title: Dialysate Sodium: Rationale for Evolution over Time.
abstract: Oligo-anuric individuals receiving hemodialysis (HD) are dependent on the dialysis machine to regulate sodium and water balance. Interest in adjusting the dialysate sodium concentration to promote tolerance of the HD procedure dates back to the early years of dialysis therapy. Evolution of dialysis equipment technologies and clinical characteristics of the dialysis population have prompted clinicians to increase the dialysate sodium concentration over time. Higher dialysate sodium concentrations generally promote hemodynamic stabilization and reduce intradialytic symptoms but often do so at the expense of stimulating thirst and promoting volume expansion. The opposite may be true for lower dialysate sodium concentrations. Observational data suggest that the association between dialysate sodium and outcomes may differ by serum sodium levels, supporting the trend toward individualization of the dialysate sodium prescription. However, lack of randomized controlled clinical trial data, along with operational safety concerns related to individualized dialysate sodium prescriptions, have prevented expert consensus regarding the optimal approach to the dialysate sodium prescription.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) School of Medicine and UNC Kidney Center, Chapel Hill, North Carolina.|The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Flythe
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Finnian R
authors.initials: FR
authors.lastname: Mc Causland
mesh_terms: D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012964:Sodium / Q000008:administration & dosage* / Q000097:blood*; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000517:prevention & control*
chemical_list: D015312:Hemodialysis Solutions; D012964:Sodium