Frequency of Routine Bloodwork Among Patients With Chronic Kidney Disease: A Narrative Review to Inform Appropriateness of Care.

Purpose of Review: People living with chronic kidney disease (CKD), individuals receiving dialysis therapies, and those with both native and transplant kidneys undergo routine blood testing for regular follow-up and monitoring of CKD and its complications. There is a lack of evidence supporting the established frequency and utility of testing, which is largely based on historical practice and expert consensus. While early identification and correction of critical laboratory values can lead to improved clinical outcomes, surveillance bloodwork does not always lead to changes or improvements in patient care. As with all investigations, bloodwork has implications for patients, health care providers and our health care system, impacting costs and the environment. Frequent monitoring of highly variable laboratory values may also lead to overtreatment or undertreatment. The purpose of this review is to synthesize the existing evidence pertaining to current blood testing frequencies across the spectrum of patients with CKD to fully inform the appropriateness of care. Sources of information: The sources included published studies and available guidelines regarding the frequency of routine surveillance bloodwork in patients with CKD G3-5, including those receiving all types of dialysis therapies, and recipients of a kidney transplant. Methods: Information was gathered from database searches using a search strategy that included keywords related to bloodwork, lab work, frequency, chronic kidney disease, kidney transplant, and dialysis modalities. Reference lists of relevant studies were also screened. Key findings: There is a paucity of evidence underpinning monthly routine lab testing across the spectrum of patients with CKD. Five observational studies compared outcomes between in-center hemodialysis patients undergoing monthly bloodwork and those receiving less frequent bloodwork (every six weeks). Of those five studies, four demonstrated that it is safe to undergo less frequent testing. The totality of current data, while limited, suggests that for in-center hemodialysis patients, less frequent testing is a safe strategy. No such data exist for other dialysis or non-dialysis CKD populations. Evidence is needed to inform an appropriate testing frequency across the spectrum of patients with CKD to optimize care at the patient, provider, system, and planetary levels. Limitations: A formal systematic review was not undertaken, and therefore, there is a possibility of bias in the included studies.