Dialysis Problems with Fresenius Granuflo and NaturaLyte: Timeline of Warnings & Information

Austin Kirk

By Austin Kirk
Posted August 31, 2012


As a result of problems with dialysis treatments involving Fresenius Medical Care’s Granuflo Powder and NaturaLyte Liquid Acid Concentrates, which have been used as part of dialysate prescriptions at clinics throughout the United States in recent years, patients may have faced an increased risk of suffering a sudden heart attack, cardiac arrest or death during or shortly after hemodialysis.

▸ More Information: Fresenius Dialysis Heart Problems

Substantial questions have been raised about when Fresenius knew about the risk of these dialysis problems and why they delayed providing critical information to consumers and the medical community that could have saved hundreds of lives.

Fresenius Medical Care not only owns and operates thousands of dialysis clinics throughout the United States, but they also sell other facilities products used during treatment, including Granuflo and Naturalyte. These products are used as part of the dialysate prescription in combination with a bicarbonate buffer. However, Fresenius failed to provide adequate warnings and information about the importance of monitoring and adjusting bicarbonate buffers to avoid an substantial risk of patients suffering cardiopulmonary arrest or sudden death during dialysis treatment.

Although it appears that Fresenius knew or should have known about the risk of problems during dialysis with Granuflo and NaturaLyte shortly after the products were introduced, they certainly had knowledge of the problems for several years. However, they delayed providing any dialysis warnings, and when they did acknowledge the problems, they only informed doctors at their own clinics.

Full warnings and information about the risks was withheld from other dialysis clinics for several months, while hundreds of thousands of patients continued to be exposed to a risk of Granuflo and NaturaLyte being used inappropriately due to the inadequate instructions.

Time Line of Fresenius Dialysis Warnings and Problems

  • 2003: Fresenius introduced Granuflo Dry Acid Concentrate without providing adequate warnings and instructions about the rate at which the sodium acetate contained in the product is converted to bicarbonate by the body.
  • 2004-2011: Fresenius ignored signs of problems, including a steady increase in patient serum pre-dialysis bicarbonate levels, which they should have known would increase the risk of sudden heart problems during dialysis if dialysate prescriptions were not monitored and adjusted.

    Although the manufacturer knew or should have known about the risk of these dialysis problems from their products, they continued to aggressively market Granuflo and NaturaLyte, attempting to convert clinics to use of the acid concentrates and bundling the products with other Fresenius dialysis products to provide pricing discounts.
  • 2010: An internal review of patients treated at 667 Fresenius owned dialysis clinics found that there were at least 941 instances where individuals suffered a sudden cardiac arrest during treatment. This number likely only represents a small portion of the total number of deaths and serious health problems caused by Granuflo and NaturaLyte at dialysis clinics throughout the United States.
  • November 2011: Fresenius Medical Care sent a detailed internal memo about the risk of NaturaLyte and Granuflo problems to their own clinics, warning about the importance of monitoring pre-dialysis bicarbonate levels and adjusting dialysate prescriptions to avoid the risk of cardiopulmonary arrest and death.

    Despite a 6 to 7 fold increased risk of cardiac arrest or heart attack during dialysis for individuals with borderline pre-dialysis bicarbonate levels and overt alkalosis, Fresenius only provided this information to their owned and operated clinics. They failed to warn doctors and nurses at other clinics that used Granuflo and NaturaLyte about the risk of problems.
  • March 2012: The FDA inquired about the risk of dialysis problems with Fresenius Granuflo and NaturaLyte treatments after receiving a copy of the internal memo from a source. Prior to this inquiry, Fresenius appears to have provided no information about the risks associated with their dialysis products.
  • 3/29/2012: Fresenius sent an “Urgent Product Notification” to all clinics that purchased and used their products, finally warning about the “urgent” need to monitor bicarbonate levels and adjust dialysate prescriptions based on individual patients to avoid the risk of cardiac arrest and death during dialysis treatment.
  • 3/29/2012: The FDA classified this warning letter as a NaturaLyte and Granuflo recall, indicating that the action was considered the most serious type of recall, involving a situation where there is a reasonable probability that use of the product will cause serious adverse health consequences or death.
  • 5/25/2012: In response to the NaturaLyte and Granuflo problems, the FDA issued a safety communication for healthcare professionals warning about the importance of recognizing the acetate, acetic acid and/or citrate levels in dialysate concentrates and the need to consider the impact of these products when administering dialysate prescriptions.
  • 6/14/2012: The New York Times reported that the FDA is investigating whether Fresenius violated federal law by failing to warn about the risk of dialysis treatment problems with Granuflo and NaturaLyte as early as possible after they knew about the risks. In the article, the FDA director of compliance for medical devices indicated that they were “troubled” by the failure of Fresenis to issue warnings to their entire customer base when they provided warnings to their own clinics.


The dialysis treatment lawyers at Saiontz & Kirk, P.A. are reviewing potential claims for individuals throughout the United States who suffered a sudden heart attack, cardiac arrest or death during or shortly after dialysis treatment involving Fresenius Medical Care’s Granuflo Powder or NaturaLyte Liquid Acid Concentrates, which have been used as part of dialysate prescriptions at clinics throughout the United States in recent years.

Due to problems with dialysis instructions and warnings provided with Granuflo and NaturaLyte, individuals faced an increased risk of serious and potentially life-threatening complications and financial compensation may be available through a Fresenius dialysis wrongful death lawsuit or individual injury claims.


