title: The effect of citrate dialysate on intradialytic heparin dose in haemodialysis patients: study design of a randomised controlled trial.
abstract: BACKGROUND
  Unfractionated heparin is the most common anticoagulant used in haemodialysis (HD), although it has many potential adverse effects. Citrate dialysate (CD) has an anticoagulant effect which may allow reduction in cumulative heparin dose (CHD) compared to standard acetate dialysate (AD).
  
  
  METHODS
  This double-blinded, randomised, cross-over trial of chronic haemodialysis patients determines if CD allows reduction in CHD during HD compared with AD. After enrolment, intradialytic heparin is minimised during a two-week run-in period using a standardised protocol based on a visual clotting score. Patients still requiring intradialytic heparin after the run-in period are randomised to two weeks of HD with AD followed by two weeks of CD (Sequence 1) or two weeks of HD with CD followed by two weeks of AD (Sequence 2). The primary outcome is the change in CHD with CD compared with AD. Secondary outcomes include metabolic and haemodynamic parameters, and dialysis adequacy.
  
  
  CONCLUSIONS
  This randomised controlled trial will determine the impact of CD compared with AD on CHD during HD.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01466959.
authors: Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. davina_j_tai@hotmail.com.
authors: Davina J
authors: DJ
authors: Tai
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. kelvincwleung@gmail.com.
authors: Kelvin
authors: K
authors: Leung
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. pravani@ucalgary.ca.|Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. pravani@ucalgary.ca.
authors: Pietro
authors: P
authors: Ravani
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. rob.quinn@albertahealthservices.ca.|Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. rob.quinn@albertahealthservices.ca.
authors: Robert R
authors: RR
authors: Quinn
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. nairne.scott-douglas@albertahealthservices.ca.
authors: Nairne
authors: N
authors: Scott-Douglas
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. jennifer.macrae@albertahealthservices.ca.
authors: Jennifer M
authors: JM
authors: MacRae
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D019343:Citric Acid / Q000494:pharmacology*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000494:pharmacology*; D004311:Double-Blind Method; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D006435:Renal Dialysis; D012107:Research Design
chemical_list: D000925:Anticoagulants; D015314:Dialysis Solutions; D019343:Citric Acid; D006493:Heparin