Which blood tests do people on dialysis need to do regularly?

I have seen such conflicting opinions about the blood tests people on dialysis need to do regularly - monthly, quarterly and so on. Every doctor, every hospital and every dialysis technician has his or her own opinion. Yes, every individual has a specific requirement and the list of tests will vary depending on his or her condition. But there surely must be a common bare minimum that every dialyzor must get done, right?

Hemoglobin is probably the only test that everyone concurs. Most people get this done every month at least. A good hemoglobin is essential for general well-being. It also dictates the amount of Erythropoietin you need to take.

On the rest of the tests, pretty much everyone has their own opinion.

Some people get the Creatinine and Urea done every month. I totally understand getting these done for people in the early stages of CKD. What purpose does the Creatinine serve, however, once someone is on regular Maintenance Hemodialysis? The kidneys have pretty much shut shop, never to open again. What is the point in doing the Creatinine? A test should be done if, based on the result, some action can be taken. If someone's Creatinine goes up by 2 points, is the frequency of dialysis going to be increased? If the Creatinine has gone down by 2 points, are you going to reduce his frequency of dialysis?

Coming to Urea, if you are going to do the pre-HD and post-HD urea and use it to estimate the Kt/V, a measure of adequacy of dialysis, fine. Doing only the pre-HD urea serves no purpose, in my humble, non-medical, only-based-on-common-sense opinion.

Clinics that are concerned about HCV cross-infection often insist on a SGPT, a liver function indicator, every month. That is fine and should be encouraged with the rampant cross-infection with this virus (at least in India) these days.

Calcium and Phosphorus are tested with varying frequency. With the amount of trouble I had with both of these, I would really suggest keeping a tab on these. At least quarterly, if not monthly?

The biggest problem with dialysis in India, as I keep repeating ad nauseam, is that patients have to pay out of pocket for their medical expenses. When that happens, automatically, non-medical factors come into play while deciding the frequency and type of blood tests. At NephroPlus, we are constantly battling this problem. Patients often suspect our intentions when we recommend blood tests for them. I can totally understand and relate to their thinking. So, it is important for patients to be educated and aware enough of their medical condition to be able to take such decisions in their best interests, balancing their financial concerns with their medical ones.


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