How Much Water Can You Drink With Chronic Kidney Disease and Type 2 Diabetes?
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Kidney Disease and Type 2 Diabetes: How Much Water Should You Drink?

Kidney Disease and Type 2 Diabetes: How Much Water Should You Drink?
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Updated on October 27, 2025
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Hydration is a surprisingly important diabetes health factor, and it’s even more important if you also have chronic kidney disease (CKD).

CKD develops in 10 to 40 percent of people with type 2 diabetes, and when you have both, it is sometimes referred to as diabetic kidney disease.

 Having either condition may affect what you can eat and drink, but having both requires navigating two sets of treatment and management recommendations simultaneously, including how much water you should drink.
Your hydration needs continue to change if kidney disease progresses.

 It’s important to work with your healthcare team to balance your hydration needs with the management of diabetic kidney disease.

Diabetes and Hydration

Staying properly hydrated is crucial if you have type 2 diabetes, as it plays a vital role in blood glucose management. Proper hydration helps keep your blood sugar in a safe range. On the other hand, dehydration can cause glucose levels to become too concentrated, leading to blood sugar spikes.

Consistently high blood glucose can also lead to dehydration; frequent urination and extreme thirst are common diabetes symptoms. Raised blood glucose levels require the kidneys to work harder to absorb extra sugar from the blood. When they can’t keep up, excess sugar leaves the body via urine, which also removes fluids from other tissues in the body. This increased frequency of elimination can lead to dehydration.

Illnesses that cause acute diarrhea and vomiting can also cause severe dehydration, making them the most common cause of a dangerous type 2 diabetes complication called diabetic ketoacidosis (DKA).

 If you get sick, prioritize drinking plenty of fluids to prevent dehydration. People with diabetes who struggle to keep fluids down for at least four hours, or who experience diarrhea and vomiting for at least six hours, should head straight to an emergency room.

Dehydration can lead to kidney damage as well, as nutrients in the blood can’t reach the kidneys if you haven’t consumed enough fluids.

 As such, maintaining proper hydration may help reduce your risk of developing diabetic kidney disease if you have type 2 diabetes.

What Is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes.
What Is Diabetic Ketoacidosis (DKA)?

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Chronic Kidney Disease and Hydration

The kidneys help your body hold onto as much water as it can when you need it, and they trigger feelings of thirst when you need more. They also help eliminate excess water in urine to avoid fluid buildup. Since maintaining this fluid balance is a key part of the kidneys’ complex role, having the right amount of water in your body can become increasingly challenging as chronic kidney disease progresses.

In the early stages of kidney disease, staying properly hydrated is essential to keeping your kidneys working as well as they can.

 Enough fluids help them clear sodium, urea, and other waste products from the body.

As you enter more advanced stages of kidney disease but aren’t on dialysis, your healthcare provider may advise you to limit how much fluid you consume. Your kidneys may not be able to get rid of fluid as efficiently, leading to buildup known as fluid retention. Be on the lookout for signs of fluid retention:

  • Swollen feet and ankles
  • Breathlessness when walking a short distance
  • Breathlessness while lying on your back

Let your doctor know promptly if you're experiencing fluid retention.

Some people with advanced kidney disease ultimately rely on dialysis when their kidneys can no longer clean the blood or produce enough urine. Dialysis involves transporting blood out of the body, filtering it through a machine, then returning the filtered blood to the body.

 People on dialysis must adhere to fluid intake restrictions, with the amounts depending on whether the body can still produce any urine.

How Much Water Should You Drink?

No daily fluid intake recommendations apply to everyone with diabetic kidney disease. “Optimal water intake should be individualized, based on clinical assessment and risk factors rather than a universally recommended amount,” says Abbal Koirala, MBBS, an assistant professor of medicine at Johns Hopkins University in Baltimore. “Both excessive and insufficient water intake may be harmful, and the ideal range depends on a person’s CKD stage, other medical conditions they may have such as heart failure, and their risk of fluid overload or low sodium in the blood, also known as hyponatremia.”

