**7. How to treat: My opinion**

It is clear that the traditional algorithm indicating use of anti-secretory agents for ulcerlike FD and prokinetics for dysmotility-like FD does not meet the complexity of FD in the context of ESRD. The ordinary exclusion of patients with inadequate dialysis clearance from studies about FD implies that hypervolemia can be involved in the high prevalence of FD in the cases of more typical patients on HD (those excluded from the studies). In these cases, hypervolemia could trigger gastric emptying delay. I think that patients on HD with FD should first have their dry-weight re-evaluated. Indeed, FD can be an extra tool to help estimate real dry-weight of our HD patients. Second, metoclopramide can be used before each meal and at bedtime. Its beneficial effects on nutritional status are widely document‐ ed [62,69]. Third, screening for depressive symptoms and psychotherapy are essential in the treatment of FD among HD patients. Concerning anti-depressant drugs, sertraline is a good option because of its anti-inflammatory effects. Finally, acupuncture can be tried to ameliorate dyspeptic symptoms. Acupuncture's action in accelerating gastric emptying is particularly attractive.
