ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO435

Reducing Frequency of Surveillance Bloodwork in Chronic In-Centre Hemodialysis (ICHD) Patients from Every Six to Eight Weeks: A Quality Improvement Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kim, Tina, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Shome-Vasanthan, Epsita, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Al-Wahsh, Huda, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Hemmett, Juliya, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Chou, Sophia, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Qirjazi, Elena, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

Regular surveillance bloodwork is vital for hemodialysis patients to monitor complications such as anemia, chronic kidney disease-mineral and bone disorder (CKD-MBD), and electrolyte abnormalities. Previous studies have shown that reducing the frequency of bloodwork from every 4 to 6 weeks did not negatively affect the achievement of anemia and CKD-MBD targets. However, the impact of further reducing routine bloodwork frequency to every 8 weeks has not been explored. This study aims to assess the impact of reducing routine bloodwork frequency from every 6 to 8 weeks in chronic in-center hemodialysis (ICHD) patients on achieving anemia and CKD-MBD targets.

Methods

In this prospective cohort study, the Alberta Kidney Care-South program, which includes 7 hemodialysis centers in Calgary, reduced routine bloodwork frequency for chronic ICHD patients from every 6 to 8 weeks. We compared the impact of this change in the intervention cohort (Dec. 1, 2020 – Nov. 5, 2022) to a control cohort (Oct. 31, 2019 – Oct. 31, 2020). Primary outcomes were proportion of patients within the target range for anemia and CKD-MBD, frequency of hyperkalemia, and cost savings attributable to the change in frequency of bloodwork. Logistic regression mixed models were used to assess the effect of reduced bloodwork frequency on the odds of achieving anemia and CKD-MBD targets, adjusted for demographic and clinical characteristics.

Results

A total of 787 control patients and 956 intervention patients were included. During the intervention period, the odds of achieving target ranges for hemoglobin, calcium, and phosphate decreased by 13% [95% CI: 0.83, 0.91] (P-value < 0.001), 17% [95% CI: 0.76, 0.90] (P-value < 0.001), and 6% [95% CI: 0.89, 1.00] (P-value = 0.050), respectively, compared to the control period. No significant change was observed in achieving target ranges for parathyroid hormone and iron saturation.

Conclusion

Reducing routine bloodwork frequency from every 6 to 8 weeks in chronic ICHD patients was associated with lower odds of achieving anemia and CKD-MBD targets. However, the clinical significance of these findings is unclear. Further studies are needed to elucidate the ideal frequency of surveillance investigations in this patient population.