THE ACCESS — AN ATLAS OF THE U.S. DIALYSIS SYSTEMPLATE IV — PROOF STATE — 07|2026

The Draws

A GENERATED VIEW · EVERY LAB CLOCK, AND WHO WINDS IT

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. It names much of the rest of the laboratory profile, but it never clocks it. Every other rhythm on the calendar 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.

HOW TO READ · ONE ROW = ONE DRAW · TWELVE COLUMNS = ONE YEAR · FILLED MARK = THE FLOOR — FEDERAL LAW, DIRECT OR INCORPORATED · OPEN MARK = THE GUIDELINE BODIES · DASHED MARK = THE HOUSE’S CUSTOM · NO MARKS = NO SET CLOCK · THE LEDGER BELOW CARRIES THE EXACT LANGUAGE, WITH SOURCES
AN ATLAS OF THE U.S. DIALYSIS SYSTEMWIDE GRAMMAR — THE LAB CLOCKSPLATE IV
The DrawsPROOF STATE · ED. 001 · 07|2026
THE DRAW ONE YEAR — MARKS AT THE LONGEST COMPLIANT INTERVAL WHO SETS THE CLOCK J F M A M J J A S O N D DIALYSIS ADEQUACY -- DELIVERED KT/V HD THE FLOOR -- AT LEAST MONTHLY DIALYSIS ADEQUACY -- DELIVERED WEEKLY KT/V PD THE FLOOR -- AT LEAST EVERY 4 MONTHS HEMOGLOBIN / HEMATOCRIT HD + PD THE FLOOR -- AT LEAST MONTHLY SERUM ALBUMIN + BODY WEIGHT HD + PD THE FLOOR -- AT LEAST MONTHLY HBSAG -- HBV-SUSCEPTIBLE PATIENT IN-CENTER HD (PD: BY POLICY) INCORPORATED -- MONTHLY WHILE SUSCEPTIBLE ANTI-HBS -- VACCINE RESPONDER IN-CENTER HD (PD: BY POLICY) INCORPORATED -- ANNUAL RETEST HBV -- CHRONICALLY INFECTED PATIENT IN-CENTER HD (PD: BY POLICY) NO ROUTINE CLOCK NO ROUTINE CLOCK HEPATITIS C SCREENING IN-CENTER HD GUIDELINE -- EVERY 6 MONTHS IRON INDICES -- TSAT + FERRITIN HD + PD GUIDELINE -- EVERY 1-3 MONTHS CALCIUM + PHOSPHATE HD + PD GUIDELINE -- EVERY 1-3 MONTHS PTH HD + PD GUIDELINE -- EVERY 3-6 MONTHS ALKALINE PHOSPHATASE HD + PD GUIDELINE -- EVERY 12 MONTHS 25(OH) VITAMIN D HD + PD NO SET CLOCK -- GUIDELINE-OPTIONAL NO SET CLOCK -- GUIDELINE-OPTIONAL HEMOGLOBIN A1C (DIABETIC PATIENTS) HD + PD GUIDELINE -- 2x/YEAR, UP TO 4x LIPID PANEL HD + PD NO ROUTINE REDRAW -- GUIDELINE’S OWN WORDS NO ROUTINE REDRAW -- GUIDELINE’S OWN WORDS VITAMIN B12 + FOLATE HD + PD THE HOUSE -- CUSTOM, NO OUTSIDE CLOCK CHEMISTRY PANEL (ELECTROLYTES, ETC.) HD + PD THE HOUSE -- MONTHLY BY CUSTOM THE FRAME (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 (STABLE) / AT LEAST MONTHLY (UNSTABLE). THE ONLY ANNUAL FEDERAL CLOCK IS THE STABLE-PATIENT REASSESSMENT. MARKS ARE DRAWN FROM A JANUARY START AT THE LONGEST COMPLIANT INTERVAL · RANGES AND EXACT LANGUAGE LIVE IN THE LEDGER · A CALENDAR IS AN ILLUSTRATION, NOT A PRESCRIPTION
MARGIN — RESERVED FOR THE HAND
KEY
THE FLOOR — FEDERAL LAW, DIRECT OR BY INCORPORATION
THE GUIDELINE — KDIGO / KDOQI / ISPD / CDC-AS-GUIDANCE
THE HOUSE — FACILITY CUSTOM, NO OUTSIDE CLOCK
NO MARKS ON THE LINE = NO SET CLOCK
THE LEDGER — THE EXACT LANGUAGE · LAST VERIFIED 2026-07-10
THE DRAWMODALITYTHE FLOORTHE GUIDELINETHE HOUSESRCVERIFIED
Dialysis adequacy -- delivered Kt/VHD42 CFR 494.80(c)(1): assessed on an ongoing basis, "at least monthly by calculating delivered Kt/V or an equivalent measure"KDOQI HD Adequacy 2015: target spKt/V 1.4, minimum 1.2 (the floor-vs-target split is Plate X)—eCFR 494.80(c)(1); KDOQI 20152026-07-10
Dialysis adequacy -- delivered weekly Kt/VPD42 CFR 494.80(c)(2): "at least every 4 months by calculating delivered weekly Kt/V or an equivalent measure"ISPD 2020 (Brown et al.): goal-directed PD -- no single number carries the goal (Plate X's argument)—eCFR 494.80(c)(2); ISPD 20202026-07-10
Hemoglobin / hematocritHD + PD42 CFR 494.90(a)(4): "The patient's hemoglobin/hematocrit must be measured at least monthly"KDIGO Anemia 2026: hemoglobin every 1-3 months in G5D—eCFR 494.90(a)(4); KDIGO Anemia 20262026-07-10
Serum albumin + body weightHD + PD42 CFR 494.90(a)(2): "A patient's albumin level and body weight must be measured at least monthly"Additional nutrition indicators "may be monitored, as appropriate" (same subsection) -- the dietitian's lane—eCFR 494.90(a)(2)2026-07-10
HBsAg -- HBV-susceptible patientIN-CENTER HD (PD: BY POLICY)By incorporation: 494.30(a)(1)(i) adopts CDC MMWR 2001 (RR05) -- serologic status known before first treatment; susceptible patients tested for HBsAg monthly; vaccination begun on admissionThe incorporated document is written for chronic HEMODIALYSIS settings; PD programs adapt the calendar by policy—eCFR 494.30(a)(1)(i); CDC MMWR 2001;50(RR05); IG v1.1 V-tag guidance2026-07-10
