{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:08:49Z","timestamp":1789697329872,"version":"4.0.1"},"reference-count":123,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,9]],"date-time":"2025-03-09T00:00:00Z","timestamp":1741478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of &lt;4\u20134.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed\/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive\u2013behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients.<\/jats:p>","DOI":"10.3390\/jcm14061846","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T05:46:52Z","timestamp":1741585612000},"page":"1846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1627-0235","authenticated-orcid":false,"given":"Maurizio","family":"Bossola","sequence":"first","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Translational Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4188-9032","authenticated-orcid":false,"given":"Ilaria","family":"Mariani","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Translational Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8527-5594","authenticated-orcid":false,"given":"Camillo Tancredi","family":"Strizzi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Translational Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Pasquale","family":"Piccinni","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Translational Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Di Stasio","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"214","DOI":"10.36720\/nhjk.v10i2.343","article-title":"How to control interdialytic weight gain (Idwg) among hemodialysis patients","volume":"10","author":"Wijayanti","year":"2021","journal-title":"Nurse Health J. Keperawatan"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1053\/j.ajkd.2016.08.030","article-title":"Interdialytic weight gain: Trends, predictors, and associated outcomes in the international dialysis outcomes and practice patterns study (DOPPS)","volume":"69","author":"Wong","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1053\/j.jrn.2021.11.007","article-title":"The Worldwide Prevalence of Nonadherence to Diet and Fluid Restrictions Among Hemodialysis Patients: A Systematic Review and Meta-analysis","volume":"32","author":"Vr","year":"2022","journal-title":"J. Ren. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1053\/j.jrn.2017.05.003","article-title":"Revisiting Interdialytic Weight Gain and Mortality Association With Serum Albumin Interactions: The Japanese Dialysis Outcomes and Practice Pattern Study","volume":"27","author":"Kurita","year":"2017","journal-title":"J. Ren. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1161\/CIRCULATIONAHA.108.807362","article-title":"Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis","volume":"119","author":"Regidor","year":"2009","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1046\/j.1523-1755.2000.00941.x","article-title":"Interdialytic weight gain and survival in hemodialysis patients: Effects of duration of ESRD and diabetes mellitus","volume":"57","author":"Kimmel","year":"2000","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cabrera, C., Brunelli, S.M., Rosenbaum, D., Anum, E., Ramakrishnan, K., Jensen, D.E., and St\u00e5lhammar, N.-O. (2015). A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol., 16.","DOI":"10.1186\/s12882-015-0110-9"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1159\/000362743","article-title":"Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients","volume":"39","author":"Lee","year":"2014","journal-title":"Am. J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1046\/j.1523-1755.2003.00064.x","article-title":"Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS","volume":"64","author":"Saran","year":"2003","journal-title":"Kidney Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/sdi.12925","article-title":"Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients","volume":"33","author":"Murali","year":"2020","journal-title":"Semin. Dial."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1111\/j.1432-2277.2009.00881.x","article-title":"Interventions to improve medication-adherence after transplantation: A systematic review","volume":"22","author":"Matteson","year":"2009","journal-title":"Transpl. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/BF00844851","article-title":"Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients","volume":"4","author":"Cummings","year":"1981","journal-title":"J. Behav. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S1051-2276(98)90019-X","article-title":"The effect of a self-monitoring tool on self-efficacy, health beliefs, and adherence in patients receiving hemodialysis","volume":"8","author":"Tanner","year":"1998","journal-title":"J. Ren. