This is a physiology study of two commercially available dialysate acid concentrates. It is
a prospective, single center single blind, cross-over, two week investigation of
intradialytic acid-base kinetics and physiology using two commercially available acetate
hemodialysate compositions in prevalent hemodialysis patients.
Approximately 10-20 prevalent hemodialysis patients will be recruited. Subjects will receive
one weekly hemodialysis treatment using each of the two acetate acid dialysates of
NaturaLyte and GranuFlo.
Subjects eligible to be entered into this study will meet all of the following criteria:
1. Adult female or male patients; age ≥18 years.
2. End stage renal disease (ESRD) patients treated for >90 days with the modality of
maintenance hemodialysis receiving treatments three times per week for the prior
3. Patients utilizing a hemodialysis vascular access of a functioning arteriovenous
fistula (AVF) or graft (AVG) during the prior month. The patient's AVF/AVG must be
considered in stable functioning condition and not be expected to require any
surgical revision/intervention during participation in the trial.
4. Patients with an average spKt/V of ≥1.2 during 30 days prior to screening as
determined by historic monthly laboratory adequacy measurements; for patients with
only one available spKt/V an average will not be performed. (Note: spKt/V should not
be captured from dialysis machine adequacy measurements.)
5. A sodium bicarbonate basic dialysate prescription that has not had any changes for 30
days prior to randomization, and is anticipated to be unchanged during study
participation as determined by the investigator.
6. Unchanged heparin dosing regimen for the past 30 days prior to randomization and
anticipated unchanged heparin dosing during participation in this clinical trial.
7. No changes two weeks prior to randomization or anticipated changes throughout the
study in any phosphate binders, calcium supplements, anticoagulant therapies that are
not used for hemodialysis treatment (e.g. warfarin, dabigatran, apixaban, rivaroxaban
and acetylsalicylic acid (ASA)), non-dialysate sodium bicarbonate and/or citrate
based concomitant medications.
8. No significant change in predialysis weight (i.e. >2kg in change) within two weeks
prior to screening.
9. Willing to comply with all study procedures and be available for the duration of the
1. Patients unable to provide a signed and dated informed consent for this clinical
2. Pregnant or lactating female patients.
3. Females of reproductive potential who do not agree to use a highly effective method
of contraception, as determined by the investigator.
4. Missed or anticipated to not attend any prescribed hemodialysis treatments within two
weeks prior to screening and during participation in the study.
5. Screening or historic laboratory values of aspartate aminotransferase (AST), alanine
transaminase (ALT), and alkaline phosphatase (ALP) levels ≥ 2 times the upper limit
of normal. These blood laboratory tests must have been performed within 30 days prior
to screening or prior to randomization.
6. A screening or historic laboratory value of total bilirubin >1.9 mg/dL that was
collected within 30 days prior to screening or obtained before randomization.
7. Uncontrolled anemia as defined as a screening or historic hemoglobin value of <9 g/dL
that was collected within 30 days before screening or prior to randomization.
8. Uncontrolled clinically significant blood pressure as determined by the investigator
within 30 days prior to screening.
9. Active or recent bleeding disorder within the past 30 days.
10. Screening or historic platelet count <100,000 platelets per microliter (mcL) that was
collected within 30 days prior to screening or before randomization.
11. Chronic supplemental oxygen use within 30 days prior to randomization.
12. Current active and significant chronic obstructive pulmonary disease (COPD) as
determined by the investigator.
13. Currently treated or recently treated in the past 30 days with
glucocorticoids/corticosteroids, with exception of inhaled and/or topical