title: Are dialysate sodium levels too high?
abstract: Universal lower dialysate [Na+] is often advocated as a means of improving the dire cardiovascular plight of our dialysis patients. However, there is evidence associating lower dialysate [Na+] and increased morbidity and mortality especially in frailer patients, probably as a result of more frequent intra-dialytic hypotension. In this editorial, we summarize arguments for and against lower dialysate [Na+], and provide recommendations around selecting the most appropriate dialysate [Na+] for specific clinical subsets that may benefit from manipulation of salt and water balance. The lack of overall clarity on relative benefits and risks of lower dialysate [Na+] does not support the case for empirical "across the board" change, and experimental testing in clinical trials is required to determine safe and effective use.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Dunlop
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D015314:Dialysis Solutions / Q000737:chemistry* / Q000493:pharmacokinetics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D009017:Morbidity; D006435:Renal Dialysis; D012307:Risk Factors; D012964:Sodium / Q000032:analysis*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014882:Water-Electrolyte Balance
chemical_list: D015314:Dialysis Solutions; D012964:Sodium