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.

中文翻译：

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维持性血液透析接受者中的常规血液采样频率和患者结果。

理由与目标

维持性血液透析（HD）接受者通常进行监测血液工作。尽管更频繁的血液检查可能会带来更好的结果，但几乎没有证据支持任何特定的监测间隔。

学习规划

回顾性基于人群的队列研究。

设置与参与者

截至2011年4月1日，加拿大安大略省所有流行的高清接受者，以及从2011年4月1日至2016年3月31日在加拿大安大略省开始进行维持高清的事件患者队列。

接触

每月进行一次监测血液工作的频率，相对于每6周一次。

结果

主要结果是全因死亡率。次要结果是主要的不良心血管事件，全因住院和高钾血症发作。

分析方法

使用Cox比例风险并根据人口统计学和临床​​特征进行调整，以评估血液测试频率与全因死亡率之间的关联。使用Cox模型的Andersen-Gill扩展对次要结局进行评估，以考虑潜在的复发事件。

结果

7,454名流行病患者接受了17项HD计划的月度血液采样方案护理（n = 5,335例），并接受了8项每6周进行一次血液采样的方案（n = 2,119例）。与每6周进行一次血液采样相比，更频繁的监测与较低的全因死亡率风险无关（校正后的HR，1.16； 95％CI，0.99-1.38）。每月监测与任何次要结局的较低风险均无关联。事故高清接收者之间的结果是一致的。

局限性

不可估量的混杂；与血液采样频率无关的中心实践的有限数据；在规定的采样间隔之外，没有关于计划外血液检查工作频率的信息。

结论

与每6周进行一次检测相比，在HD接受者中进行每月例行血液检查与死亡，心血管事件或住院的风险较低没有关联。考虑到对健康资源的影响，HD接受者的常规血液采样频率值得重新评估。