Abstract: PUB200
Frequency of Routine Blood Work among Patients on Chronic Dialysis: A Narrative Review
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Cau, Alessandro, The University of British Columbia, Vancouver, British Columbia, Canada
- SIngh, Rajinder, The University of British Columbia, Vancouver, British Columbia, Canada
- Levin, Adeera, The University of British Columbia, Vancouver, British Columbia, Canada
Group or Team Name
- British Columbia Renal Agency.
Background
Home dialysis patients, including both those on hemodialysis and peritoneal dialysis, undergo monthly blood testing to identify and correct harmful laboratory abnormalities such as hyperkalemia and assess for dialysis adequacy. The frequency and utility of testing, however, is not supported by available evidence and is largely based on historical practice and expert consensus. While early identification and correction of critical laboratory values may theoretically lead to improved clinical outcomes, unnecessary testing has implications on patient quality of life, practitioner workload, use of healthcare resources and the environment. Frequent monitoring of a highly variable laboratory value (i.e., phosphate) will lead to over- or under-treatment where no outcome data exists.
Methods
PubMed search identified literature on blood work frequency amongst dialysis patients of any modality. Search strategy included keywords related to blood work, lab work, frequency, and dialysis modalities. Separate searches were also performed to identify studies addressing a similar question in patients with other chronic diseases such as kidney transplant recipients and diabetes. Reference lists of relevant studies were also screened. Studies were included if they were relevant to our population of interest and addressed either the evidence behind or consequences of routine monthly blood work.
Results
Overall, there are no randomized controlled studies on this topic to date. There were four observational studies comparing outcomes between in-centre hemodialysis patients undergoing monthly blood work and those receiving less frequent blood work. Of those four studies, two were conducted in Canada, one in Lebanon and one in Korea. There were no studies of patients on home dialysis including peritoneal dialysis or hemodialysis.
Conclusion
There is a paucity of evidence underpinning monthly routine lab testing among home dialysis patients. Furthermore, there is little available evidence to suggest that it is unsafe to undergo less frequent testing. More high-level evidence is needed to inform an appropriate testing frequency in these patients which in turn, has the potential to transform care at the patient, provider, system, and planetary levels.