**4.2.3 Final individualized guidelines**

The default sodium prescription should be equal the serum sodium. Dialysate with identical sodium concentration to serum keeps sodium diffusion neutral; this approach relies exclusively on ultrafiltration for mass transfer of sodium/volume. If attempting to minimize variables, an isotonic dialysate is preferred; in this way ultrafiltration is responsible for the net sodium transfer while not being silently counteracted by dialysate sodium diffusing into the patient.

Dialysate with higher sodium concentration than the patient's serum sodium will provide a net sodium transfer into the patient. Hypertonic dialysate is only indicated chronically for non-hypertensive patients with significant, recurrent intradialytic hypotension or acutely for prevention of disequilibrium syndrome.

Dialysate with lower sodium concentration than the patient's serum sodium will accept a net sodium transfer out of the patient. If attempting to maximize methods for BP control and IDWG management, the utilization of hypotonic dialysate is preferred, insofar as is tolerated by interdialytic symptoms.
