title: Dialysate Sodium: Choosing the Optimal Hemodialysis Bath.
abstract: Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and is a major cause of hospitalizations. It is often addressed by reinforcing the importance of a low-salt diet with patients and challenging estimated dry weights. More recently, interest has shifted toward the dialysate sodium prescription as a strategy to improve fluid overload and its adverse sequelae. The availability of high-flux high-efficiency dialysis in conjunction with the need to ensure its tolerability for patients has resulted in an increase in dialysate sodium prescriptions from 120 to ≥140 mEq/L. However, we are now tackling the unforeseen consequences associated with high dialysate sodium prescriptions. High dialysate sodium concentration is associated with high interdialytic weight gain, a commonly used surrogate for hypervolemia contributing to hypertension. The association between mortality and high dialysate sodium concentration remains controversial with conflicting data. It is clear that fluid management in the diverse end-stage renal disease population is extremely complex and more clinical trials are needed. In the meantime, while patients require treatments and clinical decisions need to be made, this review article attempts to summarize the current evidence for individualized dialysate sodium prescriptions based on patients' volume status, comorbid conditions, plasma sodium level, and hemodynamic response to dialysis therapy.
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Jair
authors.initials: J
authors.lastname: Munoz Mendoza
authors.affiliation: Satellite Healthcare, San Jose, CA; Department of Medicine, Division of Nephrology, Stanford University, Palo Alto, CA.
authors.forename: Rohini
authors.initials: R
authors.lastname: Arramreddy
authors.affiliation: Satellite Healthcare, San Jose, CA; Department of Medicine, Division of Nephrology, Stanford University, Palo Alto, CA. Electronic address: schillerb@satellitehealth.com.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schiller
mesh_terms: D004039:Diet, Sodium-Restricted; D005260:Female; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000737:chemistry*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D061214:Patient Safety; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D018570:Risk Assessment; D012964:Sodium / Q000097:blood / Q000378:metabolism*; D016019:Survival Analysis; D014869:Water Intoxication / Q000209:etiology / Q000517:prevention & control; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control*
chemical_list: D015312:Hemodialysis Solutions; D012964:Sodium
keywords: Dialysate sodium; dry weight; fluid overload; hemodialysis; inter-dialytic weight gain; intra-dialytic hypotension; review; sodium gradient; target weight