A narrative review of routine haematological and biochemical parameter monitoring in maintenance haemodialysis patients and comparison of clinical guidelines

Routine monitoring of haematological and biochemical parameters is essential in managing people with kidney failure on maintenance haemodialysis (HD), guiding assessment of HD adequacy and kidney failure-associated complications, including anaemia, chronic kidney disease-mineral and bone disorder, and electrolyte disturbances. Currently, however, there is no consensus on optimal testing frequency of key parameters, with variations across clinical guidelines and limited robust evidence. This narrative review synthesises current guideline recommendations and empirical research on the frequency and scope of routine laboratory testing of people on maintenance HD, focusing on areas of consensus, controversy, and future research needs. Key laboratory parameters were established to standardise the evaluation of foundational and region-specific guidelines, and direct literature searches for research within the last decade. Given the paucity of randomised controlled trials (RCTs), this narrative review is derived primarily from observational research and clinical guidelines. Guideline recommendations varied from flexible, clinician-driven frequencies in foundational guidelines, to prescriptive schedules in region-specific guidelines, though with consistencies across specific parameters. Empirical evidence indicated benefits of reduced testing frequency broadly when addressing medical over-testing. However, limited evidence exists to link parameter-specific testing intervals with outcomes such as hospitalisation, sustaining international variation in guidelines. Future research should pair patient-reported outcome measures with parameter target levels longitudinally in pragmatic RCTs to clarify causal links between optimal monitoring intervals and patient outcomes to develop risk-stratified monitoring frameworks for sustainable HD care.