Dialysate Sodium Lowering Trial

Inclusion Criteria: * Age \>18 years * Patients undergoing thrice weekly in-center conventional HD * At least 90 days since start of hemodialysis * Absence of pulmonary edema / signs of fluid overload on physical exam * Currently dialyzing at a DNa \>=137 mEq/L * Single session Kt/V \>=1.3 each month for the past 2 months * Hypertensive, defined by a pre-dialysis BP of \>140/90 or treatment with 1 or more antihypertensive agents * No more than 1 skipped treatment and no more than 1 session per month shortened by \>10 min * Life expectancy \>12 months * Able to provide Informed Consent * Speaks and understands English Exclusion Criteria: * Prone to IDH, defined as IDH occurring in \>10% of treatments in the past 3 months. IDH will be defined as symptoms (e.g. cramps, dizziness, loss of consciousness) and/or intra- or post-dialytic systolic BP \<90 mm Hg and/or use of intervention(s) (UF goal lowered, treatment stopped early, or saline given) because of IDH * Pregnancy