Introduction: Patients with kidney failure undergoing maintenance hemodialysis (HD) therapy are routinely counseled to reduce dietary sodium intake to ameliorate sodium retention, volume overload, and hypertension. However, low-sodium diet trials in HD are sparse and indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake. This study aimed to determine whether 4 weeks of low-sodium, home-delivered meals in HD patients reduces interdialytic weight gain (IDWG). Secondary outcomes included changes in dietary sodium intake, thirst, xerostomia, blood pressure, volume overload, and muscle sodium concentration.Methods: Twenty HD patients (55 AE 12 years, body mass index [BMI] 40.7 AE 16.6 kg/m 2 ) were enrolled in this study. Participants followed a usual (control) diet for the first 4 weeks followed by 4 weeks of three low-sodium, home-delivered meals per day. We measured IDWG, hydration status (bioimpedance), standardized blood pressure (BP), food intake (3-day dietary recall), and muscle sodium (magnetic resonance imaging) at baseline (0 M), after the 4-week period of usual diet (1 M), and after the meal intervention (2 M). Findings:The low-sodium meal intervention significantly reduced IDWG when compared to the control period (−0.82 AE 0.14 kg; 95% confidence interval, −0.55 to −1.08 kg; P < 0.001). There were also 1 month (1 M) to 2 month (2 M) reductions in dietary sodium intake (−1687 AE 297 mg; P < 0.001); thirst score (−4.4 AE 1.3; P = 0.003), xerostomia score (−6.7 AE 1.9; P = 0.002), SBP (−18.0 AE 3.6 mmHg; P < 0.001), DBP (−5.9 AE 2.0 mmHg; P = 0.008), and plasma phosphorus −1.55 AE 0.21 mg/dL; P = 0.005), as well as a 0 M to 2 M reduction in absolute volume overload (−1.08 AE 0.33 L; P = 0.025). However, there were no significant changes in serum or tissue sodium (all P > 0.05).Discussion: Low-sodium, home-meal delivery appears to be an effective method for improving volume control and blood pressure in HD patients. Future studies with larger sample sizes are needed to examine the long-term effects of home-delivered meals on these outcomes and to assess cost-effectiveness.