Lay summary
Dialysis patients have a short longevity, and most die from cardiovascular disease. Cumulative clinical experience and research strongly suggests that this is driven by persistent fluid overload and elevated blood pressure, which contributes cardiac damage and sudden cardiac death. Reducing sodium exposure during dialysis is a promising intervention that may reduce cardiovascular mortality, by mitigating some of the cardiac damage. However, this intervention may also make blood pressure unstable, and harm patients if they are medically frail. We will perform a pragmatic phase 4, multi-centre, cluster-randomised controlled clinical trial of NZ dialysis units as part of a wider global trial, randomising NZ incentre dialysis units to higher versus lower sodium exposure during dialysis. We will determine whether this reduces clinical cardiovascular events, and determine effects of this intervention on hospitalisation and drug cost in our local New Zealand patients. This intervention is free, and if effective could be implemented overnight.