In this review, dialysis fluid composition and management in routine practice were reassessed and promising new advances were examined. The result is a comprehensive handbook with state-of-the-art recommendations for the choice of dialysis fluid constituents, for the optimal concentrations thereof, and for improved management of the dialysis fluid regarding its chemical and microbial purity as well as its temperature and flow characteristics. Furthermore, on-line changes to the dialysis fluid prescription, as conducted in profiling and biofeedback approaches, are considered. The role of ultrafiltration was particularly focused on, as the adequate and controlled removal of excess water from the patient is one of the key factors in dialysis efficiency and tolerance. A multitude of uremic syndrome and dialysis related complications can be alleviated or even prevented by appropriate adjustments to the dialysis fluid composition and management.