Opinion on the (Hemo)dialysate Sodium Prescription: Dialysate Sodium Prescription Should Not Be Considered in Isolation

With advances in hemodialysis technology and the desire to achieve cardiovascular stability during dialysis, prescribed dialysate sodium concentration has gradually increased over years. Short-term trials suggest low (<138 mEq/L) is beneficial reducing interdialytic weight gain, pre- post-dialysis BP, predialysis serum sodium; but it increases intradialytic hypotensive episodes. We believe prescription cannot be considered isolation. Our approach use patient symptoms, meticulous fluid volume management temperature conjunction with neutral managing our dialysis patients. Long-term are needed inform optimum prescription.