summer cooling and hydration in many places. You can add your fruit and herbs of choice to a pitcher of water and let it stand for a few hours. The longer you let it stand, the stronger the fruit or herb flavor will be.
It's important to choose ingredients that are low in potassium. Good choices are blackberries, blueberries, cherries, cranberries, cucumber, raspberries, strawberries, and citrus fruits (but not oranges, which have more potassium). You can mix it up. Many people find infused water really tasty on a hot day!
Urinary tract infections (UTIs) can cause damage to your kidneys. Studies⁸ show that if you are susceptible to UTIs, consuming dried cranberries or cranberry juice can help decrease the frequency of infections and protect your kidneys from damage.
Cranberries are also low in potassium, and many people find them delicious. Other low-potassium juices include apple, grape, beet, pineapple, and grapefruit. However, you should check with your doctor before drinking grapefruit juice as it can interfere with many medications, including statins and high blood pressure medication.
Ginger is good for digestion and helps keep you from getting an upset stomach. Studies⁹ show ginger might even slow the progression of kidney disease. However, while commercially made ginger ale has less sugar than other sodas, it still has a lot of sugar.
Additionally, commercial brands tend not to use much real ginger. Ginger beer, which is harder to find in the US, does have more ginger, but it still contains quite a bit of sugar.
One answer is to make your own, which is surprisingly easy. Most ginger ale recipes contain club soda, which has quite a bit of potassium, so if you're limiting potassium, consider using seltzer water instead. You can make it with fresh ginger and control the sugar content. Try adding a bit of lemon or lime juice.
So, what drinks should you avoid? There are some beverages that people with kidney problems should be particularly careful to avoid. Here are a few:
Coconut water. Coconut water is often touted as a natural alternative to sports drinks and is safe for most people. However, even in healthy people, it has been shown¹⁰ to increase urinary potassium and thus should be consumed in moderation. If you have been instructed to reduce potassium, you should not drink coconut water or coconut milk.
Soda drinks, including diet. Drinking two or more carbonated drinks a day has been associated¹¹ with an increased risk of chronic kidney disease. Cola and other sodas contain a lot of phosphorus. You should limit or avoid soda in general because of the sugar content. Diet soda is no better for you, as it was found to be associated¹² with a higher incidence of end-stage kidney disease, and artificial sweeteners can adversely affect your insulin levels.
Prune juice. Prunes are also very high in potassium.
Surprisingly, it is not necessary to avoid alcohol completely if you have kidney disease — unless you are on medication that is contraindicated. Light to moderate drinking can actually be beneficial to people with chronic kidney disease. Talk to your doctor about whether you should continue to drink alcohol.
If you have not already been drinking alcohol, you should not start when you have kidney disease, as drinking alcohol is associated with increased death risks from various causes. You should also not drink heavily or binge drink, and if drinking, try to opt for red wine, which contains polyphenols and bio activators that can protect your kidneys.
Binge drinking, however, can cause acute kidney damage and renal failure in some cases.
It's vital for people with kidney disease to consume the right amount of fluids. In early-stage kidney disease, this often means increasing your fluid consumption, while if you are in end-stage kidney failure or on dialysis, you will be instructed to limit fluid consumption a lot.
While plain water is the best drink for your kidneys, other fluids are perfectly acceptable, including coffee, green tea, low-potassium juices, and infused water. Avoid sweetened, carbonated beverages and coconut water.
Hyponatremia | National Kidney Foundation
Water | Harvard T.H. Chan
6 Tips to be “water wise” for healthy kidneys | National Kidney Foundation
Potassium and your CKD diet | National Kidney Foundation