Comparison of 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. 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