Ultrafiltration–sodium profiles and their impact on thirst and xerostomia in hemodialysis patients

Chronic kidney disease affects 10-15% of the global population, with hemodialysis causing significant thirst and xerostomia due to fluid restrictions. These symptoms impair quality of life and treatment adherence. While ultrafiltration (UF) and sodium profiling have been studied separately, their combined effect remains understudied, particularly in Middle Eastern populations. We conducted a randomized crossover trial with 20 ESRD patients comparing: (1) ascending/descending UF with linear sodium reduction (150→138 mmol/L) versus (2) conventional HD with constant UF/sodium (140 mmol/L). Participants completed 16 sessions per protocol with washout periods. Outcomes were measured using validated Thirst Questionnaire (5-item) and Xerostomia Inventory (11-item), both showing excellent reliability (Cronbach's α > 0.7/>0.8). The intervention group showed significant improvements versus conventional HD: 44% reduction in thirst scores (36.5 vs. 64.5, p < 0.001). 22% lower xerostomia (19.0 vs. 24.4, p = 0.002). 73% fewer hypotension episodes (15% vs. 55%, p < 0.05). These benefits are mechanistically linked to improved hemodynamic stability achieved through synergistic sodium and ultrafiltration profiling. This approach, which maintains plasma osmolality and intravascular volume, offers a practical, cost-neutral solution for symptom management. This approach significantly ameliorates patient-reported thirst and xerostomia and reduces intradialytic hypotension, offering a practical, cost-neutral strategy to enhance treatment tolerability. This approach should be adopted in routine practice, particularly for the growing ESRD population. Future studies should explore personalized strategies and long-term effects.Trial registration: This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N5) on 07/01/2023. https//irct.behdasht.gov.ir/trial/67,695.