Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients

Kidney Int. 2004 Sep;66(3):1232-8. doi: 10.1111/j.1523-1755.2004.00876.x.


Background: Predialysis plasma sodium (Na(+)) concentration is relatively constant in hemodialysis (HD) patients, and a higher dialysate Na(+) concentration can promote an increase in the interdialytic fluid ingestion to achieve an individual's osmolar set point, and individualization of dialysate Na(+) concentration may improve interdialytic weight gain (IDWG), blood pressure (BP), and HD-related symptoms.

Methods: Twenty-seven nondiabetic, non-hypotension prone HD patients were enrolled in a single-blind crossover study. Subjects underwent nine consecutive HD sessions with the dialysate Na(+) concentration set to 138 mEq/L (standard Na(+) HD), followed by nine sessions wherein the dialysate Na(+) was set to match the patients average pre-HD plasma Na(+) measured three times during the standard Na(+) phase multiplied by 0.95 (individualized dialysate Na(+) HD). Dry weight, dialysis prescription, and medications were not modified during the six weeks of the study.

Results: Pre-HD Na(+) was similar in both periods of the study (standard Na(+) HD, 134.0 +/- 1.4 mEq/L; individualized Na(+) HD, 134.0 +/- 1.5 mEq/L; P= 0.735). There was a significant decrease in interdialytic weight gain (2.91 +/- 0.87 kg vs. 2.29 +/- 0.65 kg; P< 0.001), interdialytic thirst scores, and episodes of intradialytic hypotension in the individualized Na(+) period compared with the standard phase. Pre-HD BP was lower in individualized Na(+) HD in patients with uncontrolled BP at baseline (N= 15), but not in those with controlled BP at baseline (N= 12) (DeltaBP -15.6/-6.5 mm Hg in uncontrolled vs. DeltaBP +6.4/+4.5 mm Hg in controlled, P= <0.001 for systolic BP and P= <0.001 for diastolic BP).

Conclusion: An individualized Na(+) dialysate based on predialysis plasma Na(+) levels decreases thirst, IDWG, HD-related symptoms, and pre-HD BP (in patients with uncontrolled BP at baseline).

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Blood Pressure
  • Cross-Over Studies
  • Female
  • Hemodialysis Solutions / administration & dosage*
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis / methods*
  • Sodium / administration & dosage*
  • Sodium / blood


  • Hemodialysis Solutions
  • Sodium