← the access Reviewed as of 15 July 2026
THE ACCESS · HOW IS CARE MEASURED AND JUDGED?

The Draws

Every dialysis program keeps a lab calendar, and almost nobody can say where it came from. Drawn out, the answer is stark: the federal rulebook writes a clock for exactly three measures in its own words—adequacy, hemoglobin, albumin—and lets the hepatitis B calendar ride in through an incorporated CDC document written for hemodialysis. Every other rhythm belongs to the guideline bodies, or to the house. If a line on your annual list has no row here, ask for the document behind it.

TEXT ALTERNATIVE ↓
WIDE DRAWING · SCROLL SIDEWAYS TO READ IT ALL · THE FULL CONTENT IS ALSO IN WORDS BELOW
The floor—federal law sets this clock, directly or by incorporation
The guideline—KDIGO / KDOQI / ISPD / CDC-as-guidance
The house—facility custom, no outside clock
A bare line—no set clock at all
Reviewed as of 15 July 2026 Changelog

The drawing in words

  1. The frame (42 CFR 494.80): initial comprehensive assessment within the latter of 30 days or 13 outpatient HD sessions; follow-up reassessment within 3 months; then at least annually if stable, at least monthly if unstable. Within the assessment frame, the only annual federal clock is the stable-patient reassessment. (Part 494 carries other annual duties elsewhere—e.g. the annual transplant-center communication at 494.90(c)(3).) [1]
  2. Dialysis adequacy, delivered Kt/V (HD)—THE FLOOR: at least monthly. 42 CFR 494.80(c)(1). [1]
  3. Dialysis adequacy, delivered weekly Kt/V (PD)—THE FLOOR: at least every 4 months. 42 CFR 494.80(c)(2). [1]
  4. Hemoglobin / hematocrit (HD + PD)—THE FLOOR: at least monthly. 42 CFR 494.90(a)(4). KDIGO Anemia 2026 says every 1-3 months in G5D. [1 · 2]
  5. Serum albumin + body weight (HD + PD)—THE FLOOR: at least monthly. 42 CFR 494.90(a)(2). [1]
  6. HBsAg, HBV-susceptible patient (in-center HD; PD by policy)—INCORPORATED: monthly while susceptible. 494.30(a)(1)(i) adopts CDC MMWR 2001 (RR-5). The incorporated document is written for chronic hemodialysis; PD programs adapt the calendar by policy. [1 · 3 · 4]
  7. Anti-HBs, vaccine responder (in-center HD; PD by policy)—INCORPORATED: annual retest. Below 10 mIU/mL the patient is susceptible again, and returns to the monthly row. [3 · 4]
  8. HBV, chronically infected patient—NO ROUTINE CLOCK. The incorporated guidance says chronically infected patients do not require routine follow-up testing for infection-control purposes; annual HBsAg is called reasonable, not required. [3 · 4]
  9. Hepatitis C screening (in-center HD)—GUIDELINE: every 6 months. There is no federal clock, and explicitly so: 494.30(a)(1)(i) adopts the CDC recommendations with the exception of screening for hepatitis C. The 6-month cadence is KDIGO Hepatitis C 2022 (1B). [1 · 5]
  10. Iron indices, TSAT + ferritin (HD + PD)—GUIDELINE: every 1-3 months on iron therapy. KDIGO Anemia 2026. Federal law names iron stores in the assessment (494.80(a)(4)) and asks that they be monitored on a routine basis (494.90(a)(4)); the laboratory-profile enumeration is CMS’s interpretive guidance (V505). Neither sets a cadence. [1 · 2 · 4]
  11. Calcium + phosphate (HD + PD)—GUIDELINE: every 1-3 months in G5D. KDIGO CKD-MBD 2017. Mineral metabolism is a mandated plan-of-care area (494.90(a)(3)) with no federal cadence. [1 · 6]
  12. PTH (HD + PD)—GUIDELINE: every 3-6 months. KDIGO CKD-MBD 2017. [6]
  13. Alkaline phosphatase (HD + PD)—GUIDELINE: every 12 months; more often with elevated PTH. KDIGO CKD-MBD 2017. [6]
  14. 25(OH) vitamin D (HD + PD)—NO SET CLOCK, guideline-optional. KDIGO CKD-MBD 2017 says it might be measured, with repeat testing determined by baseline values and treatment. Where it is annualized, that is facility policy. [6]
  15. Hemoglobin A1c, diabetic patients (HD + PD)—GUIDELINE: twice a year, up to four times a year off-target. KDIGO Diabetes 2022, with the stated caveat that HbA1c reliability is low in dialysis patients. No dialysis Condition clocks glycemic labs. [1 · 7]
  16. Lipid panel (HD + PD)—NO ROUTINE REDRAW. KDIGO Lipids 2013: measure at initial evaluation; follow-up measurement is not required for the majority of patients. A semi-annual lipid line is house custom. [8]
  17. Vitamin B12 + folate (HD + PD)—THE HOUSE: custom, no outside clock. It is workup-driven, not calendar-driven. [2 · 6]
  18. Chemistry panel, electrolytes and the rest (HD + PD)—THE HOUSE: monthly by custom. Comprehensive metabolic testing is named in the interpretive guidance’s laboratory profile (V505), not in the CFR—so the WHAT is CMS’s guidance and the WHEN is nobody’s; the monthly rhythm rides the mandated monthly hemoglobin and albumin. [4]
  19. Marks are drawn from a January start at the longest compliant interval. A calendar is an illustration, not a prescription.

BRACKETED NUMBERS TRACE EACH LINE TO THE SOURCE LIST BELOW · EVERY SOURCE IS HELD IN THE REFERENCES LEDGER WITH ITS LOCATOR, ITS LAST-CHECKED DATE, AND HOW IT WAS VERIFIED