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

Published on Apr 1, 2020in American Journal of Kidney Diseases6.653
· DOI :10.1053/j.ajkd.2019.08.016
Alison Thomas1
Estimated H-index: 1
(U of T: University of Toronto),
Samuel A. Silver13
Estimated H-index: 13
(Queen's University)
+ 14 AuthorsRon Wald44
Estimated H-index: 44
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. Study Design Retrospective population-based cohort study. 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. Exposure Frequency of surveillance blood work, monthly versus every 6 weeks. Outcomes The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, all-cause hospitalization, and episodes of hyperkalemia. 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. 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. 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. 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.
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  • Citations (1)
References29
Newest
#1Samuel A. Silver (Queen's University)H-Index: 13
#2Abdullah Alaryni (Islamic University)
Last. Eduard A. Iliescu (Queen's University)H-Index: 9
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Rationale & Objective Few data exist revealing how the frequency of routine blood work for patients on maintenance hemodialysis therapy affects patient outcomes and the costs of care. Our objective was to determine the effect of changing the frequency of blood work from 4- to 6-week intervals on the achievement of anemia and chronic kidney disease–mineral and bone disorder (CKD-MBD) targets. Study Design Retrospective interrupted time series from June 1, 2012, to December 31, 2015. Setting & Par...
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#1Christopher Naugler (U of C: University of Calgary)H-Index: 19
#2Irene Ma (U of C: University of Calgary)H-Index: 2
Family physicians are becoming more aware that non-selectively ordering a high number of laboratory tests per requisition can be harmful to patients and our health care system, as it leads to an increased number of abnormal test results that will consist of both true-and false-positive results.[1][1
5 Citations
#1Tamara Isakova (NU: Northwestern University)H-Index: 32
#2Thomas L. Nickolas (CUMC: Columbia University Medical Center)H-Index: 39
Last. Holly Kramer (LUC: Loyola University Chicago)H-Index: 40
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Chronic kidney disease–mineral and bone disorder (CKD-MBD) encompasses laboratory and bone abnormalities and vascular calcification and has deleterious effects on clinical outcomes. KDOQI (Kidney Disease Outcomes Quality Initiative), an initiative of the National Kidney Foundation, addressed this issue with the publication of a clinical practice guideline for bone metabolism and disease in CKD in 2003, and 2 years later, a new definition and classification scheme for CKD-MBD was developed follow...
64 CitationsSource
#1David C. WheelerH-Index: 64
The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD) represents a selective update of the prior guideline published in 2009. This update, along with the 2009 publication, is intended to assist the practitioner caring for adults and children with CKD, those on chronic dialysis therapy, or individuals with a kidney transplant. Specifically,...
245 Citations
Purpose of review:The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused.Sources of information:A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi proc...
1 CitationsSource
#1Allison Tong (USYD: University of Sydney)H-Index: 41
#2Braden Manns (U of C: University of Calgary)H-Index: 8
Last. Reva ParksH-Index: 1
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Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report ...
48 CitationsSource
#1Rachel Urquhart-Secord (USYD: University of Sydney)H-Index: 2
#2J. Craig (USYD: University of Sydney)H-Index: 85
Last. Allison Tong (USYD: University of Sydney)H-Index: 41
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Background In the context of clinical research, investigators have historically selected the outcomes that they consider to be important, but these are often discordant with patients' priorities. Efforts to define and report patient-centered outcomes are gaining momentum, though little work has been done in nephrology. We aimed to identify patient and caregiver priorities for outcomes in hemodialysis. Study Design Nominal group technique. Setting & Participants Patients on hemodialysis therapy a...
77 CitationsSource
#1Keitaro Yokoyama (Jikei University School of Medicine)H-Index: 28
#2Noriaki Kurita (Fukushima Medical University)H-Index: 10
Last. Shunichi Fukuhara (Fukushima Medical University)H-Index: 56
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#1Eric I. Benchimol (Children's Hospital of Eastern Ontario)H-Index: 31
#2Tjeerd van Staa (Lond: University of London)H-Index: 83
Last. Sinéad M. Langan (Lond: University of London)H-Index: 34
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Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these ...
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In many biomedical studies, the event of interest can occur more than once in a participant. These events are termed recurrent events. However, the majority of analyses focus only on time to the first event, ignoring the subsequent events. Several statistical models have been proposed for analysing multiple events. In this paper we explore and illustrate several modelling techniques for analysis of recurrent time-to-event data, including conditional models for multivariate survival data (AG, PWP...
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#1Eduardo Lacson (Tufts University)H-Index: 29
#2Klemens B. Meyer (Tufts University)H-Index: 40
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