Patients who are starting hemodialysis and have residual kidney function will be evaluated for eligibility to take part in this study. The patient’s kidney doctor and the site investigators will decide if the patient can join the study. Patients who do not have enough residual kidney function will not be eligible for this study. A full list of eligibility criteria is listed below.
Inclusion Criteria
- Age ≥ 18 years
- New-onset kidney dysfunction requiring dialysis (also known as end-stage kidney disease [ESKD] or end-stage renal disease [ESRD] or chronic kidney disease stage 5 on dialysis [CKD5D]) starting in-center, chronic hemodialysis, or anticipated to be started on in-center, chronic hemodialysis within the next 6 weeks
- Has received ≤18 sessions of hemodialysis (i.e., on hemodialysis for ≤6 weeks) when approached for potential study participation
- Kidney urea clearance ≥3.5 mL/min/1.73 m2
- Urine volume of ≥500 mL/24 h
Exclusion Criteria
- Serum potassium level that is persistently ≥5.8 mEq/L
- Serum sodium level that is persistently ≤125 mEq/L
- Serum bicarbonate level that is persistently ≤17 mEq/L
- Requirement or anticipated requirement of high-volume fluid removal
- History of medical non-adherence that, in the opinion of the site investigators and/or treating providers, precludes safe study participation
- A medical condition that, in the opinion of the site investigators and/or treating providers, would jeopardize the safety of the patient
- Expected dialysis modality change (e.g., home hemodialysis, peritoneal dialysis) or kidney transplantation within the next 6 months
- Estimated survival of <6 months, in the opinion of the site investigators and/or treating providers
- Estimated transfer to a dialysis facility outside the care of the participating study team within the next 6 months
- Known pregnancy or planning to attempt to become pregnant or lactating women
- Unable or unwilling to follow the study protocol for any reason