Anti-HBs -- vaccine responderIN-CENTER HD (PD: BY POLICY)Same incorporation: "Retest patients who respond to the vaccine annually for anti-HBs" (IG v1.1, carrying CDC 2001)While anti-HBs < 10 mIU/mL the patient is SUSCEPTIBLE again -- back to the monthly row—IG v1.1 (CDC 2001 via 494.30)2026-07-10
HBV -- chronically infected patientIN-CENTER HD (PD: BY POLICY)Same incorporation: chronically infected patients "do not require any routine follow-up testing for purposes of infection control"; annual HBsAg is called "reasonable," not required——IG v1.1 (CDC 2001 via 494.30)2026-07-10
Hepatitis C screeningIN-CENTER HDNONE -- and explicitly so: 494.30(a)(1)(i) adopts the CDC recommendations "with the exception of screening for hepatitis C." The carve-out is in the regulation's own wordsKDIGO Hepatitis C 2022: screen in-center HD patients on entry, then every 6 months (1B); resolved infection retested by NAT every 6 months—eCFR 494.30(a)(1)(i); KDIGO HCV 20222026-07-10
Iron indices -- TSAT + ferritinHD + PDContent only: "iron studies" are named in the assessment's laboratory profile (IG V505) -- no federal cadenceKDIGO Anemia 2026: hemoglobin, ferritin, and TSAT every 1-3 months on iron therapy (PIVOTAL-informed thresholds: hold when ferritin > 700 ng/mL or TSAT >= 40%)—IG V505; KDIGO Anemia 20262026-07-10
Calcium + phosphateHD + PDContent only: mineral metabolism is a mandated plan-of-care area (494.90(a)(3)) -- no federal cadenceKDIGO CKD-MBD 2017, G5D: serum calcium and phosphate every 1-3 months; more often when treating or abnormal—eCFR 494.90(a)(3); KDIGO CKD-MBD 20172026-07-10
PTHHD + PDContent only (mineral metabolism plan-of-care area)KDIGO CKD-MBD 2017, G5D: PTH every 3-6 months—KDIGO CKD-MBD 20172026-07-10
Alkaline phosphataseHD + PDNoneKDIGO CKD-MBD 2017, G5D: every 12 months; more frequently with elevated PTH—KDIGO CKD-MBD 20172026-07-10
25(OH) vitamin DHD + PDNoneKDIGO CKD-MBD 2017: 25(OH)D "might be measured, with repeated testing determined by baseline values and therapeutic interventions" (2C) -- a measure-maybe, not a calendarCommonly annualized by facility policy (often paired with the annual reassessment); recheck ~12 weeks after starting repletion is practice, not mandateKDIGO CKD-MBD 20172026-07-10
Hemoglobin A1c (diabetic patients)HD + PDNone -- no dialysis Condition clocks glycemic labsKDIGO Diabetes 2022: twice yearly is reasonable, up to 4x/year off-target -- WITH the stated caveat that HbA1c reliability is LOW in dialysis patients (CGM/GMI offered as the alternative)Whether to draw it at all in-unit is a program decision -- the diabetes manager's lab, wherever managedKDIGO Diabetes 20222026-07-10
Lipid panelHD + PDNoneKDIGO Lipids 2013: measure at initial evaluation; "follow-up measurement of lipid levels is not required for the majority of patients" -- the fire-and-forget postureA semi-annual lipid line on a house list is custom, not a mandateKDIGO Lipids 20132026-07-10
Vitamin B12 + folateHD + PDNoneNo cadence in the major guidelines -- workup-driven (e.g., unexplained anemia, MCV), not calendar-drivenWhere a semi-annual or annual line exists, it is facility custom -- ask for the document behind itabsence verified against the anemia/MBD guidelines above2026-07-10
Chemistry panel (electrolytes, etc.)HD + PDContent only: "comprehensive metabolic testing" is named in the assessment's laboratory profile (IG V505) -- the WHAT is federal, the WHEN is notNo single guideline clocks the panel; the monthly rhythm rides the monthly floor labs aboveMonthly panels are near-universal custom -- drawn with the mandated monthly hemoglobin and albuminIG V5052026-07-10
THE ACCESS · 07|2026
ED. 001 · GENERATED VIEW SRC: 42 CFR 494.80 / 494.90 / 494.30 (eCFR) · CMS ESRD IG V1.1 (2008) · CDC MMWR 2001 (RR05) · KDIGO 2013–2026 · KDOQI 2015 · ISPD 2020
PLATE IV · PROOF STATE · LAST VERIFIED 2026-07-10 GENERATED FROM THE ATLAS DATASET
AWAITING THE AUTHOR’S PASS PLATE V