Ideal Sodium Dialysate Concentration: A Brazilian Perspective

The current interpretation of the controversial and dynamic nature of the literature reports in this area leads me to lean towards the preference of a standard DNa+ in the upper range (138 mEq/L) of the current international utilization and preference of clinical directors in Brazil. My opinion to individualize (plus and minus 2 mmol/L of DNa+ prescription) would be based on clinically relevant signals of excessive interdialytic weight gain and uncontrolled hypertension (to decrease DNa+ concentration), or intradialytic hypotension episodes (to increase DNa+ concentration). In my experience, the individualization, based on this approach, would be applicable to a minority (less than 15%) of patients. As new data from randomized clinical trials emerge (particularly the robust RESOLVE trial), I would certainly need (and would be happy) to revise my point of view on this issue.