How do you manage hemodialysis for an ESKD patient presenting with severe hyponatremia and a serum sodium more than 10 mEq/L below the lowest available dialysate sodium concentration?

There are multiple ways of dealing with this situation. One option is not to dialyze if not urgent and let the sodium come up before starting dialysis. The most exact way of dealing with the situation is to do hemofiltration either continuously or intermittently with a concomitant D5W infusion adjus...

I agree. The risk of ODS is very low in these patients, but in the patient at high risk (i.e., risk factors and starting Na < 120 mEq/dL), then I would favor CRRT either at a low DFR or replacement fluid rate, or by adding D5W either peripherally or into the dialysate/replacement fluid to limit the ...