Boonphiphop Boonpheng, MD, a clinical assistant professor of medicine at Case Western Reserve University and University Hospitals in Ohio, suggests considering additional factors when determining ideal fluid intake:

  • A person’s metabolism
  • Insensible losses (the tiny but constant loss of water through the skin and during exhalation)
  • The impact of fever, sweating, or exercise, especially in those who live in a hot or humid climates
  • Diarrhea

Dr. Boonpheng highlights other considerations that can make water recommendations with CKD and diabetes complex. “In advanced kidney disease or for those on dialysis, you might need to restrict water intake to prevent low sodium levels in the blood,” says Boonpheng. “However, if you have a history of kidney stones, higher fluid intake helps prevent recurrence. Aim for about 70 to 85 ounces (roughly 2 to 2.5 liters) of fluids per day, spaced throughout the day, and try sipping some water after supper. If your blood sugar is poorly controlled — above 180 mg/dL — your kidneys excrete extra sugar through urine, which causes additional water loss. You may need to drink more to keep up.”

Hydration considerations may be even more complicated for people with advanced kidney disease. “People with stage 4 or 5 CKD often receive the advice to limit fluid intake to less than 1.5 liters per day to avoid hyponatremia, but a healthcare professional should adjust this for hot climates or increased insensible losses,” says Dr. Koirala. If you don't have low sodium, Koirala recommends drinking water if you’re thirsty.

If you need to receive dialysis, your fluid intake will require careful monitoring and consideration. Generally, a healthcare professional will recommend consuming 32 ounces of fluid daily if you’re not producing any urine. If you produce some urine, you can have a little extra fluid, depending on how much urine you produce.

Fluid Options for People With CKD and Diabetes

Water isn’t your only option for fluid intake, although Boonpheng recommends it as the safest source of hydration. Other healthy fluids include the following sources:

  • Ice
  • Soups
  • Stews
  • Protein drinks
  • Dairy and nondairy milk
  • Frozen fruits

While these options provide a sense of variety, extra caution may be necessary for some people adhering to restricted fluid intake. “In most cases, people with CKD and type 2 diabetes don’t need to track foods with high water content closely,” says Boonpheng. “The exception is when there are other electrolyte problems, such as low sodium levels in the blood. In those cases, it may be helpful to track total fluid intake, including soups, fruits, and other foods high in water.”

Koirala recommends that people with advanced CKD track their consumption of foods with high water content. “These can contribute to water retention in advanced CKD, leading to hyponatremia,” he says. He also suggests keeping an eye on fruit and vegetable intake due to their potentially high potassium content, which can increase the risk of high potassium levels in people with advanced CKD. Many people with advanced CKD need to restrict their potassium intake.

In terms of beverages, avoiding caffeinated, alcoholic, and sweetened drinks can further support healthy fluid levels.

Hydration and Your Medications

The medications you take can affect the amount of fluid a healthcare professional recommends.

Some people take SGLT2 inhibitors to manage both type 2 diabetes and CKD. While these medications can reduce the risk of advanced kidney disease, they can also cause dehydration unless you hydrate well while taking them.

 “If you’re taking SGLT2 inhibitors, you lose more sugar and water through urine,” says Boonpheng. “It’s important to drink a bit more water than usual to stay hydrated. But if you have severe nausea or vomiting, or can’t eat or drink enough, contact a healthcare professional and hold off on taking this medication until you’re better.”
A doctor may prescribe diuretics as well to help treat fluid buildup or kidney failure. These medications increase the amount of urine removed from the body. However, you risk dehydration on diuretics if your dose is too high or you’re not consuming enough fluids. Disclose any kidney problems to your doctor if you’re taking diuretics for another condition, as they’ll need to personalize your daily fluid recommendation.

