From my heart

Running Dry: When Dialysis and Dehydration Collide

There’s a strange line you learn to walk when you’re on dialysis. People think the challenge is just “too much fluid,” but the truth is more complicated. It’s balance. Always balance. And when that balance tips too far in the wrong direction—when your body runs dry instead of overloaded—it can hit hard.

This morning reminded me of that.

Not for the first time, either.

I woke up already feeling off. It’s hard to describe unless you’ve lived it, but it starts as a kind of emptiness. Not hunger. Not thirst in the usual sense. Just… drained. Like your body forgot how to hold onto what it needs. Then comes the dizziness. Standing up feels like stepping onto a moving floor. Your heart starts working overtime, trying to compensate for something it can’t fix.

And then it hits you: dehydration.

When you’re on peritoneal dialysis—especially long sessions, 12–13 hours overnight like I do—your body is constantly being pulled and filtered. Fluid shifts aren’t gentle. They’re controlled, but they’re real. And if too much fluid comes off, or if you didn’t quite take in enough the day before, your body pays for it.

For me, it showed up fast this morning. Lightheaded. Weak. That “I might pass out if I push this too far” feeling. Even something simple like walking across the room felt like a challenge. And the worst part? You know exactly what it is, because you’ve been here before.

That’s the dangerous part of dehydration on dialysis—it sneaks up on you, but it also becomes familiar. Too familiar.

People outside of this don’t always realize how serious it can be. Dehydration isn’t just being thirsty. It can drop your blood pressure, strain your heart, mess with your electrolytes, and leave you feeling like your body is shutting down piece by piece. It can turn a normal morning into a fight just to feel stable again.

And yet, you still have to manage it carefully. You can’t just chug water like anyone else. Every sip matters. Every decision about fluid is calculated. Too much, and you’re dealing with swelling, breathing issues, and extra strain on your system. Too little, and you end up like I did this morning—running on empty.

It’s exhausting, mentally as much as physically.

Because it’s not just about today. It’s about knowing this could happen again tomorrow. It’s about constantly second-guessing yourself: Did I drink enough? Did I take off too much? Am I about to feel awful again?

And when you’re already dealing with everything dialysis brings—the time, the isolation, the way it reshapes your entire life—these moments hit even harder.

This morning was rough. I got through it, like I always do. You slow down. You adjust. You listen to your body. You ride it out.

But it’s a reminder.

Dialysis isn’t just machines and numbers and routines. It’s a daily negotiation with your own body. And sometimes, even when you’re doing everything right, it still knocks you down.

And you get back up anyway.