A narrative review of routine haematological and biochemical parameter monitoring in maintenance haemodialysis patients and comparison of clinical guidelines

Sep 30, 2026

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Routine monitoring of haematological and biochemical parameters is essential for managing adults with kidney failure receiving maintenance haemodialysis, supporting assessment of dialysis adequacy and complications including anaemia, CKD-mineral and bone disorder, and electrolyte disturbances. No consensus exists on optimal testing frequency, with variation across clinical guidelines and limited high-quality evidence. This narrative review synthesises guideline recommendations and empirical research, highlighting areas of consensus and controversy, and outlining needs for future pragmatic RCTs.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Introduction

Methods

Guideline search strategy

Empirical evidence search strategy

Luu etal. BMC Nephrology (2026) 27:19 [https://doi.org/10.1186/s12882-025-04657-4](https://doi.org/10.1186/s12882-025-04657-4) BMC Nephrology REVIEW Open Access A narrative review of routine haematological and biochemical parameter monitoring in maintenance haemodialysis patients and comparison of clinical guidelines Harry H. Luu 1,2*, Jade Ryan 1 and Nigel D. Toussaint 1,3 Abstract Routine monitoring of haematological and biochemical parameters is essential in managing people with kidney failure on maintenance haemodialysis (HD), guiding assessment of HD adequacy and kidney failureassociated complications, including anaemia, chronic kidney disease-mineral and bone disorder, and electrolyte disturbances. Currently, however, there is no consensus on optimal testing frequency of key parameters, with variations across clinical guidelines and limited robust evidence. This narrative review synthesises current guideline recommendations and empirical research on the frequency and scope of routine laboratory testing of people on maintenance HD, focusing on areas of consensus, controversy, and future research needs. Key laboratory parameters were established to standardise the evaluation of foundational and region-specific guidelines, and direct literature searches for research within the last decade. Given the paucity of randomised controlled trials (RCTs), this narrative review is derived primarily from observational research and clinical guidelines. Guideline recommendations varied from flexible, clinician-driven frequencies in foundational guidelines, to prescriptive schedules in region-specific guidelines, though with consistencies across specific parameters. Empirical evidence indicated benefits of reduced testing frequency broadly when addressing medical over-testing. However, limited evidence exists to link parameter-specific testing intervals with outcomes such as hospital isation, sustaining international variation in guidelines. Future research should pair patient-reported outcome measures with parameter target levels longitudinally in pragmatic RCTs to clarify causal links between optimal monitoring intervalsand patient outcomes to develop risk-stratified monitoring frameworks for sustainable HD care. Keywords Kidney failure, Maintenance haemodialysis, Laboratory testing, Monitoring frequency, Clinical guidelines *Correspondence: Harry H. Luu [Harry.Luu@health.qld.gov.au](Harry.Luu@health.qld.gov.au) 1Department of Nephrology, The Royal Melbourne Hospital (RMH), Grattan Street, Parkville, Victoria 3052, Australia 2School of Medicine and Dentistry, Griffith University, Gold Coast, Australia 3Department of Medicine (RMH), University of Melbourne, Parkville, Australia © Crown 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Luu et al. BMC Nephrology (2026) 27:19 Introduction Haemodialysis (HD) is the most common kidney replacement therapy for people with kidney failure. Clinical goals for people with kidney failure focus on improving quality of life; and routine laboratory testing of haematological and biochemical parameters has become integrated into those receiving

FAQs

Why is routine monitoring of haematological and biochemical parameters important in maintenance haemodialysis?

It guides assessment of haemodialysis adequacy and helps manage complications such as anaemia, CKD-MBD, and electrolyte disturbances.

What problem does this narrative review address regarding monitoring frequency?

There is no consensus on optimal testing frequency, and guidelines vary while robust evidence remains limited.

What does the review recommend for future research?

Future studies should pair patient-reported outcome measures with parameter target levels over time in pragmatic randomised controlled trials to clarify causal links and support risk-stratified monitoring frameworks.

Sep 30, 2026

Uploaded by Đào