From the Guidelines
Hemodialysis workup should include laboratory tests such as HBsAg, anti-HBs, and anti-HBc for HBV screening, HCV antibody testing, and HIV screening, as recommended by the CDC and KDIGO guidelines. These tests are essential for identifying patients at risk of infections and ensuring timely intervention to prevent complications. According to the American Journal of Kidney Diseases 1, HBV screening should include testing for HBsAg, anti-HBs, and anti-HBc before admission to an outpatient dialysis facility. Additionally, HCV infection should be screened for by detection of antibodies to HCV, as recommended by the 2018 KDIGO hepatitis C guideline 1. HIV screening should also be performed for all patients between the ages of 13 and 64 years, using an HIV antibody test consistent with US Preventive Services Task Force guidelines 1.
Some key points to consider when ordering laboratory tests for hemodialysis workup include:
- HBV screening: HBsAg, anti-HBs, and anti-HBc testing
- HCV screening: HCV antibody testing
- HIV screening: HIV antibody testing for patients between 13 and 64 years old
- Other tests may be necessary based on individual patient needs and risk factors, such as comprehensive metabolic panel, complete blood count, and iron studies.
It is crucial to prioritize these tests to ensure the safety and well-being of patients undergoing hemodialysis, as infections can have severe consequences on morbidity, mortality, and quality of life. The most recent and highest-quality study, published in 2020 in the American Journal of Kidney Diseases 1, provides the best evidence for these recommendations.
From the Research
Laboratory Tests for Hemodialysis Workup
The following laboratory tests are required for hemodialysis (HD) workup:
- Creatinine levels 2
- Urea levels 2
- Total and ionized calcium levels 2, 3, 4
- Albumin levels 2
- Sodium levels 2
- Potassium levels 2, 5
- Phosphate levels 2, 3, 4, 6, 5
- Parathyroid hormone (PTH) levels 2, 3, 4, 6, 5
- Hemoglobin levels 5
- Urea reduction ratio (URR) 5
- Ferritin levels 5
- Transferrin saturation (TSAT) 5
Frequency of Laboratory Testing
The frequency of laboratory testing for hemodialysis patients may vary, but a study suggests that a reduced testing frequency is possible without impacting the quality of care 5. The study found that therapeutic interventions following routine laboratory testing did not exceed six times yearly for all parameters.
Target Levels for Laboratory Tests
The target levels for laboratory tests in hemodialysis patients are:
- Calcium: within the K/DOQI recommended target range 4
- Phosphate: within the K/DOQI recommended target range 4
- Calcium phosphate product: within the K/DOQI recommended target range 4
- Intact PTH: within the K/DOQI recommended target range 4
- Hemoglobin: within the KDIGO targets 5
- URR: within the KDIGO targets 5
- Serum phosphate: within the KDIGO targets 5
- Calcium: within the KDIGO targets 5
- Potassium: within the KDIGO targets 5
- Parathormone (PTH): within the KDIGO targets 5
- Ferritin: within the KDIGO targets 5
- TSAT: within the KDIGO targets 5