for people ages 18 years and up (full criteria)
at San Francisco, California
study started
completion around
Principal Investigator
by Ramin Sam, MD
Headshot of Ramin Sam
Ramin Sam



At times patients with advanced renal failure present with severe hyperkalemia or acidosis and very high serum blood urea nitrogen (BUN) concentrations. These patients cannot be dialyzed aggressively as the lowering of serum BUN may results in disequilibrium syndrome but on the other hand they need aggressive dialysis in order to lower their serum potassium or fix their severe acidosis. If one is able to add urea to the dialysis fluid, one can prevent the rapid lowering of serum BUN and osmolality at the same time as doing aggressive dialysis to lower serum potassium and/or fix the metabolic acidosis.

Official Title

Adding Urea to the Final Dialysis Fluid in Order to Prevent Dialysis Disequilibrium in Patients Who Need Aggressive Dialysis for Electrolyte Abnormalities


Ure-Na 15 gram tablets would be used to add to the dialysis fluid How much urea to add would be a simple calculation based on the 45X dialysis system and the patients serum urea concentration. The dialysate fluid urea concentration would be made to be about 15-40 mg/dL lower than the serum concentration. The patients labs/vitals and symptoms would be closely monitored throughout the dialysis treatment.


Dysequilibrium Syndrome, ESRD, Hyperkalemia, Metabolic Acidosis, Urea, Disequilibrium, Potassium, Acid/base, Acidosis, Dialysis Solutions, Urea in the dialysate, Urea dialysate


You can join if…

Open to people ages 18 years and up

  • Serum Urea > 120
  • Serum Potassium > 5.5 or serum CO2 < 15 or need for aggressive dialysis due to toxic ingestion
  • need for dialysis

You CAN'T join if...

  • Pediatric
  • need for CRRT


  • Zuckerberg San Francisco General Hospital
    San Francisco California 94110 United States

Lead Scientist at UCSF

  • Ramin Sam, MD
    College: University of Illinois-Urbana Medical School: University of Illinois-Chicago Internal Medicine Residency: Loyola University Nephrology Fellowship: Loyola University Interests: My clinical/research interests are varied and include sodium disorders, hemodialysis, acid/base disorders, transjugular kidney biopsies and lipoprotein glomerulonephropathy.


not yet accepting patients
Start Date
Completion Date
University of California, San Francisco
Phase 1/2 research study
Study Type
Expecting 20 study participants
Last Updated