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1037\/0278-6133.21.4.393","article-title":"Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis","volume":"21","author":"Christensen","year":"2002","journal-title":"Health Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/S0738-3991(02)00036-8","article-title":"Stages of change and fluid intake in dialysis patients","volume":"49","author":"Molaison","year":"2003","journal-title":"Patient Educ. Couns."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1046\/j.1365-2648.2003.02725.x","article-title":"Self-efficacy training for patients with end-stage renal disease","volume":"43","author":"Tsay","year":"2003","journal-title":"J. Adv. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1053\/j.ajkd.2005.02.032","article-title":"A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: A randomized controlled trial","volume":"45","author":"Sharp","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_18","first-page":"217","article-title":"Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention","volume":"39","year":"2012","journal-title":"Nephrol. Nurs. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/nhs.12003","article-title":"Effect of health contract intervention on renal dialysis patients in Korea","volume":"15","author":"Cho","year":"2013","journal-title":"Nurs. Health Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/nur.21539","article-title":"Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis","volume":"36","author":"Welch","year":"2013","journal-title":"Res. Nurs. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1681\/ASN.2012111134","article-title":"Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis","volume":"25","author":"Cukor","year":"2014","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1053\/j.ajkd.2017.09.014","article-title":"Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A. Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis","volume":"71","author":"Griva","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/hdi.12744","article-title":"The effect of a hemodialysis patient education program on fluid control and dietary compliance","volume":"23","year":"2019","journal-title":"Hemodial Int."},{"key":"ref_24","first-page":"5869","article-title":"Effects of rational-emotive therapy on adherence to fluid restrictions of patients maintained on hemodialysis prior to and after kidney transplantation","volume":"31","author":"Hou","year":"2020","journal-title":"J. Clin. Rehab. Tissue Eng. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ctim.2014.10.011","article-title":"Improving adherence and biomedical markers in hemodialysis patients: The effects of relaxation therapy","volume":"23","author":"Pasyar","year":"2015","journal-title":"Complement. Ther. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1053\/j.jrn.2015.04.005","article-title":"The effect of psychological intervention on thirst and interdialytic weight gain in patients on chronic hemodialysis: A randomized controlled trial","volume":"25","author":"Bellomo","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s12160-015-9741-0","article-title":"Effect of a Behavioral Self-Regulation Intervention on Patient Adherence to Fluid-Intake Restrictions in Hemodialysis: A Randomized Controlled Trial","volume":"50","author":"Howren","year":"2016","journal-title":"Ann. Behav. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/ndt\/gfv084","article-title":"High versus low dialysate sodium concentration in chronic haemodialysis patients: A systematic review of 23 studies","volume":"31","author":"Basile","year":"2016","journal-title":"Nephrol. Dial Transpl."},{"key":"ref_29","first-page":"CD011204","article-title":"Low dialysate sodium levels for chronic haemodialysis","volume":"1","author":"Dunlop","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1681\/ASN.2019090877","article-title":"Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial","volume":"31","author":"Marshall","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1007\/s11255-024-03972-3","article-title":"Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: A systematic review and meta-analysis","volume":"56","author":"Bossola","year":"2024","journal-title":"Int. Urol. