Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence

Abstract

We performed a comprehensive literature review to examine evidence on the effects of hydration on the kidney. By reducing vasopressin secretion, increasing water intake may have a beneficial effect on renal function in patients with all forms of chronic kidney disease (CKD) and in those at risk of CKD. This potential benefit may be greater when the kidney is still able to concentrate urine (high fluid intake is contraindicated in dialysis-dependent patients). Increasing water intake is a well-accepted method for preventing renal calculi, and current evidence suggests that recurrent dehydration and heat stress from extreme occupational conditions is the most probable cause of an ongoing CKD epidemic in Mesoamerica. In polycystic kidney disease (PKD), increased water intake has been shown to slow renal cyst growth in animals via direct vasopressin suppression, and pharmacologic blockade of renal vasopressin-V2 receptors has been shown to slow cyst growth in patients. However, larger clinical trials are needed to determine if supplemental water can safely slow the loss of kidney function in PKD patients.

Hyperosmolality, High Blood Pressure, and Decreased Estimated Glomerular Filtration Rate in US Adolescents, National Health and Nutrition Examination Survey 1999–2012

“…Vasopressin may also contribute to CKD [9]. Following chronic administration of a vasopressin analogue to healthy rats, animals with normal kidneys develop renal hypertrophy [46] and albuminuria [10].…”

“…Following chronic administration of a vasopressin analogue to healthy rats, animals with normal kidneys develop renal hypertrophy [46] and albuminuria [10]. Multiple mechanisms for vasopressin-induced renal damage have been proposed, such as glomerular hyperfiltration [9], activation of the renin-angiotensin-aldosterone system [47], and renal interstitial inflammation secondary to increased metabolic demand [48].…”

“…This hypothesis may be supported by experimental observations that severe cyclical dehydration induces renal injury and raises blood pressure [6] via both vasopressin release [7] and the polyol metabolic pathway [8], the body's 2 primary methods of responding to increased plasma osmolality [5]. Vasopressin has shown to be a mediator of CKD [9] and may also be a risk factor for hypertension via stimulation of the renin-angiotensinaldosterone system [10] and sodium reabsorption through stimulation of renal ENaC channels [11]. Activation of the polyol pathway of fructose metabolism can cause oxidative stress, potentially inducing renal injury [8,12].…”

European Healthy Hydration Awareness Campaign for Dietitians

“…Recently, it has been shown that increasing water intake in low-volume drinkers reduces copeptin levels in healthy adults [13,14] and decreases by 48% the recurrence of urinary tract infections [15]. Also, increasing water intake seems to benefit individuals of all stages of CKD or at risk of CKD [16].…”

Evaluation of Medical Costs of Kidney Diseases and Risk Factors in Japan

“…Vanholder [30] pointed out the importance of primary prevention of CKD, demonstrating that it is more important than secondary prevention. Clark [31] et al reported the beneficial effects of increasing water intake on renal function in patients and those at risk of CKD, especially at the early stages of disease. Gulla et al [32] pointed out the necessity of timely referrals of patients with CKD, and of a system to promote them, because referrals were often made too late.…”