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Learning About Sick-Day Guidelines for People With CKD or ESRD

Why are sick-day guidelines important?

When you have chronic kidney disease (CKD) or end-stage renal disease (ESRD), it’s important to have a sick-day plan to help manage pain or an illness, like the flu. If you have diarrhea, vomiting, or a fever, you can lose a lot of fluids and become dehydrated. This can make your kidneys worse. Taking certain medicines when you're sick can also cause more harm to your kidneys.

Your doctor will give you guidelines, or recommendations, to put in your sick-day plan. Following your plan can help protect your kidneys while you’re sick.

How do you make a sick-day plan?

Work with your doctor to write a sick-day plan for what to do when you are sick. Keep your plan where you, a family member, or a caregiver can easily find it. Be sure your plan has how to contact your doctor, including at night and on weekends.

Here are some general sick-day guidelines:

  • Know how to take your medicines. Your doctor may adjust your medicines while you’re sick. For example, if you have vomiting or diarrhea and can’t keep down fluids, you may need to stop taking certain medicines.

  • Do not stop taking any medicines without talking to your doctor first. Also, contact your doctor if you are having any problems with your medicines.

  • Write down all the medicines you take. Have this information ready when you contact your doctor.

  • Be careful with over-the-counter medicines. Do not take anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). They can make chronic kidney disease worse.

  • Do not take dietary supplements unless your doctor says it's okay. These include vitamins, minerals, and herbal products.

  • Drink plenty of fluids like water to prevent dehydration. If you usually need to limit your fluids, talk to your doctor before you increase the amount of fluids you drink.

  • Try to eat normally. Do not go for many hours without eating. If you have questions about how often and how much to eat when you’re sick, talk to your doctor or a dietitian.

  • Manage other health conditions as needed. Follow your doctor’s directions for managing things like diabetes and blood pressure while you're sick.

  • Get plenty of rest. It can help you feel better.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have trouble breathing or you have fast breathing.
  • You have trouble staying awake or being woken up.
  • You suddenly feel confused.
  • You feel like you may faint or you are falling down.

Contact your doctor now or seek immediate medical care if:

  • You feel you cannot manage on your own.
  • You vomit more than 4 times in 12 hours or cannot keep down fluids.
  • You have low blood pressure.
  • You have moderate or high ketones (if you take SGLT2 inhibitors or insulin).
  • You have an increased heart rate.
  • You have a fever.
  • You cannot eat or drink enough.
  • You have major changes in blood sugar levels.
  • You have symptoms that have not gotten better after 72 hours.
© 2000-2026 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.