How do you manage persistently high interdialytic weight gain in a patient whose ultrafiltration rate regularly exceeds 13 mL/kg/hr?

How do you manage a hemodialysis patient with ultrafiltration rates regularly exceeding 13 mL/kg/hr who declines longer or additional sessions despite dietary counseling?

• Continue UF above 13 mL/kg/hr to reach target weight
• Cap UF at 13 mL/kg/hr and accept a weight above target
• Lower dialysate sodium to reduce thirst and IDWG
• Push for transition to home hemodialysis or peritoneal dialysis
• Other