Mc Causland FR, Ravi KS, Curtis KA, et al. - Among hospitalized maintenance hemodialysis (HD) patients, the observed absolute SBP decline did not differ between patients who received higher vs lower dialysate sodium concentration (DNa), in intention-to-treat analyses. Higher DNa was associated with a lower risk of intra-dialytic hypotension (IDH), in post-hoc adjusted analyses.

• A total of 139 hospitalized maintenance HD patients were randomly assigned to receive higher (142 mmol/L) or lower (138 mmol/L) DNa for up to six sessions, in this double-blind single center randomized controlled trial.

• The average SBP decline did not differ significantly between the higher and lower DNa groups (23 ±16 vs 26 ±16 mmHg; P = 0.57).

• In higher vs lower DNa groups, there were similar proportions of total sessions complicated by IDH (54% vs 59%; OR 0.72).

• An association of higher DNa with 8 mmHg (95%CI 2 to 13 mmHg) less decline in SBP, vs lower DNa, was revealed in post-hoc analyses adjusting for imbalances in baseline features.

• Similar patient symptoms and adverse events were observed between groups.