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0272-6386(82)80093-0","article-title":"The chronic efficacy and safety of high sodium dialysate: Double-blind, crossover study","volume":"2","author":"Henrich","year":"1982","journal-title":"Am. J. Kidney Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1046\/j.1440-1797.2000.00004.x","article-title":"Low-sodium hemodialysis without fluid removal improves blood pressure control in chronic hemodialysis patients","volume":"5","author":"Farmer","year":"2000","journal-title":"Nephrology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1111\/j.1523-1755.2004.00876.x","article-title":"Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients","volume":"66","author":"Peixoto","year":"2004","journal-title":"Kidney Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1053\/j.ajkd.2011.06.030","article-title":"Effect of lowering dialysate sodium concentration on interdialytic weight gain and blood pressure in patients undergoing thrice-weekly in-center nocturnal hemodialysis: A quality improvement study","volume":"58","author":"Bayes","year":"2011","journal-title":"Am. J. Kidney Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3889\/oamjms.2016.056","article-title":"Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis","volume":"4","author":"Grozdanovski","year":"2016","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Manji, S., Shah, J., Twahir, A., and Sokwala, A. (2021). Association between dialysate sodium concentration and interdialytic weight gain in patients undergoing twice weekly haemodialysis. BMC Nephrol., 22.","DOI":"10.1186\/s12882-021-02401-2"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/j.ajkd.2014.10.021","article-title":"Effect of low versus high dialysate sodium concentration on blood pressure and endothelial-derived vasoregulators during hemodialysis: A randomized crossover study","volume":"65","author":"Inrig","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"742","DOI":"10.3109\/0886022X.2013.789961","article-title":"Effect of dialysate sodium reduction on body water volume, blood pressure, and inflammatory markers in hemodialysis patients\u2014A prospective randomized controlled study","volume":"35","author":"Beduschi","year":"2013","journal-title":"Ren. Fail."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Nkf Kdoqi Guidelines (2006). Clinical Practice Guidelines for Hemodialysis Adequacy, Update 2006. Am. J. Kidney Dis., 48, S2\u2013S90.","DOI":"10.1053\/j.ajkd.2006.03.051"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1365-2702.2010.03348.x","article-title":"An exploration of the relationship between adherence with dietary sodium restrictions and health beliefs regarding these restrictions in Irish patients receiving haemodialysis for end-stage renal disease","volume":"20","author":"Walsh","year":"2011","journal-title":"J. Clin. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"87","DOI":"10.5935\/0101-2800.20130015","article-title":"Factors associated to salt intake in chronic hemodialysis patients","volume":"35","author":"Nerbass","year":"2013","journal-title":"J. Bras. Nefrol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/039139888801100307","article-title":"Quantitative estimation of dietary intake in patients on hemodialysis","volume":"11","author":"Kimura","year":"1988","journal-title":"Int. Artif. Organs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/CIRCULATIONAHA.109.192703","article-title":"Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association\u2019s strategic Impact Goal through 2020 and beyond","volume":"121","author":"Hong","year":"2010","journal-title":"Circulation"},{"key":"ref_45","first-page":"71","article-title":"Assessment of salt intake in hemodialysis","volume":"21","author":"Maduell","year":"2001","journal-title":"Nefrologia"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"217","DOI":"10.17219\/acem\/67050","article-title":"Nutrient intake assessed with Diet History Questionnaire II, in relation to long-term calcium-phosphate control in hemodialysis patients with end-stage renal failure","volume":"27","author":"Wyskida","year":"2018","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/ckj\/sfx037","article-title":"Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires","volume":"10","author":"Gkza","year":"2017","journal-title":"Clin. Kidney J."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Xie, Z., McLean, R., and Marshall, M. (2018). Dietary sodium and other nutrient intakes among patients undergoing hemodialysis in New Zealand. Nutrients, 10.","DOI":"10.3390\/nu10040502"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1053\/j.jrn.2018.01.015","article-title":"The frustrating attempt to limit the interdialytic weight gain in patients on chronic hemodialysis: New insights into an old problem","volume":"28","author":"Bossola","year":"2018","journal-title":"J. Ren. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.clnesp.2024.06.022","article-title":"Interdialytic weight gain and low-salt diet in patients on chronic hemodialysis: A systematic review and meta-analysis","volume":"63","author":"Bossola","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1093\/ndt\/gfn599","article-title":"The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis","volume":"24","author":"Kayikcioglu","year":"2009","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/hdi.12902","article-title":"Pilot study to reduce interdialytic weight gain by provision of low-sodium, home-delivered meals in hemodialysis patients","volume":"25","author":"Perez","year":"2021","journal-title":"Hemodial. Int."