13 Comments • Add Your Comments

  • B martins says:

    My mom has just started treatments at their clinic in culver city. Has the problem been completely resolved.

    Posted on November 4, 2012 at 7:32 pm

    • Austin Kirk says:

      @B martins – a recall was issued for Granuflo and NaturaLyte to revise the instructions provided for physicians, emphasizing the importance of monitoring bicarbonate levels. The FDA has also issued an alert to medical providers about the importance of more closely monitoring levels with these products.

      Posted on November 8, 2012 at 12:13 pm

  • Randy says:

    In January of 2010, I had a heart attack as I was being taken off of dialysis. I was taken by ambulance to the ER. During catheridization, I was found to have some blockages. Not sure if this falls under your case or not.

    Posted on November 29, 2012 at 1:54 pm

  • chung says:

    My wife had dialysis on 9/29/2012 at 5:00 to 8: 00 pm.
    On 9/30/2012 at 8:30 pm she had a cardiac arrest and passed away

    Posted on February 13, 2013 at 4:13 am

  • terri says:

    my husband had a heart attach 3 hours after his treatment he should have been told i should have been told since i was his caretaker i feel like they killed him omg this is awful please stand up and tell them to tell the truth for your love ones and for those with no voice

    Posted on April 28, 2013 at 1:01 pm

  • Cathy says:

    I’ve been at my current Fresenius clinic in West Plano TX for close to five years now. I’ve spent my whole life off and on dialysis, this is the first time I’ve used a Fresenius clinic. I’m not an expert but for the first 2yrs I witnessed many alarming things, patients standing up with their lines in to relieve leg cramps because a few months prior Fresenius Corporate decided (a law suit must’ve been filed) to remove the footrests on all the chairs. I witnessed this gentleman fall flat on his face, lines in which tore up his access! Personally I’ve experienced inconsistency in the way I’m run, some days and some techs are capable and my treatment goes smoothly. However, when I have to ask a tech if they have me on the right bath that scares me. I wish Fresenius would do a better job teaching nurses, techs and patients. I call my unit “the unit that enables you to be helpless.” If patients want to bury their head in the sand and don’t learn to advocate for themselves Fresenius is that kind of clinic. They are not shy about admitting its a corporation, a business…..the goal is the make money. Just like a restaurant has to turn tables they have to turn chairs. And when healthcare becomes an assembly line it becomes dehumanized and death is the consequence. We, in the dialysis arena, are already feeling the fallout from Obamacare! I wish all the numbskulls that thought Obamacare is the answer, how wrong you all are! Take a trip to a VA hospital, preferably in a large city and then if you’re still for the Obamacare, ask a Canadian how long it takes to see a doc?

    Posted on May 13, 2013 at 11:51 pm

  • Jeannine says:

    I was on Dialysis in 2008 several different places and I have Tachycardia now

    Posted on May 16, 2013 at 10:07 pm

  • terri says:

    My husband who is a CHF and Stroke patient goes to Dialysis Fresenius Center in Flemington,NJ. On Aug. 8th 2013 I received a call from his transportation company telling me they couldnt bring him home because he had soiled himself during treatment. I called the centered to find out what happened and why didnt they call me they said it wasnt a dialysis issue* he was coming off the machine hes your patient) and he was fine and said transportation was going to call you. When I picked him up he was sitting outside still in his soiled pants with soil all over him they never cleaned him up or offer him a gown or scrubs to change into. They were more upset that they had to clean everything. I did file a cpmplaint with the state that day. This is a pure case of neglect towards a patient under their care.

    Posted on August 9, 2013 at 8:28 am

  • Paul says:

    I have been taking dialysis at Fresenius for over A year. I have no problems with my treatment.I have never heard of Granuflo,or Natural light.Is this a prescription that certan people use or is it part of my treatment?

    Posted on September 29, 2013 at 3:24 pm

  • candy says:

    When did this problem begin? My dad suffered a heart attack during his treatment and died in 2001 He was a patient at one of the Fresenius clinics south side Chicago. It would happen that I was employed by Fresenius as a lpn and did witness several patients experience the same kind of symptoms and be transferred to a hospital.

    Posted on January 1, 2014 at 10:10 pm

  • rich says:

    Sorry to hear that, my mother too passed away jan 29 2012, received dialysis jan 27 – this is a shame

    Posted on January 30, 2015 at 6:04 pm

  • Roberta says:

    My husband passed in 2011 after completing his overnite dialysis treatment at home. He appeared fine and walked into our living room and had a major heart attack and died. We were dealing with Frecenius Clinic in Las Vegas and had been on home dialysis with myself as his caregiver for a few weeks and according the his doctors his clearances were good and his numbers within the range they wanted. No one ever mentioned to me the potential risk he was exposed to with this treatment and the fluids you mention in your article, nor would even attempt to tell me why he suddenly died without any warning or symptoms allowing me to call for help. My interest in this is simply to perhaps help in the future for someone who is lead to believe all is well with their loved one’s dialysis when in reality they were at great risk.

    Posted on June 5, 2015 at 7:27 pm

  • LATRESE says:

    My mom passed away within 48 hours after receiving Dialysis of cardiac arrest. She had been get dialyzed since 2003 never missing a day of treatment. So was she receiving granuflo the entire time? because from day one she was never herself.

    Posted on July 9, 2015 at 1:49 pm

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