In the last few weeks I had recurrent conversations with a few of my patients and it seemed to me like I could press the replay button and repeat the same set of recommendations to them. 

It was all in relation to review of laboratory values and talking about diminished kidney function.

Not alarming in most instances, but requiring attention. And why is it important? As a rheumatologist I deal with a lot of inflammatory conditions and most, if not all remedies used in my field are metabolized by the kidneys, and only near perfect renal function allows me to predict that these medicines 1)work 2)do not suddenly become dangerous, toxic or 3)even contraindicated. Even for management of conditions like plain arthritis, where we recommend medications like naproxen or ibuprofen, many times in over-the-counter doses, one has to pay very close attention to kidney function. That becomes paramount especially as dealing with patients in older age group, or in patients taking many medicines at the same time, what is called polypharmacy. The medications can be unfriendly for the liver when taken above indicated dosages, but also can injure kidneys if used frequently or in high doses. Sluggish kidney function causes that the medicine [or its metabolites] hangs out if the system for too long and damages other organs, such as bone marrow and liver. And of course this becomes problematic while we are trying to control, let’s say osteoarthritis - we don’t have that many great options to treat that illness, and many people take additional medication or even supplements at the same time, that in result can impair the kidney function.

The one value I particularly pay attention to is called GFR, or glomerular filtration rate, which is calculated based on patient’s age and e.g. gender adjusted and shows me a real value of how the waste is managed by the kidneys - is it very robust and quick like the water running through the waterfall [values above 60-70 are good, or as reported by National Kidney Foundation normal results range from 90 to 120 mL/min/1.73 m2] or is it more sluggish, standing - almost like a water in a lazy, muddy lake with a lot of debris, not a great filtration and just not a lot of movement?

In my office the KIDNEY conversation often is going is into reviewing patient’s age, other medical problems and medications that can change kidney function, like many drugs for high blood pressure, and dietary habits - like overuse of salt, not enough hydration or not the greatest hydration, like too much caffeinated drinks. Many times it’s other issues, patient-specific, that we have to carefully review with patient together.

One conversation I had recently with a patient was an inspiration to write this post. I was asking them what they are drinking to stay hydrated throughout the day, and they told me that after they are done with one morning coffee, then another cup of coffee, that's pretty much it, then they have to push themselves to stay hydrated at all because they do not like the taste of plain water. I am not surprised by this answer - a lot of people don’t like the flavor of plain water; many decide not to buy bottled water, which is to help an environment, then many cities purify their water with poorly tasting additives and that results in the taste of chlorinated, chemical water. The latter can be remedied with various filters, but nevertheless I suggested to the patient a few ideas to make water more tolerable or simply more pleasant - looking or tasting. The way I think about healthy ways to add hydration to your day is not only to help you stay on top of your kidney water exchange game, and getting rid of all the waste from your body, but also to have a very pleasurable (meditative?) experience while doing so.

With that I follow the seasons - in Spring I’ll enjoy and suggest dried herbal teas like mild lavender collected in late summer, later in that season I add fresh mint leaves from my garden, or pots, then first berries to my water and make infused water drinks. Summer season is an infused water paradise - try a few, try it all - add cherries, bluberries, basil, oregano to your water and record what you love. Repeat as needed. In the Fall there may be abundance of other fruit, like plums and pears that I slice up and add to water, and in Winter you can enjoy slices of fruits and even vegetables added to your drinks [apple or cucumber anyone?]. I do like bagged tea, but I have some concerns about the quality of the process of adding preservatives and chemicals that go into the process of making packaging in ready to use products. Sometimes you cannot make your tea from scratch, it's simply very impractical and even impossible. So the bottom line I suggested to my patient - don’t look at coffee as source of hydration, let me call it medicated drink, if you don’t enjoy plain water and you don’t want to buy various flavored waters available in department stores, be creative and make your own herbal teas, fruit and vegetable teas that you can enjoy following the seasons, made in environment-friendly fashion and that taste wonderful. I’m sure everybody can find something that they will enjoy. 

The disclosure here - not everybody can enjoy every single fruit and vegetable, you may need to avoid certain plants that cause allergies or normally irritate your gut. Another tip -  when I talk to my patients I am aware of their past medical history, what brought them to me, what medications they are on; then I look at all the chart’s data, various blood results in front of me and then voila - I can advise my patient in a very patient-centered way. Only a skilled physician or clinician can have a conversation with you regarding proper hydration; if you have certain conditions, like congestive heart failure, extra water is actually not recommended. It’s always best to consult with the provider or physician that knows you before you start any new diet routine, especially if you plan to incorporate that on an ongoing basis. 

Most of all if you are healthy you can enjoy a multitude of hydration varieties not necessarily relying on plain water.