Routine Laboratory Testing Every 4 Versus Every 6 Weeks for Patients on Maintenance Hemodialysis: A Quality Improvement Project

Abstract

Few data exist revealing how the frequency of routine blood work for patients on maintenance hemodialysis therapy affects patient outcomes and the costs of care. Our objective was to determine the effect of changing the frequency of blood work from 4-to 6-week intervals on the achievement of anemia and chronic kidney disease-mineral and bone disorder (CKD-MBD) targets.

The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients

“…17 Recent work by our group highlighted the stability of target achievement for anemia and CKD-MBD parameters after a de-escalation of blood sampling frequency from monthly to every 6 weeks at a single dialysis program in Ontario. 18 No change in mortality was observed after this change in practice.…”

Reducing Phlebotomy in Hemodialysis Patients: A Quality Improvement Study

“…In reality, the standard of care in the United States for patients with kidney failure outside the hospital is checking blood work once per month. 15 A recent quality improvement effort in Canada suggested that spacing blood work out even further may reduce costs and physician workload without harm to patient safety. 15 In addition, providers without experience with dialysis may not realize that blood is easily drawn at dialysis without requiring peripheral venipuncture.…”

“… 15 A recent quality improvement effort in Canada suggested that spacing blood work out even further may reduce costs and physician workload without harm to patient safety. 15 In addition, providers without experience with dialysis may not realize that blood is easily drawn at dialysis without requiring peripheral venipuncture. Some mistakenly think that blood drawn at dialysis may be altered or inaccurate due to the dialysis process itself, not realizing that blood can be drawn off the circuit before it enters the machine for cleaning.…”

Briefly Noted

“…The retrospective study of a single large dialysis center examined periods of 252 days before and after the switch in intervals. 16 Dialysis unit practices regarding volume management were obtained from the DOPPS Medical Directors Survey in 273 units in 12 countries. Units that routinely used lower dialysate temperature had a lower adjusted risk of cardiovascular mortality (HR 0.76) while sodium modeling conferred a higher risk (HR 1.34).…”

“…Performing routine lab testing in HD patients every 6 weeks (instead of every month) had no negative effects on achieving target hemoglobin or phosphate levels nor on overall mortality. The retrospective study of a single large dialysis center examined periods of 252 days before and after the switch in intervals …”