Dial-Bicarb
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. Unfortunately, the optimal concentration for patient health is generally unknown. To address this knowledge gap, Drs Amber Molnar and Samuel Silver propose conducting the Dial Bicarb pragmatic cluster randomized trial to compare different concentrations of bicarbonate in the dialysis solution.
Canadian hemodialysis centres already use a range of dialysate with the bicarbonate concentrations used in this trial. The trial team will embed the trial in >140 Canadian hemodialysis centres over four years and aim to include >20,000 patients and over 12 million dialysis treatments in the trial’s analysis. Furthermore, the trial team will analyze data collected during routine care and stored in large healthcare databases.
If the trial results demonstrate that a lower concentration of bicarbonate 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 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
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 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.
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 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. His research program uses 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.