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Bossola, M., Di Stasio, E., Viola, A., Cenerelli, S., Leo, A., Santarelli, S., and Monteburini, T. (2020). Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis. Nutrients, 12.","DOI":"10.3390\/nu12010260"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1159\/000517340","article-title":"A Systematic Review and Meta-Analysis: Hyponatremia Predicted All-Cause and Cardiovascular Mortality in Dialysis Population","volume":"51","author":"Li","year":"2022","journal-title":"Blood Purif."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1159\/000492034","article-title":"Salt Intake and All-Cause Mortality in Hemodialysis Patients","volume":"48","author":"Ikenoue","year":"2018","journal-title":"Am. J. Nephrol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Suzuki, N., Hitomi, Y., Takata, H., Ushiya, S., Yamada, M., Sakai, Y., Konishi, T., Takeda, Y., Sumino, Y., and Mizo, M. (2021). Association between salt intake and long-term mortality in hemodialysis patients: A retrospective cohort study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0260671"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/ndt\/gfv341","article-title":"Pre-dialysis serum sodium and mortality in a national incident hemodialysis cohort","volume":"31","author":"Rhee","year":"2016","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s11259-023-10104-2","article-title":"Thirst: Neuroendocrine regulation in mammals","volume":"47","author":"Todini","year":"2023","journal-title":"Vet. Res. Commun."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"R1260","DOI":"10.1016\/j.cub.2016.11.019","article-title":"Thirst","volume":"26","author":"Leib","year":"2016","journal-title":"Curr Biol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Mount, D.B., Sayegh, M.H., and Singh, A.K. (2012). Core Concepts in the Disorders of Fluid, Electrolytes and Acid-Base Balance, Springer. Chapter: The Physiology of Water Homeostasis.","DOI":"10.1007\/978-1-4614-3770-3"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrneph.2017.149","article-title":"The neural basis of homeostatic and anticipatory thirst","volume":"14","author":"Gizowski","year":"2018","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/nrn.2017.71","article-title":"Neural circuits underlying thirst and fluid homeostasis","volume":"18","author":"Zimmerman","year":"2017","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13741-017-0081-4","article-title":"The sensitivity of the human thirst response to changes in plasma osmolality: A systematic review","volume":"7","author":"Hughes","year":"2018","journal-title":"Perioper. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s11255-020-02401-5","article-title":"Thirst in patients on chronic hemodialysis: What do we know so far?","volume":"52","author":"Bossola","year":"2020","journal-title":"Int. Urol. Nephrol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1038\/nrneph.2011.218","article-title":"Xerostomia in patients on chronic hemodialysis","volume":"8","author":"Bossola","year":"2012","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s11255-013-0576-y","article-title":"Sodium gradient, xerostomia, thirst and inter-dialytic excessive weight gain: A possible relationship with hyposalivation in patients on maintenance hemodialysis","volume":"46","author":"Zwiech","year":"2014","journal-title":"Int. Urol. Nephrol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1053\/ajkd.2000.19810","article-title":"Decreased salivary function in patients with end-stage renal disease requiring hemodialysis","volume":"36","author":"Kao","year":"2000","journal-title":"Am. J. Kidney Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/BF02993714","article-title":"Salivary function in patients with chronic renal failure undergoing hemodialysis","volume":"16","author":"Kaya","year":"2002","journal-title":"Ann. Nucl. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/S0272-6386(03)00908-9","article-title":"Salivary and lacrimal secretion is reduced in patients with ESRD","volume":"42","author":"Postorino","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1177\/00220345000790090301","article-title":"Low unstimulated salivary flow and subjective oral dryness: Association with medication, anxiety, depression, and stress","volume":"79","author":"Bergdahl","year":"2000","journal-title":"J. Dent. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/00006842-199803000-00018","article-title":"Depressive symptoms as an underlying factor of the sensation of dry mouth","volume":"60","author":"Anttila","year":"1998","journal-title":"Psychosom. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1002\/dmrr.396","article-title":"The symptoms of hyperglycaemia in people with insulin-treated diabetes: Classification using principal components analysis","volume":"19","author":"Warren","year":"2003","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/SPC.0000000000000314","article-title":"Thirst in heart failure: What do we know so far","volume":"12","author":"Allida","year":"2018","journal-title":"Curr. Opin. Support. Palliat. Care"},{"key":"ref_74","first-page":"168","article-title":"Enhancing Oral Mucosal Barrier, Mitigating Microinflammation, and Addressing Malnutrition in Dialysis Patients: The Impact of Tangerine Peel Lemon Glycerin","volume":"30","author":"Ao","year":"2024","journal-title":"Altern. Ther. Health Med."},{"key":"ref_75","first-page":"337","article-title":"Development of the thirst distress scale","volume":"29","author":"Welch","year":"2022","journal-title":"Nephrol. Nurs. J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1111\/j.1523-1755.2004.00933.x","article-title":"Interdialytic weight gain in patients on hemodialysis is associated with dry mouth and thirst","volume":"66","author":"Bots","year":"2004","journal-title":"Kidney Int."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"233","DOI":"10.2147\/TCRM.S240125","article-title":"Enhancement of Adherence to Therapeutic and Lifestyle Recommendations Among Hemodialysis Patients: An Umbrella Review of Interventional Strategies","volume":"16","author":"Zhianfar","year":"2020","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_78","unstructured":"World |Health Organization (1998). Therapeutic Patient Education: Continuing Education Programmes for Health Care Providers in the Field of Prevention of Chronic Diseases: Report of a WHO Working Group, World Health Organization, Regional Office for Europe."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1159\/000448856","article-title":"Current psychosomatic practice","volume":"86","author":"Fava","year":"2017","journal-title":"Psychother. Psychosom."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e020633","DOI":"10.1136\/bmjopen-2017-020633","article-title":"Efficacy and safety of intradialytic exercise in haemodialysis patients: A systematic review and meta-analysis","volume":"9","author":"Pu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3904\/kjim.2017.020","article-title":"Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients","volume":"34","author":"Rhee","year":"2019","journal-title":"Korean J. Intern. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/ckj\/sfv099","article-title":"Effects of exercise in the whole spectrum of chronic kidney disease: A systematic review","volume":"8","author":"Barcellos","year":"2015","journal-title":"Clin. Kidney J."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1177\/0269215518760380","article-title":"Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: Systematic review and meta-analysis","volume":"32","author":"Lopes","year":"2018","journal-title":"Clin. Rehabil."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"430","DOI":"10.2215\/CJN.05980613","article-title":"Improving outcomes for ESRD patients: Shifting the quality paradigm","volume":"9","author":"Nissenson","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.hrtlng.2024.04.012","article-title":"Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis","volume":"67","author":"Wefer","year":"2024","journal-title":"Heart Lung"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.1875-595X.2004.tb00270.x","article-title":"Preferences and saliva stimulation of eight different chewing gums","volume":"54","author":"Bots","year":"2004","journal-title":"Int. Dent. J."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.physbeh.2009.02.028","article-title":"Chewing gum alleviates negative mood and reduces cortisol during acute laboratory psychological stress","volume":"97","author":"Scholey","year":"2009","journal-title":"Physiol. Behav."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.hlc.2020.09.004","article-title":"A RandomisEd ControLled TrIal of ChEwing Gum to RelieVE Thirst in Chronic Heart Failure (RELIEVE-CHF)","volume":"30","author":"Allida","year":"2021","journal-title":"Heart Lung Circ."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Chen, Y.Q., Wang, C.L., Chiu, A.H., Yeh, M.C., and Chiang, T.I. (2023). Chewing Gum May Alleviate Degree of Thirst in Patients on Hemodialysis. Medicina, 60.","DOI":"10.3390\/medicina60010002"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1191\/0269216305pm1009oa","article-title":"The management of xerostomia in patients on haemodialysis: Comparison of artificial saliva and chewing gum","volume":"19","author":"Bots","year":"2005","journal-title":"Palliat. