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No benefit seen to frequent blood testing for patients on hemodialysis
Researchers of a published study observed no differences in mortality risk, cardiovascular events or hospitalization based on the frequency of blood testing in patients on hemodialysis.
“Despite its perceived importance and the deep entrenchment of this practice in [hemodialysis] HD care, there is no evidence to support a specific interval for routine laboratory sampling,” Alison Thomas, MN, of the division of nephrology at St. Michael’s Hospital in Canada, and colleagues wrote. “Many centers perform their measurements every month, but this interval is based on convention rather than empirical evidence of benefit to patients. Frequent blood testing could also have undesirable consequences by inflating the number of false-positive readings and identifying spurious abnormalities that escalate patient anxiety while generating further testing.”
Following efforts in nephrology care to “eliminate health investigations and procedures that are of low value to patients,” researchers sought to compare clinical outcomes between two strategies of routine blood testing: monthly vs. every 6 weeks. Participants were categorized as prevalent hemodialysis recipients (on hemodialysis in April 2011, n = 7,454) or incident recipients (those that began treatment between April 2011 and March 2016; n = 10,666).
They found that, compared with sampling every 6 weeks, monthly monitoring was not associated with a lower risk for all-cause mortality (adjusted HR = 1.16), cardiovascular events (aHR = 1.11), all-cause hospitalization (aHR = 1.03), all-cause emergency department visits (aHR = 1.03) or episodes of hyperkalemia (aHR = 1.33) for prevalent patients. Results were similar for the incident cohort.
Furthermore, for incident hemodialysis recipients, researchers observed an association between monthly blood sampling and a higher risk for cardiovascular events (aHR = 1.18), all-cause hospitalization (aHR = 1.11) and episodes of hyperkalemia (aHR = 1.20).
“Our findings challenge the fundamental notion that more frequent blood sampling improves clinical outcomes in HD recipients,” the researchers concluded. “Whereas the majority of patients in Ontario and those receiving care at large dialysis providers in the United States are exposed to sampling of routine parameters every month, we found that this approach did not yield better outcomes as compared with a strategy of blood sampling every 6 weeks. Though our results do not suggest an optimal sampling frequency for routine blood work, it should provide patients, clinicians and administrators with a measure of confidence that widening blood testing intervals to 6 weeks may not compromise outcomes.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.