It is Time to Individualize the Dialysate Sodium Prescription

Sodium mass balance in hemodialysis patients is primarily dependent on dietary salt intake and sodium removal during dialysis. One of the most important goals of dialysis therapy is to fully remove the mass of sodium that has accumulated in the interdialytic period. It is currently the practice in dialysis centers all over the world to use a standardized dialysate sodium concentration (Na(+) D) for all patients. The aim of the present article was to summarize the current evidence for an individualized Na(+) D prescription. Three main points are discussed: (i) Na(+) D prescription, which must necessarily take into account the sodium setpoint and the sodium gradient; (ii) clinical experience with an individualized Na(+) D prescription, and (iii) guidelines for individualizing the Na(+) D prescription. To summarize, recent data suggest that tailoring Na(+) D to an individual's sodium setpoint has the potential for short- and long-term benefits for patients. Prospective interventional studies are warranted to further understand its effects, stratified for patients with low or high serum sodium levels.