Abstract: SA-PO800

Anemia Management in Hemodialysis Patients – Is Six-Weekly Monitoring of Hemoglobin Sufficient?

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Alaryni, Abdullah Abdulaziz, Kingston General Hospital, Kingston, Ontario, Canada
  • Shamseddin, M. Khaled, Kingston General Hospital, Kingston, Ontario, Canada
  • Macleod, Frances, Kingston General Hospital, Kingston, Ontario, Canada
  • Iliescu, Eduard A., Kingston General Hospital, Kingston, Ontario, Canada
Background

The KDIGO guidelines recommend monitoring of hemoglobin (Hb) in hemodialysis patients (HD pts.) at least monthly (not graded). Canadian HD programs vary from every 4 to 6-weeks and protocols exist for both schedules. Our centre changed from monthly to every 6 weeks in March, 2014. The objective of this QI report is to examine the volume of CBC measurements, costs, and proportion of pts. with Hb on target before and after the change.

Methods

This is a retrospective study of prevalent HD pts. in South-Eastern Ontario including all in-centre, satellite and home HD. The primary variables were the number of CBCs performed (obtained from EMR) during the 252 days before and 252 days after Mar. 24, 2014 and the associated costs (CDN $ 8.27/CBC Ontario Provincial Fee Schedule). The 252 day equal periods represent exactly 8 complete monthly cycles and 6 complete 6-weekly cycles before and after the change. The proportion of pts. with Hb on target (100 – 120 g/L) was assessed for a longer period of 2 yrs. before and after the change to assess long term outcomes.

Results

The profile of HD pts. is 430 - 440 total, 46 % in-centre, 43 % satellite, 11 % home HD, majority Caucasian, mean age 66 yr., 44 % female, 46 % DM, and 45 % with CVC. The CBC numbers and costs decreased overall but more in satellite than in in-centre pts (Table 1). The proportion of patients with Hb on target 2 years before and after were similar, 60 and 60.5 % respectively.

Conclusion

The results of this study suggest that anemia management in HD pts. results in similar outcomes with CBC measured every 6 weeks as with monthly with reduced cost. The reduction in CBCs was lower in in-centre pts. who had more CBCs measured between the routine bloodwork likely due to higher acuity and overall this is rational use of more frequent testing in sicker pts. The results of this study provide a regional perspective as this is the only HD program in the region, but may not be generalizable to HD programs with different population characteristics.

Table 1.
 Monthly Cycles6-Weekly CyclesReduction/Savings
In-Centre (# CBC)21941995199
Satellites (# CBC)16051275330
Total (# CBC)37993270529
Cost (CDN $)31,417.7327,042.904,374.83