Simran Arora

Hydrated Or Overhydrated? How Balance Is Key To Healthy Kidneys

hydration

Chronic <span>kidney disease</span> (<span>CKD</span>) is no longer a distant public health concern—it is something we are seeing in clinics every day. With over 600 million people affected globally and a rapidly increasing burden in India, the usual culprits—diabetes and hypertension—are well established. However, in routine practice, one factor that is consistently overlooked is chronic underhydration.

<em>Dr Anurag Gupta, Senior Consultant Nephrologist and Dialysis Director at Sir Ganga Ram Hospital, in an interview with Health and Me, spoke about the consequences of <span rel="noindex">dehydration</span> on the kidneys.</em>

In Indian settings, especially during summers, it is not uncommon to see patients—drivers, outdoor workers, even hospital staff—going long hours with minimal fluid intake. Many of them present with recurrent stones, urinary infections, or unexplained decline in kidney function. While we may not always label dehydration as the primary cause, it is often a silent contributor.

<h2>What happens when you are dehydrated?</h2>

From a physiological standpoint, the explanation is straightforward. Reduced fluid intake leads to lower renal perfusion and higher vasopressin levels, resulting in concentrated urine and increased tubular workload. When this becomes a daily pattern rather than an isolated event, it is reasonable to believe that cumulative injury occurs. Emerging data from heat-stressed regions, including parts of India, are now supporting this clinical observation.

Another issue is the widespread misunderstanding around <span>hydration</span>. Some patients barely drink water through the day, while others—after a diagnosis—swing to the opposite extreme, assuming excessive water intake will “clean” the kidneys. Both approaches are problematic. Overhydration, particularly in the elderly, can lead to hyponatremia, something we do encounter in practice. What works better is simple, practical advice—maintaining a light-coloured urine is often more useful than prescribing a fixed number of litres.

At the same time, hydration cannot be viewed in isolation. Our dietary and lifestyle patterns are equally concerning. High salt intake remains the norm rather than the exception, directly contributing to hypertension and kidney damage. Sedentary lifestyle and poor glycemic control further compound the problem. Another area we tend to underestimate is the indiscriminate use of over-the-counter painkillers and alternative medications. Many patients do not even consider these harmful, yet we frequently encounter kidney injury linked to them.

<h2>Is your diet giving you kidney disease?</h2>

Protein intake is often a source of confusion, particularly with the rising popularity of high-protein diets. In otherwise healthy individuals, moderate intake is not an issue. However, in CKD patients, unchecked protein consumption can accelerate disease progression. On the other hand, excessive restriction—sometimes self-imposed—can lead to malnutrition. This is where individualised guidance becomes essential, rather than blanket advice.

In day-to-day nephrology practice, doctors often focus heavily on pharmacological management. While necessary, it should not overshadow basic preventive measures. Adequate hydration, reduced salt intake, sensible protein consumption, and avoidance of nephrotoxins are simple interventions, but they are not emphasised enough.

If we are serious about addressing the growing CKD burden in India, these “basic” measures need to be brought back to the center of our conversations—with patients and within the medical community.

Health Conditions A-Z

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Chronic kidney disease (CKD) is no longer a distant public health concern—it is something we are seeing in clinics every day. With over 600 million people affected globally and a rapidly increasing burden in India, the usual culprits—diabetes and hypertension—are well established. However, in routine practice, one factor that is consistently overlooked is chronic underhydration.Dr Anurag Gupta, Senior Consultant Nephrologist and Dialysis Director at Sir Ganga Ram Hospital, in an interview with Health and Me, spoke about the consequences of dehydration on the kidneys. In Indian settings, especially during summers, it is not uncommon to see patients—drivers, outdoor workers, even hospital staff—going long hours with minimal fluid intake. Many of them present with recurrent stones, urinary infections, or unexplained decline in kidney function. While we may not always label dehydration as the primary cause, it is often a silent contributor.What happens when you are dehydrated?From a physiological standpoint, the explanation is straightforward. Reduced fluid intake leads to lower renal perfusion and higher vasopressin levels, resulting in concentrated urine and increased tubular workload. When this becomes a daily pattern rather than an isolated event, it is reasonable to believe that cumulative injury occurs. Emerging data from heat-stressed regions, including parts of India, are now supporting this clinical observation.Another issue is the widespread misunderstanding around hydration. Some patients barely drink water through the day, while others—after a diagnosis—swing to the opposite extreme, assuming excessive water intake will “clean” the kidneys. Both approaches are problematic. Overhydration, particularly in the elderly, can lead to hyponatremia, something we do encounter in practice. What works better is simple, practical advice—maintaining a light-coloured urine is often more useful than prescribing a fixed number of litres.Is hydration the only factor?At the same time, hydration cannot be viewed in isolation. Our dietary and lifestyle patterns are equally concerning. High salt intake remains the norm rather than the exception, directly contributing to hypertension and kidney damage. Sedentary lifestyle and poor glycemic control further compound the problem. Another area we tend to underestimate is the indiscriminate use of over-the-counter painkillers and alternative medications. Many patients do not even consider these harmful, yet we frequently encounter kidney injury linked to them.Is your diet giving you kidney disease?Protein intake is often a source of confusion, particularly with the rising popularity of high-protein diets. In otherwise healthy individuals, moderate intake is not an issue. However, in CKD patients, unchecked protein consumption can accelerate disease progression. On the other hand, excessive restriction—sometimes self-imposed—can lead to malnutrition. This is where individualised guidance becomes essential, rather than blanket advice.In day-to-day nephrology practice, doctors often focus heavily on pharmacological management. While necessary, it should not overshadow basic preventive measures. Adequate hydration, reduced salt intake, sensible protein consumption, and avoidance of nephrotoxins are simple interventions, but they are not emphasised enough.If we are serious about addressing the growing CKD burden in India, these “basic” measures need to be brought back to the center of our conversations—with patients and within the medical community.