Routine Monthly Blood Draws in Hemodialysis: Where Is the Evidence?

Lacson, Eduardo; Meyer, Klemens B.

doi:10.1053/j.ajkd.2019.11.009

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Future directions include confirming safety of reducing routine blood work frequency, ideally through pragmatic randomized controlled trials across many geographic locations, or at minimum additional observational studies as suggested by Lacson and Meyer. 21 Furthermore, studying patient and staff perceptions is key for the uptake and sustainability of integrating any further changes in policy around routine blood work frequency.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Frequency of Surveillance Blood Work in Patients Treated With Maintenance Hemodialysis: A Local Quality Improvement Initiative

Shome-Vasanthan,

Chou,

Hemmett

et al. 2024

Can J Kidney Health Dis

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Introduction: There is little evidence on the ideal frequency of routine blood work in maintenance dialysis patients to manage complications, including anemia, mineral bone disease (MBD), and hyperkalemia. Recent quality improvement studies from Ontario showed no negative impacts when decreasing the frequency from monthly to every 6 weeks in conventional in-center hemodialysis (ICHD) patients. In December 2020, Alberta Kidney Care–South (AKC-S) reduced the frequency of routine blood work from every 6 weeks to every 8 weeks for ICHD patients. Objective: We aimed to assess the impact of reducing blood work frequency on patient outcomes. Methods: We compared prevalent AKC-S ICHD patients in 2 cohorts: (1) retrospective control (October 31, 2019-October 31, 2020) and (2) prospective intervention (December 1, 2020-December 1, 2021). Primary outcomes were true frequency of routine blood work, odds of patients being within target for anemia and MBD, and proportion of lab values of hyperkalemia. Furthermore, we compared hospitalizations and mortality. Results: A total of 972 patients in Calgary’s ICHD program were included, 787 in each period (with 602 patients overlapping both cohorts). The frequency of routine blood work decreased from every 39.5 days in the control period to every 54.2 days in the intervention period ( P < .01). There was a reduction in the odds of phosphate values in targets ( P = .02), and an increase in the odds of labs with hyperkalemia (>6.0 mmol/L) during the intervention period ( P = .01). There was no significant change in the odds of being within the accepted targets during the intervention period compared with the control period for hemoglobin, Tsat, calcium, or parathyroid hormone (PTH). Fewer patients were hospitalized during the intervention period and the risk of death decreased as well, although additional factors such as the COVID-19 pandemic may have affected this. A cost-savings of $32 962 occurred from the reduced anemia and MBD blood work during the intervention period. Conclusions: When ICHD units in Calgary reduced routine blood work frequency from every 6 weeks to 8 weeks, there were no negative impacts on hospitalizations or deaths. A slightly lower proportion of phosphate values were within target, and a 0.7% increase in potassium values greater than 6 mmol/L was demonstrated. Our study suggests that blood work frequency in ICHD dialysis patients may be further reduced to every 8 weeks safely. Ultimately, additional pragmatic trials are needed to identify the optimal frequency of routine blood work.

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Section: Discussionmentioning

confidence: 99%

Reducing the Frequency of Surveillance Blood Work in Patients Treated With Maintenance Hemodialysis: A Local Quality Improvement Initiative

Shome-Vasanthan,

Chou,

Hemmett

et al. 2024

Can J Kidney Health Dis

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“…The survey form will also gather information about medication use as specified in online supplemental material 1, and clinical variables such as serum albumin (g/L), haemoglobin (g/L), intact phosphorus (mmol/L), calcium (mmol/L), intact parathyroid hormone (pg/mL) in ranges as specified in online supplemental material 1. The rationale behind testing the blood of patients who are on maintenance HD every month is that intervention in response to laboratory results will be beneficial for their health 22…”

Section: Methods and Analysismentioning

confidence: 99%

“…The rationale behind testing the blood of patients who are on maintenance HD every month is that intervention in response to laboratory results will be beneficial for their health. 22 Patient and public involvement All aspects of this study (development of the research question, study design and conduct of the trial, interpretation of results and editing of the final manuscript for publication) are taking place independently of patients and public involvement. The results will be disseminated to participants by their physicians.…”

Section: Dialysis Frequency and Length Of Dialysis Sessionmentioning

confidence: 99%

Multicentre, observational, retrospective cohort of hyperkalaemia burden at haemodialysis facility-level in China: the Visualize-HD study protocol

