Skip to content
Hand holding seeds while other hand plants them in soil.


Outcomes of a Higher vs. Lower Hemodialysate Bicarbonate Concentration

In Canada, healthcare providers generally use dialysate with a bicarbonate concentration from 32 mmol/L to 40 mmol/L. Observational studies suggest that a higher dialysate bicarbonate concentration may increase the risk of death and hospitalizations, but the optimal concentration for patient health is generally unknown. To address this knowledge gap, Drs. Amber Molnar and Samuel Silver propose conducting a pragmatic cluster randomized trial to compare 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. The trial will be conducted in more than 140 Canadian hemodialysis centres over four years (which will include >20,000 patients and over 12 million dialysis treatments). The trial’s new, streamlined approach includes analyzing information already collected in routine care that is stored in large healthcare databases.

If the trial team 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 this intervention 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.

To help inform the conduct of the Dial-Bicarb trial, please click on the link to complete our short survey.

Dr. Amber Molnar

Co-PI: Dr. Amber Molnar

Dr. Amber Molnar is a nephrologist at St Joseph’s Healthcare, Hamilton, an Associate Professor with the Department of Medicine Division of Nephrology at McMaster University and holds a cross appointment with the Department of Health Research Methods, Evidence and Impact. She received her MD at the University of Saskatchewan and completed Internal Medicine training at Western University. She then completed her Nephrology training followed by a two-year research fellowship and MSc in Epidemiology at the University of Ottawa.

Dr. Molnar is an Adjunct Scientist with ICES, where she uses large, provincial healthcare databases to understand clinically important associations and answer research questions pertinent to patients with kidney disease. Her research program focuses primarily on improving outcomes for patients with chronic kidney disease and on hemodialysis.

Dr. Samuel Silver

Co-PI: Dr. Samuel Silver

Dr. Samuel Silver is an Assistant Professor in the Division of Nephrology at Queen’s University. He completed his clinical training in internal medicine and nephrology at the University of Toronto. He holds a MSc in quality improvement and patient safety and completed the Veteran Affairs Quality Scholars program at the University of California-San Francisco. Dr. Silver then trained as a research fellow at Stanford University, with a focus on health services research.

Dr. Silver has received salary support through the Kidney Research Scientist Core Education and National Training (KRESCENT) program, as well as funding from CIHR, the Kidney Foundation of Canada, and Ontario Renal Network. The objective of his research program is to use administrative data and systematic reviews to inform the design of quality improvement interventions that may improve patient outcomes, with a focus on the delivery of care for patients with acute kidney injury.