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1159\/000355717","article-title":"Study on the clinical significance and related factors of thirst and xerostomia in maintenance hemodialysis patients","volume":"37","author":"Fan","year":"2013","journal-title":"Kidney Blood Press Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.1097\/NUR.0000000000000234","article-title":"The Null Effect of Chewing Gum During Hemodialysis on Dry Mouth","volume":"30","author":"Duruk","year":"2016","journal-title":"Clin. Nurse Spec."},{"key":"ref_93","first-page":"20","article-title":"The Effect of Acupressure Applied to Individuals Receiving Hemodialysis Treatment on Severity of Thirst and Quality of Life","volume":"27","year":"2021","journal-title":"Altern. Ther. Health Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1159\/000317933","article-title":"Effect of Acupressure on Thirst in Hemodialysis Patients","volume":"33","author":"Yang","year":"2010","journal-title":"Kidney Blood Press Res."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Oh, J.E., and Kim, S.N. (2022). Anti-Inflammatory Effects of Acupuncture at ST36 Point: A Literature Review in Animal Studies. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.813748"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1142\/S0192415X24500496","article-title":"Acupuncture: An Overview on Its Functions, Meridian Pathways and Molecular Mechanisms","volume":"52","author":"Rong","year":"2024","journal-title":"Am. J. Chin. Med."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Wang, S.J., Zhang, J.J., Yang, H.Y., Wang, F., and Li, S.T. (2015). Acupoint specificity on acupuncture regulation of hypothalamic- pituitary-adrenal cortex axis function. BMC Complement. Altern. Med., 15.","DOI":"10.1186\/s12906-015-0625-4"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"4180","DOI":"10.1093\/ndt\/gfs021","article-title":"Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: Results from the dialysis. outcomes and practice patterns study (DOPPS)","volume":"27","author":"Tentori","year":"2012","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"FHN Trial Group, Chertow, G.M., Levin, N.W., Beck, G.J., Depner, T.A., Eggers, P.W., Gassman, J.J., Gorodetskaya, I., Greene, T., and James, S. (2010). In-center hemodialysis six times per week versus three times per week. N. Engl. J. Med., 363, 2287\u20132300.","DOI":"10.1056\/NEJMoa1001593"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"CJN.08240718","DOI":"10.2215\/CJN.08240718","article-title":"Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes","volume":"14","author":"Dasgupta","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"036","DOI":"10.29328\/journal.jcn.1001057","article-title":"Correlation between interdialytic weight gain, left ventricular hypertrophy and FGF-23 in prevalent hemodialysis patients","volume":"4","author":"Shawky","year":"2020","journal-title":"J. Clin. Nephrol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/ki.2010.383","article-title":"Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality","volume":"79","author":"Flythe","year":"2011","journal-title":"Kidney Int."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/ki.2012.346","article-title":"Shorter length dialysis sessions are associated with increased mortality, independent of body weight","volume":"83","author":"Flythe","year":"2013","journal-title":"Kidney Int."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1038\/ki.2009.523","article-title":"Shorter dialysis times are associated with higher mortality among incident hemodialysis patients","volume":"77","author":"Brunelli","year":"2010","journal-title":"Kidney Int."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1186\/1745-6215-15-483","article-title":"Ultrafiltration biofeedback guided by blood volume monitoring to reduce intradialytic hypotensive episodes in hemodialysis: Study protocol for a randomized controlled trial","volume":"15","author":"Leung","year":"2014","journal-title":"Trials"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.2215\/CJN.01030117","article-title":"Randomized crossover trial of blood volume monitoring\u2013guided ultrafiltration biofeedback to reduce intradialytic hypotensive episodes with hemodialysis","volume":"12","author":"Leung","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1007\/s11606-019-05215-z","article-title":"Efficacy of biofeedback for medical conditions: An evidence map","volume":"34","author":"Kondo","year":"2019","journal-title":"J. Gen. Intern. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"805","DOI":"10.3346\/jkms.2014.29.6.805","article-title":"Efficacy of hemocontrol biofeedback system in intradialytic hypotension-prone hemodialysis patients","volume":"29","author":"Gil","year":"2014","journal-title":"J. Korean Med. Sci."