( see related articles by basile and lomonte . a neglected issue in dialysis practice : haemodialysate .
 in two recent ckj reviews , experts ( basile and lomonte and locatelli et al . ) 
 have reviewed haemodialysate composition . a long - neglected issue , 
 observational studies have associated the composition of haemodialysate to adverse outcomes . 
 however , the scarcity of clinical trial - derived information results in limited guideline recommendations on the issue . 
 indeed , guidelines have more frequently indicated what not to do rather than what to do . in this 
 setting , expert opinion becomes invaluable . in designing haemodialysate composition 
 , a balance should be struck between the need to correct within a time frame of around 4 hours the electrolyte and water imbalances that take 48 to 72 h to build , with the need for gradual correction of these imbalances . 
 the issue is complicated further by the impact of individual variability in dietary habits , medications and comorbidities . in this regard , a personalized medicine approach to individualization of haemodialysate 
 composition offers the best chance of improving patient outcomes . but how can haemodialysate individualization be achieved , and what clinical trial design will best test the impact of such approaches on patient outcomes ? 
Conflict of interest statement