Which instruction is most accurate for fluid management between dialysis treatments?

• A. The goal is to keep interdialytic weight gain under 1.5 kg.
• B. Increase fluids between treatments to relieve thirst.
• C. Drink a liter of water every hour between dialysis sessions.
• D. Limit fluids in between treatments to minimize the amount of fluid that needs to be removed during dialysis.

Answer: (D)

Between dialysis sessions, fluid management is about keeping fluid gains small because every extra liter collected between sessions must be removed during the next dialysis. Limiting fluids in this period reduces the volume the machine has to ultrafilter, lowering the risk of intradialytic hypotension, cramps, and edema. Drinking more fluids or trying to relieve thirst by consuming large volumes will raise the interdialytic weight gain and make the next treatment more challenging and risky. While some clinicians use a weight-gain target for individual patients, the straightforward guidance is to limit fluid intake to minimize the volume to be removed.