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The Effect of Citrasate Dialysate on Heparin Dose in Hemodialysis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01466959
Recruitment Status : Completed
First Posted : November 8, 2011
Last Update Posted : March 26, 2013
Information provided by (Responsible Party):
Dr Jennifer MacRae, University of Calgary

Brief Summary:
An alternative to systemic heparin anticoagulation for HD is citrate dialysate (CD). CD contains a small amount of citric acid rather than acetic acid as the acidifying agent. The use of citrasate may lead to lower heparin requirements in hemodialysis. This is a randomized, double blinded, two-period crossover trial in HD patients to compare the effect of citrasate dialysis (CD) and usual acetic-acid based dialysate (AD) on heparin dose.

Condition or disease Intervention/treatment Phase
Chronic Kidney Disease Other: citrate dialysate (CD) Other: acetic-acid based dialysate (AD) Not Applicable

Detailed Description:

The investigators will perform a randomized, double-blind, two-period crossover trial in chronic HD patients to compare the effect of citrasate dialysate (CD) and usual acetic-acid based dialysate (AD) on the cumulative intradialytic heparin dose. There is a four week run in phase followed by two weeks of intervention AD or CD followed by the remaining AD or CD intervention.

The primary outcome is change in intradialytic heparin dose achieved with citrasate compared with acetate dialysate. Secondary outcomes are the effect of CD compared with AD on systemic anticoagulation, bleeding time after HD, metabolic parameters, dialysis adequacy, inflammation, hemodynamic stability, and intra-rater and inter-rater reliability of the dialyzer clotting score.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Supportive Care
Official Title: The Effect of Citrasate Dialysate on Heparin Dose: A Randomized Cross Over Trial in Hemodialysis Patients.
Study Start Date : November 2011
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: AD- acetic acid dialysate
AD is a standard bicarbonate based dialysate with a small amount of acetic acid which is the standard of care for dialysis.
Other: acetic-acid based dialysate (AD)
Acetate based dialysate; AD is the standard dialysate used in hemodialysis runs 4 hours three times weekly. For the study it will be used for a period of 2 weeks and compared to the CD study time period.
Other Names:
  • Acetic acid dialysate
  • Acetate dialysate

Experimental: CD - citrasate dialysate
Dialysis with a citric acid based dialyasate.
Other: citrate dialysate (CD)
Citrasate (CD) is substituted as the dialysate during the patients regular dialysis run 4hours three times weekly for a period of 2 weeks. The only difference between citrasate and the regular dialysate is the lack of acetic acid.
Other Names:
  • Citrasate
  • Citric acid dialysate

Primary Outcome Measures :
  1. The change from baseline in the cumulative dose of heparin anticoagulation used during conventional HD [ Time Frame: 2 weeks after CD exposure, 2 weeks after AD exposure ]

Secondary Outcome Measures :
  1. The change from baseline in the number of bleeding events, and bleeding time after HD. [ Time Frame: After 2 weeks of exposure to CD ]
  2. The change from baseline in the number of intradialytic hypotension episodes and the change from baseline in the QT interval [ Time Frame: 2 weeks after intervention exposure ]
  3. The change in small and middle solute clearance from baseline. [ Time Frame: 2 weeks post exposure ]
  4. The change from baseline on laboratory inflammatory markers as well as ionized calcium (iCa), magnesium (Mg), and bicarbonate (HCO3). [ Time Frame: 2 weeks post exposure ]
  5. The intra-rater and inter-rater reliability of our dialyzer / venous chamber clotting score. [ Time Frame: 2 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • chronic stable HD patients ≥ 18 years
  • on HD at least three times per week for at least 3 months

Exclusion Criteria:

  • contraindication to heparin
  • currently using heparin-free HD
  • known clotting disorder
  • on warfarin therapy
  • dialyzing with a dysfunctional central venous catheter (blood flow rates consistently less than 300mL/min and/or frequent use of thrombolytic)
  • history of vascular access dysfunction
  • planned vascular access conversion or procedure during the study period
  • use of high calcium dialysate
  • active medical issue requiring hospitalization
  • planned kidney transplant during the study period
  • planned conversion of dialysis modality (peritoneal dialysis, nocturnal dialysis) during the study period
  • unable to provide informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01466959

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Canada, Alberta
University of Calgary
Calgary, Alberta, Canada, T2N 2T9
Sponsors and Collaborators
University of Calgary
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Study Director: Jennifer M MacRae, MD FRCPC University of Calgary

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Dr Jennifer MacRae, Principal investigator, University of Calgary Identifier: NCT01466959    
Other Study ID Numbers: ID24009
First Posted: November 8, 2011    Key Record Dates
Last Update Posted: March 26, 2013
Last Verified: March 2013
Keywords provided by Dr Jennifer MacRae, University of Calgary:
acetate based dialysate
citrasate dialysate
heparin anticoagulation
hemodynamic stability
Additional relevant MeSH terms:
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Calcium heparin
Calcium Chelating Agents
Kidney Diseases
Renal Insufficiency, Chronic
Urologic Diseases
Renal Insufficiency
Acetic Acid
Retinol acetate
Citric Acid
Sodium Citrate
Dialysis Solutions
Chelating Agents
Sequestering Agents
Molecular Mechanisms of Pharmacological Action
Fibrinolytic Agents
Fibrin Modulating Agents
Pharmaceutical Solutions
Anti-Bacterial Agents
Anti-Infective Agents
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Anticarcinogenic Agents
Protective Agents
Antineoplastic Agents