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Flythe, J., Assimon, M., and Overman, R. (2017). Target weight achievement and ultrafiltration rate thresholds: Potential patient implications. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0595-5"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"309","DOI":"10.21608\/menj.2023.315264","article-title":"Effect of sugar free gum chewing on thirst and interdialytic weight gain among patients undergoing hemodialysis","volume":"8","author":"Mohamed","year":"2023","journal-title":"Menoufia Nurs. J."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s40620-023-01844-0","article-title":"Comparison of blood volume biofeedback hemodialysis and conventional hemodialysis on cardiovascular stability and blood pressure control in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials","volume":"37","author":"Mambelli","year":"2024","journal-title":"J. Nephrol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/hdi.13033","article-title":"Artificial intelligence and digital health for volume maintenance in hemodialysis patients","volume":"26","author":"Sandys","year":"2022","journal-title":"Hemodial. Int."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Chiauzzi, E., Rodarte, C., and DasMahapatra, P. (2015). Patient-centered activity monitoring in the self-management of chronic health conditions. BMC Med., 13.","DOI":"10.1186\/s12916-015-0319-2"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Schoutteten, M., Vranken, J., Lee, S., Smeets, C.J.P., De Canni\u00e8re, H., Van Hoof, C., Peeters, J., Groenendaal, W., and Vandervoort, P.M. (2020). Towards personalized fluid monitoring in haemodialysis patients: Thoracic bioimpedance signal shows strong correlation with fluid changes, a cohort study. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-01922-6"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.ekir.2018.11.016","article-title":"Nutritional mobile applications for ckd patients: Systematic review","volume":"4","author":"Kosa","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"161","DOI":"10.37363\/bnr.2023.41222","article-title":"The effect of using fluid balance application on interdialytic weight gain in stage v chronic kidney disease patients undergoing hemodialysis","volume":"4","author":"Sulistyaningrum","year":"2023","journal-title":"Babali Nurs. Res."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/jjns.12249","article-title":"Integrated self-management program effects on hemodialysis patients: A quasi-experimental study","volume":"16","author":"Park","year":"2019","journal-title":"Jpn. J. Nurs. Sci."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Delano, M., Ganapati, V., Kamal, R., Le, B., Le, J., and Mendoza, R. (2022). Evaluating research grade bioimpedance hardware using textile electrodes for long-term fluid status monitoring. Front. Electron., 2.","DOI":"10.3389\/felec.2021.762442"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1800444","DOI":"10.1002\/admt.201800444","article-title":"Recent advances in smart wearable sensing systems","volume":"3","author":"Lou","year":"2018","journal-title":"Adv. Mater. Technol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"2100120","DOI":"10.1002\/sstr.202100120","article-title":"Scalably nanomanufactured atomically thin materials-based wearable health sensors","volume":"3","author":"Zhang","year":"2021","journal-title":"Small Struct."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"20552076231153737","DOI":"10.1177\/20552076231153737","article-title":"Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: A mixed-methods study","volume":"9","author":"Toh","year":"2023","journal-title":"Digit. Health"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"152","DOI":"10.2215\/CJN.01970219","article-title":"Ambulatory hemodialysis-technology landscape and potential for patient-centered treatment","volume":"15","author":"Hojs","year":"2019","journal-title":"Clin. J. Am. Soci. Nephrol."},{"key":"ref_123","first-page":"511","article-title":"Evaluating the effectiveness of a novel personalized health education approach for hemodialysis patients: A four-week study using a widely-used communication app in taiwan","volume":"316","author":"Lin","year":"2024","journal-title":"Stud. Health Technol. Inform."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1846\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:49:42Z","timestamp":1760028582000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,9]]},"references-count":123,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14061846"],"URL":"https:\/\/doi.org\/10.3390\/jcm14061846","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,9]]}}}