Individualized therapy according to the set point, which implies alignment of dialysate and serum sodium, has been advocated. Sodium profiling could be considered persistently symptomatic in patients because of intradialytic hypotension or disequilibrium symptoms. However, evidence supporting these approaches is weak. On first principles, the aim of dialysate treatment should be to removed quantity of sodium accumulated since the last session, but feasible and accurate methods to achieve that aim are currently unavailable. Alignment of patient serum and dialysate sodium concentrations assists in achieving this goal. Avoiding sodium loading in hemodialysis patients is a cornerstone for blood pressure and fluid status management.