Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada; ICES, London, Ontario, Canada.
Am J Kidney Dis. 2020 Apr;75(4):471-479. doi: 10.1053/j.ajkd.2019.08.016. Epub 2019 Nov 12.
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.
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.
Frequency of surveillance blood work, monthly versus every 6 weeks.
The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, all-cause hospitalization, and episodes of hyperkalemia.
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.
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.
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.
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.
维持性血液透析（HD）受者通常会进行常规监测血液检查。虽然更频繁的血液检测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。
回顾性基于人群的队列研究。
截至 2011 年 4 月 1 日，加拿大安大略省所有现患 HD 受者，以及 2011 年 4 月 1 日至 2016 年 3 月 31 日期间在加拿大安大略省开始维持性 HD 的新发病例患者队列。
监测血液检查的频率，每月一次与每 6 周一次。
主要结局为全因死亡率。次要结局为主要不良心血管事件、全因住院和高钾血症发作。
采用 Cox 比例风险模型，调整人口统计学和临床特征，评估血液检查频率与全因死亡率之间的关联。次要结局采用 Andersen-Gill 扩展的 Cox 模型进行评估，以允许潜在的复发性事件。
17 个 HD 项目中有 7454 名现患患者接受了治疗，其中 5335 名患者采用每月采血方案（n=5335 例），2119 名患者采用每 6 周采血方案（n=2119 例）。与每 6 周采血相比，更频繁的监测并未降低全因死亡率的风险（调整后的 HR，1.16；95%CI，0.99-1.38）。每月监测与任何次要结局的风险降低均无关。在新发病例 HD 受者中，结果一致。
未测量的混杂因素；与采血频率无关的中心实践相关数据有限；未提供处方采样间隔之外非计划采血频率的信息。
与每 6 周采血相比，HD 受者每月常规血液检查并未降低死亡、心血管事件或住院风险。考虑到卫生资源的影响，HD 受者常规血液采样的频率值得仔细重新评估。
