Six‐Weekly Versus Monthly Haemodialysis Blood Testing in an Australian Tertiary Kidney Service: A Quality, Safety, Green Nephrology Initiative and Cost‐Saving Analysis

There is limited evidence to guide optimal frequency of surveillance bloodwork for haemodialysis patients. In September 2023, surveillance bloodwork frequency was reduced from monthly to 6-weekly across 4 Illawarra-Shoalhaven dialysis units. 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. 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 versus 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 from 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 1.03 kg per patient-year. Of 58 dialysis nurses, 47 (81%) responded to a survey and indicated the practice change was acceptable (38/47, 81%). Reducing surveillance bloodwork frequency to 6-weekly for haemodialysis patients delivered substantial cost-savings and had positive environmental benefits without compromising safety. Strong engagement with dialysis staff supports its scalability and sustainability.