Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept?

Background: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium. Methods: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. Results: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis and discusses two strategies to remove excess sodium in patients prone to intradialytic hypotension, namely Profiled hemodialysis and the HFR Aequilibrium System. Conclusion: The Profiled hemodialysis and Aequilibrium System trials both proved effective in counteracting intradialytic hypotension.