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Kidney Week

Abstract: PO0959

Reducing Routine Bloodwork in Home Dialysis Patients: A Quality Improvement Initiative

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Shome-Vasanthan, Epsita, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Chou, Sophia, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ward, David, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Hemmett, Juliya, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Qirjazi, Elena, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

There is a paucity of evidence for routine bloodwork frequency in maintenance dialysis patients to assess and manage complications such as anemia and mineral bone disease (MBD). Recent studies showed that decreasing the frequency in conventional in-center hemodialysis (ICHD) patients had no negative impacts. Given the strain on lab services from the COVID-19 pandemic, Alberta Kidney Care-South (AKC-S) decreased the frequency of routine labs from monthly to every 2 months in home hemodialysis (HHD) and peritoneal dialysis (PD) patients. We studied the effect of this change on patient outcomes.

Methods

We retrospectively compared prevalent home dialysis patients (>3 months) in AKC-S over two 6-month periods: a) Pre-pandemic May-Oct 2019 and b) Pandemic May-Oct 2020. Primary outcomes were number of routine bloodwork days and percentage of patients within target for anemia (hemoglobin, iron saturation) and MBD (calcium, phosphorus, parathyroid hormone). We also compared hospitalizations, mortality, technique failure (defined as transition to ICHD for >60days), and cost.

Results

There were 366 home dialysis patients in 2019 (270 PD, 96 HHD) and 400 in 2020 (296 PD, 104 HHD). The number of routine bloodwork days decreased in 2020 compared to 2019 (p<0.01) (Fig 1). The proportion of patients who achieved anemia (33% vs 35%, p=0.44) and MBD (34% vs 28%, p=0.1) targets was similar. There was no difference in the number of hospitalizations (155 vs 141, p=0.34), deaths (13 vs 17, p=0.71) or technique failure (8% vs 5%, p=0.06). Projected cost savings were $102 per patient year from reduced labs.

Conclusion

AKC-S reduced the frequency of routine labs during the pandemic in home dialysis without negative consequences on patient biomarkers or outcomes. Our study suggests that bloodwork frequency in home dialysis patients may be safely reduced.

Figure 1. Distribution of the number of routine bloodwork days Home Dialysis patients had during the pre-pandemic (blue) and pandemic (orange) periods.