After nearly three decades of watching kidneys fail, Vancouver nephrologist Dr. Suneet Singh has arrived at a quiet but urgent truth: the most devastating outcomes she witnesses are rarely the result of medical complexity, but of small, accumulated neglect. The habits that protect kidney function — steady hydration, careful medication use, consistent follow-up — are neither expensive nor extraordinary, yet they remain the very things patients most often wish they had practiced. Her counsel is less a clinical prescription than a reminder that the body's most vital work is sustained by the most
Nephrologist's Guide: Hydration and Medication Caution Key to Kidney Health
Kidney failure patients experience devastating outcomes including dialysis dependency and death from electrolyte abnormalities and toxin accumulation.
People have a lot of regrets about not following up, not taking their health into their own hands
Mark
When you say people have regrets about not following up, what does that actually look like in your clinic?
Mimi
Someone comes in with kidney function at maybe 20 percent of normal. They've been feeling tired for months but didn't go to the doctor. Or they were told to take a medication and stopped because they felt fine. By the time they see me, we're talking about dialysis or transplant.
Mark
So the damage is already irreversible at that point.
Mimi
Often, yes. If we'd caught it earlier, we could have slowed it down significantly. Maybe prevented dialysis altogether.
Mark
You mentioned electrolyte drinks. Why do people think they need them if they don't actually?
Mimi
Marketing, mostly. The drinks taste better than plain water, so people will drink them. That's fine. But the electrolytes themselves aren't the active ingredient—the water is. People get confused about what their body actually needs.
Mark
And the two and a half liters—is that a hard number or a starting point?
Mimi
It's a reasonable target for most people. Some need more, some less. The point is consistency. Your kidneys need steady hydration to filter properly. Dehydration concentrates everything in your blood, makes the kidneys work harder.
Mark
What's the hardest part of your job—the medicine or the conversation?
Mimi
The conversation. I can prescribe medications. But getting someone to understand why they need to take them, why they need to come back for follow-ups, why they need to ask questions—that's the real work. And it's the part people skip.
The Pulse
- Kidney failure does not announce itself dramatically — it accumulates quietly through missed appointments, skipped medications, and questions never asked, until dialysis becomes the only remaining option.
- Dr. Singh watches patients arrive at her Vancouver clinic carrying regrets that are almost always the same: they didn't follow up, didn't adhere to prescriptions, didn't understand what was happening inside their own bodies.
- The over-the-counter medication habit poses a hidden danger — pain relievers, cold medicines, and digestive aids taken casually and without consultation can silently erode kidney function over time.
- Two and a half liters of plain water daily — not enhanced electrolyte drinks, not dramatic interventions — is among the most effective and accessible tools for maintaining kidney health.
- The trajectory Singh points toward is one of proactive engagement: patients who ask questions, show up for monitoring, and take their medications as directed simply never reach her dialysis unit.
After nearly three decades of watching kidneys fail, Vancouver nephrologist Dr. Suneet Singh has arrived at a quiet but urgent truth: the most devastating outcomes she witnesses are rarely the result of medical complexity, but of small, accumulated neglect. The habits that protect kidney function — steady hydration, careful medication use, consistent follow-up — are neither expensive nor extraordinary, yet they remain the very things patients most often wish they had practiced. Her counsel is less a clinical prescription than a reminder that the body's most vital work is sustained by the most ordinary of commitments.
Dr. Suneet Singh has spent close to thirty years as a nephrologist at Vancouver General Hospital, and what has stayed with her is not the medical complexity of kidney disease but the painful simplicity of what her patients wish they had done differently. The regrets are consistent: they didn't follow up with their doctors, didn't take their medications as prescribed, didn't ask enough questions to truly understand what was happening in their bodies. By the time they reached her clinic, the damage was already irreversible.
Singh's own daily habits reflect what she tells her patients. She drinks water deliberately and in quantity — around two and a half liters a day, beyond what food already provides — because she understands precisely what dehydration costs the kidneys. For most people, plain water is sufficient; the electrolyte-enhanced drinks widely marketed are unnecessary unless someone is training at an elite athletic level. If such drinks encourage someone to drink more and their kidney function is normal, they are harmless — but the water is what actually matters.
She is equally cautious about over-the-counter medications. Pain relievers, cold remedies, and digestive aids are taken casually and constantly, often without awareness of the damage some can cause to kidney tissue or the interactions they may trigger with other drugs. Her advice is straightforward: consult a doctor before reaching for something off the shelf. There may be a better option, or no medication may be needed at all.
What Singh has distilled from decades of witnessing kidney failure is that protection is built not through dramatic intervention but through small, sustained choices — drinking water, adhering to prescriptions, keeping appointments, and asking questions before confusion becomes crisis. The patients who practice these habits never reach her dialysis unit. Those who don't often spend their final years wishing they had.
Dr. Suneet Singh has spent nearly three decades watching kidneys fail. As a nephrologist at Vancouver General Hospital and head of the peritoneal dialysis program, she has seen the aftermath of choices made years earlier—the dialysis machines, the electrolyte imbalances that kill, the accumulation of toxins the body can no longer clear. What strikes her most, she says, is not the complexity of kidney disease but the simplicity of what people wish they had done differently.
The regrets cluster around the same few things. Patients tell her they didn't follow up with their doctors. They didn't take their medications as prescribed. They didn't ask enough questions to understand what was actually happening in their bodies. And because they didn't understand, their health never got optimized. By the time they arrived at her clinic, the damage was already done.
Singh's own practice reflects what she tells her patients. She drinks more water than most people, deliberately, because she knows what dehydration does to kidney function. Water, she explains, does something straightforward: it helps the kidneys work better, keeps blood chemistry stable, and maintains the balance of electrolytes the body needs. For most people, plain water is enough. The electrolyte-enhanced drinks people buy are not necessary unless someone is exercising at an elite level—which most of us are not. If electrolyte water makes someone actually drink more, and their kidney function tests are normal, then it's harmless. But the water itself is what matters.
She recommends aiming for two and a half liters of water daily, on top of whatever water is already in the food people eat. This is not a dramatic intervention. It is not expensive. It requires no prescription. Yet it is one of the things that has genuinely changed how she lives.
The other piece is medication caution. Over-the-counter drugs are everywhere—pain relievers, cold medicines, digestive aids—and people take them without thinking much about it. Singh warns against this habit. Before taking something without a prescription, see a doctor. There might be something better suited to what you actually need. Some medications damage kidneys. Some interact with other drugs. Some are simply unnecessary. A professional can sort through it.
What Singh has learned from her patients' regrets is that kidney health is not built on dramatic gestures. It is built on small, consistent choices: drinking water, taking medications as directed, showing up for appointments, asking questions when you don't understand something. It is built on taking your health into your own hands before your kidneys stop taking it into theirs. The people who do this never reach her dialysis unit. The people who don't often wish they had.
Notable Quotes
People have a lot of regrets about not following up, not taking their health into their own hands, and not taking their medications regularly.— Dr. Suneet Singh, nephrologist
Drinking water helps kidney function better, controls blood chemistry, and manages electrolytes—and most people just need plain water.— Dr. Suneet Singh
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