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The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients.

Authors :
Thomas A
Silver SA
Perl J
Freeman M
Slater JJ
Nash DM
Vinegar M
McArthur E
Garg AX
Harel Z
Chanchlani R
Zappitelli M
Iliescu E
Kitchlu A
Blum D
Beaubien-Souligny W
Wald R
Source :
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2020 Apr; Vol. 75 (4), pp. 471-479. Date of Electronic Publication: 2019 Nov 12.
Publication Year :
2020

Abstract

Rationale & Objective: Surveillance blood work is routinely performed in maintenance hemodialysis (HD) recipients. Although more frequent blood testing may confer better outcomes, there is little evidence to support any particular monitoring interval.<br />Study Design: Retrospective population-based cohort study.<br />Setting & Participants: All prevalent HD recipients in Ontario, Canada, as of April 1, 2011, and a cohort of incident patients commencing maintenance HD in Ontario, Canada, between April 1, 2011, and March 31, 2016.<br />Exposure: Frequency of surveillance blood work, monthly versus every 6 weeks.<br />Outcomes: The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, all-cause hospitalization, and episodes of hyperkalemia.<br />Analytical Approach: Cox proportional hazards with adjustment for demographic and clinical characteristics was used to evaluate the association between blood testing frequency and all-cause mortality. Secondary outcomes were evaluated using the Andersen-Gill extension of the Cox model to allow for potential recurrent events.<br />Results: 7,454 prevalent patients received care at 17 HD programs with monthly blood sampling protocols (n=5,335 patients) and at 8 programs with blood sampling every 6 weeks (n=2,119 patients). More frequent monitoring was not associated with a lower risk for all-cause mortality compared to blood sampling every 6 weeks (adjusted HR, 1.16; 95% CI, 0.99-1.38). Monthly monitoring was not associated with a lower risk for any of the secondary outcomes. Results were consistent among incident HD recipients.<br />Limitations: Unmeasured confounding; limited data for center practices unrelated to blood sampling frequency; no information on frequency of unscheduled blood work performed outside the prescribed sampling interval.<br />Conclusions: Monthly routine blood testing in HD recipients was not associated with a lower risk for death, cardiovascular events, or hospitalizations as compared with testing every 6 weeks. Given the health resource implications, the frequency of routine blood sampling in HD recipients deserves careful reassessment.<br /> (Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1523-6838
Volume :
75
Issue :
4
Database :
MEDLINE
Journal :
American journal of kidney diseases : the official journal of the National Kidney Foundation
Publication Type :
Academic Journal
Accession number :
31732233
Full Text :
https://doi.org/10.1053/j.ajkd.2019.08.016