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

Dialysis services are major contributors to healthcare costs and carbon emissions, with surveillance bloodwork being one source of both. Blood testing frequency varies internationally: monthly testing is standard in the US due to regulatory requirements, while Canada commonly uses 6–8 weekly testing, with studies showing cost savings and no major safety concerns. However, previous studies did not fully evaluate transfusions or unscheduled blood tests, limiting assessment of overall benefits and risks. Current kidney disease guidelines acknowledge insufficient evidence to define the optimal testing frequency’s address these evidence gaps, this original research article evaluates the clinical, economic, and environmental impact of reducing surveillance bloodwork frequency in patients receiving maintenance haemodialysis.

In September 2023, our Australian health district reduced routine haemodialysis surveillance bloodwork from monthly to every six weeks. We compared the 12 months before and after this change to assess its effects on scheduled and unscheduled bloodwork, patient safety (hospitalisations, hyperkalaemia, and haemoglobin/potassium target attainment), healthcare costs, waste generation, carbon emissions, and dialysis staff perspectives.