Multi-center Study to Investigate the Effects of Citrasate® on Heparin N Requirements During Hemodialysis Treatment
- Registration Number
- NCT01092455
- Lead Sponsor
- Randolph Quinn
- Brief Summary
The purpose of this study is to determine whether the use of Citrasate®, citric acid dialysate enables the reduction of the heparin N (anticoagulant) dose in patients undergoing hemodialysis.
- Detailed Description
During hemodialysis, waste products are removed from the blood by diffusion across the dialyzer membrane into an electrolyte solution known as dialysate. Dialysate is produced from acid concentrate, bicarbonate solution and water using a three stream proportioning system that mixes the acid concentrate, bicarbonate and water to produce the final dialysate. Patients are typically anticoagulated with heparin during dialysis to prevent blood from clotting in the extracorpoeial circuit. Heparin use is associated with significant risks including the possibility of bleeding, heparin induced thrombocytopenia (HIT) and contamination. For these reasons, the possibility of reducing heparin dose while maintaining HD adequacy is clinically attractive. Citrasate® is an FDA approved acid concentrate that contains citric acid (citrate) rather than acetic acid (acetate) which is traditionally used in acid concentrate. Citrate in higher concentrations is also a known anticoagulant. We are therefore conducting this study to determine whether the use of Citrasate, citric acid dialysate enables the reduction of the heparin requirements in patients undergoing hemodialysis.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 300
- Subject is capable of giving informed consent, or has an acceptable surrogate capable of giving consent on the subject's behalf.
- ESRD maintained on thrice weekly HD
- Stable Heparin prescription (Heparin dose) for the previous 4 weeks
- Dialyzed using bolus heparin anticoagulation with dose >/= 2000 units per treatment
- Hgb >/= 9.5 prior to study start
- eKt/V >/= 1.0 (or spKt/V >/= 1.2) in the monthly lab work prior to study start
- Any laboratory abnormality, medical condition or psychiatric disorder which in the opinion of the investigator would put the subject's disease management at risk or may result in the subject being unable to comply with study requirements
- Patient is maintained on Coumadin therapy or LMW heparin
- Known history of HIT, coagulopathy or any other bleeding and/or thrombotic disorders
- Patients dialyzed with < 2000 units of Heparin per treatment
- Dialyzed without heparin
- Known pregnancy
- Dialyzed with reuse of hemodialyzers
- Documented clotted dialyzer or dialysis lines in last 30 days (1 month) requiring changing dialyzer, bloodlines or terminating treatment
- Randomized in a clinical trial involving anticoagulation in the last 30 days
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Citrasate and heparin reduction Heparin N reduction Sequential hemodialysis treatment study in which all enrollees move through four (4) separate treatment phases. Results from the separate phases will be compared to standard bicarbonate dialysis with standard does of heparin.
- Primary Outcome Measures
Name Time Method Non-inferiority of dialyzer conductivity clearance (KECN) when dialyzed with Citrasate, acid concentrate and 80% of baseline Heparin dose compared to dialysis using standard bicarbonate dialysate and standard dose heparin N (baseline). Baseline and 6 months
- Secondary Outcome Measures
Name Time Method Non-inferiority of conductivity clearance when dialyzed with Citrasate and 66.7% baseline Heparin dose as compared to baseline. Baseline and 6 months Dialyzer or system clotting with Citrasate plus reduced Heparin compared to baseline. baseline and 6 months
Trial Locations
- Locations (8)
Yorkville Dialysis Center
🇺🇸New York, New York, United States
DaVita Medical Center Houston
🇺🇸Houston, Texas, United States
Upper Manhattan Dialysis Clinic
🇺🇸New York, New York, United States
Irving Place Dialysis Center
🇺🇸New York, New York, United States
DaVita Northwest Medical Center
🇺🇸San Antonio,, Texas, United States
DaVita Downtown Dialysis Clinic
🇺🇸San Antonio, Texas, United States
Avantus Renal Therapy-Saint Raphael Dialysis Center
🇺🇸New Haven, Connecticut, United States
DaVita Rivercenter Dialysis Clinic
🇺🇸San Antonio, Texas, United States