Zhao,

Zuo

2023

BMJ Open

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ObjectivesHyperkalaemia is a potentially life-threatening disorder in patients undergoing haemodialysis (HD). Excess mortality and hospitalisation have been associated with hyperkalaemia (HK) after the long (2-day) interdialytic interval (LIDI) in patients on thrice a week HD compared with the short (1-day) interdialytic interval. Moreover, not much research has been conducted in China on the descriptive epidemiology and management of HK among different HD centres. The aim of this study is to address this evidence gap by investigating the risk factors associated with HK clinical burden at the HD facility level, current HD centres management patterns, serum potassium management patterns, as well as the risk factors associated with crude mortality in China.DesignMulticentre, observational, retrospective cohort study.SettingThis study plans to enrol 300 HD centres across China. Haemodialysis centres having ≥100 patients on maintenance HD within 3 years before study initiation, with participation willingness, routine blood collection post-LIDI and death records will be included.ParticipantsPatients aged ≥18 years and on chronic HD for ≥3 months will be considered eligible. Summary data about serum potassium, characteristics of patients, facility practice patterns will be collected at HD facility level and death records will be at the patient level.Primary and secondary outcome measuresThe primary outcome will be to examine the association between suspected risk factors and HK prevalence at HD facility level. Suspected risk factors include dialysis prescriptions and serum potassium testing frequency, characteristics of patients and related medication usage. The secondary outcome will be to determine the HK prevalence, serum potassium management pattern and risk factors associated with crude mortality. The primary and secondary outcomes will be analysed using regression models. Exploratory outcomes will further investigate the risk factors associated with serum potassium ≥6.0 and ≥6.5 mmol/L.ConclusionThe study is expected to provide insights to improve dialysis practice patterns and understand the clinical burden of HK.Ethics and disseminationThis study protocol was reviewed and approved by the Institutional Review Boards and Ethics Committee of Peking University People’s Hospital (Approval number: 2020PHB324-01). The results will be disseminated through national and international presentations and peer-reviewed publications.Trial registration numberNCT05020717.

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“…In routine dialysis practice, the drawing of ‘monthly bloods’[ 26 ] involve regular measurements of full-blood count (FBC), serum biochemical profile (BCP) and C-reactive protein (CRP), and 3-monthly measurements of serum Ferritin, Transferrin Saturations (TSAT) and Parathyroid hormone (PTH) levels. We will utilise these routine tests when making selected comparisons between patients in the two treatment arms (see outcomes).…”

Section: Methodsmentioning

confidence: 99%

A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol

et al. 2021

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Background Incremental haemodialysis/haemodiafiltration (HD) may help reduce early mortality rates in patients starting HD. This mixed-method feasibility study aims to test the acceptability, tolerance and safety of a novel incremental HD regime, and to study its impact on parameters of patient wellbeing. Method We aim to enrol 20 patients who will commence HD twice-weekly with progressive increases in duration and frequency, achieving conventional treatment times over 15 weeks (incremental group). Participants will be followed-up for 6 months and will undergo regular tests including urine collections, bio-impedance analyses and quality-of-life questionnaires. Semi-structured interviews will be conducted to explore patients’ prior expectations from HD, their motivations for participation and experiences of receiving incremental HD. For comparison of safety and indicators of dialysis adequacy, a cohort of 40 matched patients who previously received conventional HD will be constructed from local dialysis records (historical controls). Results Data will be recorded on the numbers screened and proportions consented and completing the study (primary outcome). Incremental and conventional groups will be compared in terms of differences in blood pressure control, interdialytic weight changes, indicators of dialysis adequacy and differences in adverse and serious adverse events. In analyses restricted to incremental group, measurements of RRF, fluid load and quality-of-life during follow-up will be compared with baseline values. From patient interviews, a narrative description of key themes along with anonymised quotes will be presented. Conclusion Results from this study will address a significant knowledge gap in the prescription HD therapy and inform the development novel future therapy regimens.

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Routine Monthly Blood Draws in Hemodialysis: Where Is the Evidence?

Cited by 4 publications

References 11 publications

Reducing the Frequency of Surveillance Blood Work in Patients Treated With Maintenance Hemodialysis: A Local Quality Improvement Initiative

Reducing the Frequency of Surveillance Blood Work in Patients Treated With Maintenance Hemodialysis: A Local Quality Improvement Initiative

Multicentre, observational, retrospective cohort of hyperkalaemia burden at haemodialysis facility-level in China: the Visualize-HD study protocol

A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol

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