IN-DEPTH REVIEWS

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Sergio F.F. Santos and Aldo J. Peixoto ¹

*Division of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; and Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut and Medical Service and Renal Section, VA Connecticut Healthcare System, West Haven, Connecticut

¹ To whom correspondence should be addressed. E-mail: aldo.peixoto{at}yale.edu.

	Abstract

Hypertension and chronic volume overload are complications often seen in hemodialysis patients. Current hemodialysis practices adopt a standard dialysate sodium prescription that is typically higher than the plasma sodium concentration of most patients. As a general rule, hemodialysis patients have stable predialysis plasma sodium concentrations, and each patient has a fixed "osmolar set point." Hypertonic dialysate sodium prescriptions, including sodium modeling, predispose to positive sodium balance and lead to higher blood pressure and increased interdialytic weight gain. Conversely, lowering or individualizing dialysate sodium reduces thirst, interdialytic weight gain, and blood pressure in non-hypotension prone dialysis patients. Optimization of the dialysate sodium prescription is an important step in achieving sodium balance and improving blood pressure control in hypertensive hemodialysis patients.