Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Citrasate Dialysate on Heparin Dose: A Randomized Cross Over Trial in Hemodialysis Patients.
Brief Summary: An alternative to systemic heparin anticoagulation for HD is citrate dialysate (CD). CD contains a small amount of citric acid rather than acetic acid as the acidifying agent. The use of citrasate may lead to lower heparin requirements in hemodialysis. This is a randomized, double blinded, two-period crossover trial in HD patients to compare the effect of citrasate dialysis (CD) and usual acetic-acid based dialysate (AD) on heparin dose.


Options:
A: Inclusion Criteria:

* End stage renal disease maintained on outpatient hemodialysis at a healthcare center for \> 3 months from screening with hemodialysis using heparin (unfractionated heparin or low-molecular weight heparin) 3 times per week for a minimum of 3 hours per dialysis session and plan to continue this throughout the study.

Exclusion Criteria:

* Documented thrombotic event (acute coronary syndrome, stroke or transient ischemic attack, venous thromboembolic event) in the past 3 months.
* Active bleeding within the past 3 months from screening or documented bleeding diathesis (history of bleeding disorder) or Screening values of:

  * Platelet count \< 150,000 cells/mm3
  * INR \> 1.4
  * aPTT \> upper limit of normal (ULN)
* Abnormal liver function at Screening:

  * ALT or AST \> 2 x ULN
  * Total bilirubin \> ULN
* Concomitant medication restrictions: Concomitant use of anticoagulant/antiplatelet agents (e.g., dabigatran, rivaroxaban, clopidogrel) that may affect coagulation (except low dose aspirin (≤ 100 mg/day) during Treatment and Post-treatment Evaluation Periods is not allowed.
* Uncontrolled hypertension as judged by the Investigator. Patients with a pre- or post-dialysis blood pressure (BP) that is \> 160 mmHg on at least 3 of last 5 dialysis treatments.
* Planned major surgery in the next 6 months (e.g. renal transplant surgery)
B: Inclusion Criteria:

* chronic stable HD patients ≥ 18 years
* on HD at least three times per week for at least 3 months

Exclusion Criteria:

* contraindication to heparin
* currently using heparin-free HD
* known clotting disorder
* on warfarin therapy
* dialyzing with a dysfunctional central venous catheter (blood flow rates consistently less than 300mL/min and/or frequent use of thrombolytic)
* history of vascular access dysfunction
* planned vascular access conversion or procedure during the study period
* use of high calcium dialysate
* active medical issue requiring hospitalization
* planned kidney transplant during the study period
* planned conversion of dialysis modality (peritoneal dialysis, nocturnal dialysis) during the study period
* unable to provide informed consent
C: Inclusion Criteria:

* Patients aged over 18 years,
* hemodynamic stability,
* hemoglobin 9 - 12 g/dl.

Exclusion Criteria:

* Any hemostatic disorder favoring either bleeding or clotting,
* anti-vitamin K treatment,
* risk of bleeding according to the criteria of Swartz (12).

Treatment with aspirin, dipyridamole or any drugs likely to interfere with platelet aggregation will be registered carefully, but will not be an exclusion criterion.

All vascular access types (AV-fistula, AV graft, catheter) are allowed. However, only patients with double route vascular access ('bipuncture') will be included in the study.
D: Inclusion Criteria:

1. hemodialysis patients with age \> 18 years on regular bicarbonate hemodialysis or hemodiafiltration treatment three times a week;
2. clinical stability at least three months before the study started;

Exclusion Criteria:

1. active gastrointestinal bleeding (one ore more positive hemoccult test in the last 8 weeks, melena or proctoraggia in the last 6 months )
2. hemorrhagic stroke
3. Myeloproliferative disorders
4. Hereditary deficiency of coagulation factors, LAC phenomenon or antiphospholipid syndrome
5. Malignant disease
6. Patient submitted to antithrombotic prophylaxis with LMWH
7. Immunosuppressive therapy
8. Participation in other clinical trials

Answer: B