Reducing Frequency of Surveillance Bloodwork in Chronic In-Centre Hemodialysis (ICHD) Patients from Every Six to Eight Weeks: A Quality Improvement Study
Bibliographic record
Abstract
Background: Regular surveillance bloodwork is vital for hemodialysis patients to monitor complications such as anemia, chronic kidney disease-mineral and bone disorder (CKD-MBD), and electrolyte abnormalities. Previous studies have shown that reducing the frequency of bloodwork from every 4 to 6 weeks did not negatively affect the achievement of anemia and CKD-MBD targets. However, the impact of further reducing routine bloodwork frequency to every 8 weeks has not been explored. This study aims to assess the impact of reducing routine bloodwork frequency from every 6 to 8 weeks in chronic in-center hemodialysis (ICHD) patients on achieving anemia and CKD-MBD targets. Methods: In this prospective cohort study, the Alberta Kidney Care-South program, which includes 7 hemodialysis centers in Calgary, reduced routine bloodwork frequency for chronic ICHD patients from every 6 to 8 weeks. We compared the impact of this change in the intervention cohort (Dec. 1, 2020 - Nov. 5, 2022) to a control cohort (Oct. 31, 2019 - Oct. 31, 2020). Primary outcomes were proportion of patients within the target range for anemia and CKD-MBD, frequency of hyperkalemia, and cost savings attributable to the change in frequency of bloodwork. Logistic regression mixed models were used to assess the effect of reduced bloodwork frequency on the odds of achieving anemia and CKD-MBD targets, adjusted for demographic and clinical characteristics. Results: A total of 787 control patients and 956 intervention patients were included. During the intervention period, the odds of achieving target ranges for hemoglobin, calcium, and phosphate decreased by 13% [95% CI: 0.83, 0.91] (P-value < 0.001), 17% [95% CI: 0.76, 0.90] (P-value < 0.001), and 6% [95% CI: 0.89, 1.00] (P-value = 0.050), respectively, compared to the control period. No significant change was observed in achieving target ranges for parathyroid hormone and iron saturation. Conclusions: Reducing routine bloodwork frequency from every 6 to 8 weeks in chronic ICHD patients was associated with lower odds of achieving anemia and CKD-MBD targets. However, the clinical significance of these findings is unclear. Further studies are needed to elucidate the ideal frequency of surveillance investigations in this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".