Use of a low dialysate sodium concentration appears safe in children and young adults on maintenance hemodialysis who are not prone to hypotension, investigators reported at the 2022 American Dialysis Conference.

In a crossover study, investigators from Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy, randomly assigned 15 patients younger than 18 years to standard dialysate sodium of 138 mmol/L or low dialysate sodium of 135 mmol/L for 4 weeks, then switched to the alternate treatment for 4 weeks after a 2-week washout period. Selected patients had baseline hypertension, a predialytic serum sodium of 130 mmol/L or higher, and a low incidence of intradialytic events.

Intradialytic weight gain was significantly lower after treatment with low vs standard dialysate sodium: 2.12% vs 2.77% of body weight, the Italian team reported. First-hour refill index, a measure of pre-dialysis fluid overload, was also significantly lower when patients received low dialysate sodium: 1.65 vs 2.27.

Continue Reading

Use of low dialysate sodium was significantly associated with a lower sodium gradient of dialysate to serum sodium (-2.53 vs 0.17). Post-dialysis serum sodium was significantly lower after low sodium treatment (137.9 vs 135.5). Both dialysate concentrations were associated with a 1% rate of symptomatic dialysis sessions involving hypotension, cramps, or vomiting.

Blood pressure results did not differ between groups and warrant further research. According to the investigators, the lag phenomenon may explain the lack improvement in systolic and diastolic blood pressure following dialysis sessions.

Low dialysate sodium of 135 mmol/L is well-tolerated in selected pediatric patients, the team concluded.


Caporale O, Consolo S, Grassi F, Puccio G, Montini G, Paglialonga F. Low dialysate sodium concentration in pediatric and young adult patients on maintenance hemodialysis: a prospective, randomized, crossover study. Presented at the American Dialysis Conference, March 4-6, 2022.