Comparison of High Versus Low Bicarbonate Hemodialysis

Intradialytic Acid-base Changes and Organic Anion Production With High Versus Low Bicarbonate Hemodialysis

This study will compare hemodialysis treatment with a standard, high-bicarbonate dialysis bath versus a lower bicarbonate dialysis bath, and will compare intradialytic acid-base changes and overall control of metabolic acidosis with the 2 treatment regimens.

This study will compare hemodialysis treatment with a standard, high-bicarbonate dialysis bath versus a lower bicarbonate dialysis bath, and will compare intradialytic acid-base changes and overall control of metabolic acidosis with the 2 treatment regimens. These parameters will be assessed in patients currently receiving high-bicarbonate hemodialysis as part of usual care. They will then be switched to a lower bicarbonate prescription, after which these parameters will be reassessed. The study will also examine changes in inflammatory markers, glycemic control, ketogenesis, and lipolysis.

Inclusion Criteria:

• Age >18
• Receiving chronic thrice-weekly conventional hemodialysis for at least 6 months

Exclusion Criteria:

• Use of oral alkali within the previous month
• Hospitalization within the previous month
• Inability to provide written informed consent
• Plans for kidney transplant in the next 2 months
• Planned change in phosphate binder therapy within the next month
• Pregnancy, or planned pregnancy in the next 2 months