Stage 3 Kidney Disease Water Intake: How Many Glasses Daily?

What are Kidneys?

The kidneys are a pair of bean-shaped organs located in your belly around the ribs and are responsible for filtering impurities from the blood to form urine. They are about 4-5 inches long and are about the size of a fist. According to WebMD, kidneys contain small cells called nephrons that do the work for the kidneys. According to the CDC, the prevalence of kidney disease increases with age, and men are 63% more likely to experience renal disease. Working with a primary care physician, dietician, and diabetes educator can help with managing disease, as mentioned in this article.

About Chronic Kidney Disease

According to Mayo Clinic, chronic kidney disease (CKD) involves a gradual loss of kidney function. As water, fluid, and electrolytes build up in the kidney, this causes the kidneys to progressively deteriorate and results in advanced kidney disease. The symptoms of this disease are very subtle. Controlling the causes can slow its progression, but sometimes even that is not enough; the disease sometimes reaches an advanced and life-threatening end-stage requiring dialysis and a kidney transplant. Kidney disease is diagnosed through lab tests like creatinine clearance. The normal ranges for clearance are the following:

  • Males: 97 to 137 mL/min (1.65 to 2.33 mL/s)
  • Females: 88 to 128 mL/min (1.496 to 2.18 mL/s).11 

Cystatin C is a protein in the blood that is also indicative of kidney disease in a test called GFR.12 

Causes of chronic kidney disease

The causes of CKD can start from 3 months to a few years to cause advanced kidney disease. The causes of advanced kidney disease are:

Risk factors include diabetes mellitus, heart disease, a family history of kidney disease, abnormal kidney, smoking, kidney stones, and polycystic kidney disease.

Complications include fluid intake by the body, high blood pressure, heart disease, disease progression to advanced stage kidney disease, and irreversible damage resulting in CKD patients requiring dialysis and a kidney transplant. 

Chronic Kidney Disease stages

There are five stages of kidney disease. Kidney disease worsens with time. In CKD, patients experience disease progression marked by CKD stages that makes the disease worse and results in end-stage renal disease. Stages 1-3 are the early stages of renal disease when kidney damage is mild to moderate, while stages 4-5 indicate advanced kidney disease characterized by kidney failure, kidney damage, renal disease, and renal failure.1 CKD is diagnosed by doing lab tests for serum creatinine levels to calculate the estimated glomerular filtration rate (eGFR) and by calculating the ratio of the urinary albumin/creatinine ratio as an indication of levels of proteinuria. The eGFR levels characterise the different stages of kidney disease; 

  • Stage 1 involves eGFR levels of 90 or more
  • Stage 2 involves mild kidney damage with eGFR levels between 60-89 
  • Stage 3 involves deteriorated kidney function and eGFR levels are between 30 and 59
  • Stage 4 involves kidney failure and heavily damaged kidneys with eGFR levels around 15 and 30
  • Stage 5 involves renal failure or kidney failure with eGFR levels below 15, and renal function can only be improved through dialysis or transplantation.

Stage 3 Chronic Kidney Disease

Stage 3 CKD is characterised by kidney damage and below-normal renal function. Kidney function is lost but not to the extent of causing renal failure. It is subdivided into two stages 

  1. Stage 3A - glomerular filtration rate of 45-59ml/min
  2. Stage 3B - glomerular filtration rate of 30-44ml/min 

Stage 3 CKD is diagnosed with lab tests and blood pressure readings. It is important to prevent further progression to advanced end-stage kidney disease. The life expectancy in stage 3 kidney disease is 24 years for men over 40 and 28 years for women. Though CKD at stage 3 is not curable, it is possible to prevent the disease from progressing to kidney failure by managing symptoms.

Symptoms of stage 3 kidney disease

The most distinguishable symptoms of Stage 3 kidney disease are bone disease, anaemia, high blood pressure, urine flow above or below normal, fluid (oedema), fatigue, and lower back pain.

Determining steps to take at stage 3 kidney disease

CKD patients must follow a kidney-disease-friendly diet that includes decreasing protein, potassium, and sodium intake. Disease management also includes monitoring blood pressure with regular intake of angiotensin-converting enzyme (ACE) inhibitor medication and glucose management in diabetes. Smoking cessation and exercise are also good habits to add to a healthy lifestyle.

Questions to ask your doctor about stage 3 kidney disease

  • What medications can reduce the risk of CKD progression to advanced end-stage kidney disease?  
  • Should I take diuretics
  • Would vitamin D supplements reduce bone disease and kidney damage in CKD patients? 
  • Should cholesterol-lowering drugs be taken to counteract high blood pressure? 
  • What type of diet should I follow?

Stage 3 kidney disease water intake

Fluid intake in the form of water can help to flush out toxins and harmful antioxidants from the body so that the kidneys can function normally. High fluid intake is also harmful as electrolytes get diluted, and the blood becomes thin. It also increases the flow of urine and necessitates frequent trips to the bathroom. Drinking a lot of water can prevent the formation of kidney stones and reduces the risks of UTIs. Drinking water is also beneficial to reduce other kidney diseases like polycystic kidney disease and acute kidney injury.4  

In a study of CKD individuals with stage 3 kidney disease, patients were asked to increase their water intake from 1.0-1.5l/day for 6 months to 1 year, and their levels of copeptin, creatinine, albumin to creatinine ratio, and electrolytes were observed. They analysed the urine osmolality and other factors at the end of a year of intervention to produce optimisation of water intake values for CKD patients.5 They also intended to analyse the levels of copeptin, which increase in kidney disease, in order to help improve inhibitor drugs that may help CKD patients. It was shown that plasma copeptin decreases along with urine flow increasing in this study, indicating that drinking 1L of water is significantly effective.6

The Takeaway

CKD patients are capable of living with kidney damage and below-par renal function and can manage complications like heart disease and high blood pressure. Diabetes may also occur unexpectedly. The symptoms must be closely monitored for a better disease prognosis. Although CKD is not curable or reversible, it can be managed well so that it does not turn into end-stage renal disease. Living with kidney disease requires a diet plan, exercise, smoking cessation, and staying optimistic.

