Dial-Bicarb Trial: Lower vs. Higher Dialysate Bicarbonate Concentration in Patients Receiving Hemodialysis

We are planning to conduct a trial that will compare different concentrations of bicarbonate in the dialysis solution. The bicarbonate concentrations compared in this trial will fall in the range of what is already used in the Canadian hemodialysis centres. There is some early evidence to suggest that a higher concentration of bicarbonate in the dialysis solution may increase the risk of death and hospitalization. We will use a new, streamlined approach to do this large trial, which will be done in more than 140 Canadian hemodialysis centres (which during the 4-year trial period will care for more than 20,000 patients and provide over 12 million dialysis treatments). The streamlined approach includes analyzing information already collected in routine care that is stored in large healthcare databases. If we can show that a lower concentration of bicarbonate in the dialysis solution reduces the risk of death and hospitalization and overall improves patient health, then it could become the standard of care for all patients worldwide. This simple adjustment to the dialysis procedure can be done at no added cost and may even help to reduce healthcare costs.