Dehydration Warning Signs

Dehydration with CKD and type 2 diabetes requires prompt medical attention. Get in touch with a healthcare professional if you notice the following symptoms:

  • Intense thirst
  • Passing less urine
  • Dark urine
  • Fatigue
  • Dizziness
  • Confusion
  • Skin that doesn’t flatten right after you pinch it
  • Sunken cheeks or eyes
Conversely, fluid overload with advanced CKD may include these signs:

  • Swelling (edema)
  • Nutritional deficiencies
  • High blood pressure
  • Lung infections and fluid buildup
  • Heart failure
  • Breathing difficulties
  • Decreased blood proteins, which can affect how well dialysis works

In earlier stages of CKD, you may notice swelling and breathlessness only as signs of fluid retention.

The Takeaway

  • Managing hydration with diabetic kidney disease is complex and requires close consultation with a healthcare team, as fluid needs are highly individualized and change with the progression of kidney disease.
  • For type 2 diabetes, proper hydration is crucial because dehydration can cause blood sugar to become too concentrated, leading to spikes, and high blood glucose itself can lead to more fluid loss through increased urination.
  • Fluid recommendations vary significantly across the different stages of chronic kidney disease. While adequate fluid intake is important in early stages to clear waste, advanced stages or being on dialysis typically require restricting fluid to prevent fluid retention.
  • Optimal daily fluid intake must be tailored to the individual, considering factors such as their stage of CKD, the presence of other medical conditions like heart failure, and the use of certain medications like SGLT2 inhibitors or diuretics.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Diabetes - A Major Risk Factor for Kidney Disease. National Kidney Foundation.
  2. Healthy Hydration and Your Kidneys. National Kidney Foundation.
  3. 10 Surprising Things That Can Spike Your Blood Sugar. Centers for Disease Control and Prevention. May 15, 2024.
  4. Diabetes Symptoms: When Diabetes Symptoms Are a Concern. Mayo Clinic. June 27, 2023.
  5. Ooi E et al. Clinical and Biochemical Profile of 786 Sequential Episodes of Diabetic Ketoacidosis in Adults With Type 1 and Type 2 Diabetes Mellitus. BMJ Open Diabetes Research and Care. December 8, 2021.
  6. Managing Sick Days. Centers for Disease Control and Prevention. May 15, 2024.
  7. He Y et al. Association between hydration status and the risk and all-cause mortality of diabetic kidney disease. Renal Failure. August 7, 2024.
  8. Fluids. American Kidney Fund.
  9. Why hydration is important for kidney health. Kidney Research UK.
  10. Dialysis. Cleveland Clinic. March 28, 2021.
  11. Empagliflozin. MedlinePlus. July 15, 2025.
  12. Diuretics. Cleveland Clinic. December 12, 2024.
  13. Dehydration. Mayo Clinic. May 2, 2025.
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Igor Kagan, MD

Medical Reviewer
Castle Connolly Top Doctor

Igor Kagan, MD, is an an assistant clinical professor at UCLA. He spends the majority of his time seeing patients in various settings, such as outpatient clinics, inpatient rounds, and dialysis units. He is also the associate program director for the General Nephrology Fellowship and teaches medical students, residents, and fellows. His clinical interests include general nephrology, chronic kidney disease, dialysis (home and in-center), hypertension, and glomerulonephritis, among others. He is also interested in electronic medical record optimization and services as a physician informaticist.

A native of Los Angeles, he graduated cum laude from the University of California in Los Angeles (UCLA) with a bachelor's in business and economics, and was inducted into the Phi Beta Kappa honor society. He then went to the Keck School of Medicine at the University of Southern California (USC) for his medical school education. He stayed at USC for his training and completed his internship and internal medicine residency at the historic Los Angeles County and USC General Hospital. Following his internal medicine residency, Kagan went across town to UCLA's David Geffen School of Medicine for his fellowship in nephrology and training at the UCLA Ronald Reagan Medical Center. After his fellowship he stayed on as faculty at UCLA Health.

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Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.

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