FAQs

What is the best liquid to drink for your kidneys?

The five best drinks for CKD patients include water, black coffee, tea, lime or lemonade, and low-sugar smoothies. Water is by far the best drink for the kidneys as it contains no caffeine or sugar and can help the body flush out toxins and electrolytes without additives that cause disease. 

What is the best water for kidneys?

Sparkling water is good, but plain water that is at 170–180 degree celsius is ideal for the kidney as it is cheap and does not contain any calories or additives. Carbonated drinks or soda benefit from the bubbly feel of sparkling water. One can also add flavours like lime juice or cranberry juice to water to make it more palatable.7

Is drinking lots of water good for kidney disease?

Excessive fluid intake is not good for stage 3 CKD patients as it increases work for the kidneys and can lead to kidney failure. Hyponatremia is a condition that occurs when drinking too much water and causes a myriad of health problems like stroke, seizures, and cardiovascular diseases, according to this study

How much water should a person with stage 3 kidney disease drink?

Men should drink about 16 glasses of water a day which is approximately 3 litres, and women should drink about 10 glasses per day: around 2 litres of water a day. Typically, fluid intake must not be forced on Stage 3 CKD patients, and one should drink what they are comfortable with.8

What can you drink when you have kidney disease?

Plain and sparkling water at room temperature, low-sugar smoothies, black coffee, and green tea are some healthy drinks for kidney disease patients, as well as ginger ale, apple soda, and cream soda. 9 Dark-coloured soda and orange juice are some drinks that one must not consume with CKD. 

Will drinking water reduce protein in urine?

No, it will not. If kidney disease is left untreated, it can result in kidney failure requiring expensive treatments like peritoneal dialysis and kidney transplantation. Albumin levels in urine are indicative of kidney issues and must be addressed to prevent kidney damage, as is seen in end-stage renal disease. This phenomenon is called proteinuria

How much liquid does it take to flush your kidneys?

The amount of water intake must be around 2L per day. It can be water or a kidney-friendly beverage. This will come to about 6-8 glasses per day. 10 

Summary 

Chronic kidney disease (CKD) refers to a condition that involves the gradual deterioration of kidney function all the way to kidney failure and occurs in 5 stages. This article has focused heavily on stage 3 CKD, which is characterised by reduced kidney function and kidney damage but not to the extent of needing dialysis or transplantation. Stage 3 CKD patients should not drink excessive fluids as it increases the burden on the kidneys and may cause conditions such as hyponatremia. However, these patients should still attempt to get their daily recommended amount of fluid intake when possible. Drinking water or other suitable beverages is not a cure for proteinuria, and further guidance on how to manage kidney disease must be sought from a physician.

References:

  1. Stages of kidney disease [Internet]. 2021. Available from: https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease 
  2. Stage 3 kidney disease: symptoms, treatment, coping, and outlook [Internet]. Healthline. 2022. Available from: https://www.healthline.com/health/stage-3-kidney-disease 
  3. What is stage 3 kidney disease life expectancy? [Internet]. WebMD. Available from: https://www.webmd.com/a-to-z-guides/what-is-stage-3-kidney-disease-life-expectancy 
  4. How much water should drink with stage 1, 2, 3, 4,5kidney disease patient [Internet]. Available from: https://www.karmaayurveda.in/how-much-water-should-a-kidney-patient-intake/ 
  5. Clark WF, Huang SH, Garg AX, Gallo K, House AA, Moist L, et al. The chronic kidney disease water intake trial: protocol of a randomized controlled trial. Can J Kidney Health Dis. 2017;4:2054358117725106. 
  6. Sontrop JM, Huang SH, Garg AX, Moist L, House AA, Gallo K, et al. Effect of increased water intake on plasma copeptin in patients with chronic kidney disease: results from a pilot randomised controlled trial. BMJ Open. 2015 Nov 24;5(11):e008634.
  7. Top 5 healthy drinks for people with kidney disease | American Kidney Fund [Internet]. 2021. Available from: https://www.kidneyfund.org/article/top-5-healthy-drinks-people-kidney-disease 
  8. How much water is safe to drink for Stage 3 kidney disease? [Internet]. National Kidney Foundation. 2013. Available from: https://www.kidney.org/blog/ask-doctor/how-much-water-safe-drink-stage-3-kidney-disease-i-have-been-stage-3-four-years-and 
  9. RenalTracker Blog. Renal diet liquids: drinks for CKD patients [Internet]. 2019. Available from: https://blog.renaltracker.com/healthy-kidney-diet/renal-diet-liquids/ 
  10. 6 tips to be “water wise” for healthy kidneys [Internet]. National Kidney Foundation. 2015. Available from: https://www.kidney.org/content/6-tips-be-water-wise-healthy-kidneys 
  11. Creatinine clearance [Internet]. UCSF Health. Available from: https://www.ucsfhealth.org/medical-tests/creatinine-clearance-test 
  12. Cystatin C [Internet]. National Kidney Foundation. 2015. Available from: https://www.kidney.org/atoz/content/cystatinC 

Aarthi Narayan

Master of Science (M.S.), Biological science, University of Illinois Chicago
Scientist with 10+ years of strong industry, academic experience in Molecular biology, Tissue culture, Protein purification techniques. Mid-level experience in Diagnostics and start-ups. Excellent at completing large scale projects and experiments with minimal supervision in a timely and efficient manner.

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