Dr Daniel Hirsch1,2, Ms Donia George1, Ms Debbie Pugh1, Dr Monica Kwiatkowski1, Dr Samantha Staker1, Dr Jake Watson1, Dr Jenny HC Chen1,3, A/Prof Kelly Lambert4,5, A/Prof Karumathil Murali1,3, Dr Wing-Chi Gigi Yeung1,2,6, Dr Jeffrey Ha1,2,6
1Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 2Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, Australia, 3Graduate School of Medicine, University of Wollongong, Wollongong, Australia, 4School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia, 5Kidney Lifestyle Research Group, University of Wollongong, Wollongong, Australia, 6Renal and Metabolic Division, The George Institute for Global Health, UNSW Medicine & Health, Sydney, Australia
Biography:
Jeffrey is an academic nephrologist affiliated with Wollongong Hospital, Conjoint Senior Lecturer in the Faculty of Medicine & Health, UNSW Sydney, and postdoctoral research fellow at The George Institute for Global Health. He has global expertise in the management of cardiovascular disease in patients with kidney disease. He is a member of the Australasian Kidney Trials Network CKD Working Group, CARI Guidelines Steering Committee, serves on the Editorial Board of Kidney and Blood Pressure Research, and the committees of 2 international investigator-initiated clinical trials. He is a former editorial intern with the American Journal of Kidney Diseases (2022-2023).
Background:
There is limited evidence to guide optimal frequency of surveillance bloodwork for haemodialysis patients. Benefits of less frequent bloodwork including reductions in healthcare spending and waste generation must be weighed against potential harms. In September-2023, surveillance bloodwork frequency reduced from monthly to 6-weekly across 4 Illawarra-Shoalhaven dialysis units.
Methods:
We retrospectively evaluated actual frequency of blood tests, safety (all-cause hospitalisations, hospitalisations for hyperkalaemia, percentage of potassium and haemoglobin levels in target ranges), cost-savings, and environmental impact (reduction in carbon emissions and waste generation) of 6-weekly versus monthly scheduled bloodwork for clinically stable patients receiving in-facility haemodialysis, during the 12-months before and after this practice change. Staff perspectives were gathered via survey.
Results:
We analysed 99 patients with monthly surveillance bloodwork, and 101 patients with 6-weekly bloodwork. After reducing to 6-weekly scheduled bloodwork, frequency of FBC/EUC/CMP blood tests decreased from 48.3 to 34.9 per patient-year. Comparing 6-weekly vs. monthly groups, there was no increase in percentage of patients with ≥1 hospitalisation(72% vs. 73.5%,p=0.70), hospitalisation for hyperkalaemia (0.8% vs. 0.9%,p=0.92); percentage of patients with potassium levels(3.5-5.9 mmol/L) was similar (86.0% vs. 86.2%,p=0.88). Proportion of haemoglobin levels in target range(100-115 g/L) decreased 45.4% to 38.5%(p<0.01) but with no clear changes in Erythropoietin Stimulating Agent use. Overall, there were 3.8 fewer blood draws, 8.7 fewer blood tubes used, $AUD201.44 saved in pathology costs, and carbon emissions reduced by 1.03kg per patient-year. Of 58 dialysis nurses,47(81%) responded to a survey and indicated the practice change was acceptable(38/47, 81%).
Conclusions:
Reducing surveillance bloodwork frequency to 6-weekly for haemodialysis patients conferred substantial cost-savings and had positive environmental benefits without compromising safety. Strong engagement with dialysis staff supports its scalability and sustainability.
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