Dialysis With Fewer Draws: Evaluating Reduced Blood Work Frequency on Hemodialysis Outcomes

Routine blood work is integral to maintenance hemodialysis care, yet clinical guidelines lack graded recommendations for testing frequency. In response to operational pressures during the COVID-19 pandemic, our program reduced routine blood work from every 6 to 8 weeks. Initial results at 1 year showed no adverse clinical effects, but the long-term impact remains unknown.

We conducted a prospective cohort study within the Alberta Kidney Care-South (AKC-S) Calgary program, comparing a 23-month intervention cohort (December 1, 2020-November 5, 2022) with a 12-month historical control (October 31, 2019-October 31, 2020). The intervention reduced routine blood work frequency for all in-center hemodialysis (ICHD) patients. We evaluated the frequency of blood work, estimated cost savings, clinical outcomes (death, hospitalizations, transplantation, transition to home dialysis), biochemical outcomes (anemia and mineral and bone disorder parameters, hyperkalemia), and provider perceptions.

A total of 1138 patients were included (787 control, 956 intervention, with 605 overlapping). The number of laboratory tests per person-year decreased by 13%, resulting in an estimated cost savings of $206 CAD per person-year. Hospitalizations declined by 15% (95% CI: 0.77-0.93; P=0.001). No significant differences were observed in mortality, transplantation, or hyperkalemia. Absolute biochemical values were similar between the control and intervention periods. Providers maintained or increased comfort with reduced testing frequency.

Reducing routine blood work frequency to every 8 weeks in maintenance ICHD patients was safe over 23 months, with reduced costs and no adverse impact on clinical or biochemical outcomes. Provider support suggests the sustainability of the approach.