Education Use Only
For educational use only — The physician’s written order and the unit protocol always govern
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Dialysis Nursing Reference Card  ·  Maintenance Hemodialysis

N9 — Monthly Labs

What each routine lab means, and which results to report.
Andrew Bland, MD, FACP, FAAP Reviewed September 2026 · v1.0 draft Prints on one sheet, front and back
N9 — Monthly Labs FRONT
Front · at the chair

When: monthly lab review, and whenever a result comes back out of pattern.

Do this

  1. Draw iron studies before that session’s iron dose and note the date of the last IV iron [2].
  2. Compare each result with the last 2–3 values — a trend matters more than one number [5].
  3. Question a surprising value before acting: a hemolyzed potassium, or a TSAT drawn within 2–4 weeks of a 1-gram iron course [2].
  4. Report using the table; bring the rest to monthly rounds.
Lab What it tells you Report when
Potassium Rhythm risk Per N1: Potassium Bath Selection
Hemoglobin (monthly) Oxygen carrying; guides ESA dose Rise of more than 1 g/dL in 2 weeks; at or above your protocol’s hold threshold; below 9 g/dL; unexpected drop of 1 g/dL or more [1,2]
Ferritin and TSAT (every 1–3 months) Iron stores; iron available now Ferritin above 700 ng/mL or TSAT 40% or higher (iron held); ferritin below 45 or MCV below 80 (blood loss?); TSAT below 20% with ferritin above 500 [2]
Albumin (monthly) Nutrition and inflammation Below 3.5 g/dL, or falling with weight loss or poor intake [3]
spKt/V (monthly) Delivered dialysis dose Below 1.4 on a three-times-weekly schedule, or an unexplained drop of more than 0.2 — check the access [4,6]
Calcium, phosphorus (every 1–3 months) Bone and mineral balance Outside your protocol’s range, or a steady trend one way [5]
PTH (every 3–6 months) Parathyroid activity A rising trend [5]
ALT (monthly) Liver; hepatitis surveillance Any new elevation — see N11: Infection Control: Hepatitis B and C, Vaccination, Isolation [7]
Bicarbonate (total CO2) Acid–base Per N2: Dialysate Prescription Check

Call the nephrologist when

  • Potassium is 6.5 or higher, or any high potassium with symptoms or ECG change — now.
  • Hemoglobin is below 9 g/dL with chest pain, shortness of breath, or fainting, or has risen more than 1 g/dL in 2 weeks [1].
  • A hepatitis B or C test turns newly positive — same day (N11: Infection Control: Hepatitis B and C, Vaccination, Isolation).
  • Everything else in the table: at rounds, or sooner per your unit protocol.

Don’t

  • Don’t change the bath, ESA, iron, binder, or vitamin D dose without an order or protocol.
  • Don’t read a TSAT drawn soon after IV iron as the patient’s baseline [2].
N9 — Monthly Labs BACK
Back · why, and the evidence

Why

  1. The epoetin label requires a dose cut of 25% or more when hemoglobin rises more than 1 g/dL in any 2-week period [1].
  2. KDIGO 2026: test ferritin and TSAT every 1–3 months on hemodialysis, and withhold routine iron at ferritin above 700 or TSAT 40% or higher [2].
  3. A serum albumin below 3.5 g/dL was associated with higher long-term mortality (HR 1.84) [3].
  4. KDOQI targets an spKt/V of 1.4 per treatment for three-times-weekly dialysis [4]; a Kt/V drop of more than 0.2 is a KDOQI indicator of access dysfunction [6].
  5. KDIGO 2017: calcium and phosphorus every 1–3 months, PTH every 3–6 months, with trends weighted over single values [5].

Go deeper

References

  1. Amgen Inc. EPOGEN (epoetin alfa) injection, prescribing information. Revised April 2024. accessdata.fda.gov
  2. KDIGO Anemia Work Group. KDIGO 2026 clinical practice guideline for the management of anemia in CKD. Kidney Int. 2026;109(1S):S1-S99. PubMed 41485812
  3. Öneç K, et al. Baseline serum albumin for long-term risk stratification in maintenance hemodialysis patients. J Clin Med. 2026;15:333. PubMed 41517580
  4. Rocco MV, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66:884-930. PubMed 26498416
  5. KDIGO CKD-MBD Update Work Group. KDIGO 2017 CKD-MBD guideline update. Kidney Int Suppl. 2017;7:1-59. PubMed 30675420
  6. Lok CE, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164. PubMed 32778223
  7. KDIGO Hepatitis C Work Group. KDIGO 2022 guideline for hepatitis C in CKD. Kidney Int. 2022;102(6S):S129-S205. PubMed 36410841

Reviewed by Andrew Bland, MD, FACP, FAAP · v1.0 draft 2026-09-26. For education; the physician’s written order and the unit protocol always govern.