Why Patients Miss Dialysis Treatments, With Steven Brunelli, MD

Health issues accounted for 48% of missed dialysis treatments reported by patients in a survey presented at the American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado. Most respondents (63%) said the circumstances behind their missed treatment arose that same day.¹

Steven M. Brunelli, MD, MSCE, a study coauthor and vice president and medical director of health analytics and insights at DaVita Clinical Research, discussed the findings in an interview with HCPLive. The results highlight the range of barriers patients face and suggest opportunities for individualized approaches to rescheduling missed treatments.

Missed dialysis treatments are associated with an increased risk of hospitalization and mortality, yet the circumstances behind individual missed sessions are often not well understood in clinical practice.¹ Previous research has also suggested that rescheduling a missed hemodialysis treatment may attenuate the associated risk of hospitalization, although it does not eliminate that risk.²

In a retrospective study published in Kidney Medicine, missed treatments were associated with a 2.09-fold higher hospitalization rate over the following 7 days compared with attended treatments. Rescheduled treatments were associated with a 1.68-fold higher rate compared with attended treatments, suggesting a less pronounced elevation in risk when patients returned for treatment the following day.²

“We’re talking about patients who are expected to show up at a center for a particular treatment, and for a variety of reasons are unable to do so on that day,” Brunelli said. “In order to help promote better treatment attendance, we first needed to understand what was the genesis of the missed treatment.”

Surveying Patients Who Missed Dialysis Treatments

Using internal electronic health records, investigators identified 3,998 patients at a large kidney care organization who missed ≥1 dialysis treatment for reasons other than hospitalization between December 15, 2025, and January 6, 2026.¹

Each patient was mailed a 10-question questionnaire examining reasons for missed treatments and potential rescheduling. A total of 244 patients responded, representing approximately 6.1% of those surveyed.¹

Health, Transportation, and Scheduling Behind Missed Sessions

Among respondents, 76% reported missing 1 treatment in the past month, 14% reported missing 2, and 6% reported missing ≥3 treatments. Most (63%) indicated the circumstances leading to a missed treatment arose on the day of the scheduled session.¹

Health-related reasons accounted for 48% of missed treatments, followed by transportation (11%), personal schedules or obligations (9%), and other reasons (32%).¹

Patients also expressed concerns about the potential consequences of missing dialysis. Nearly half worried that missing a treatment would cause health problems. Swelling (60%) and feeling tired or weak (55%) were more commonly feared than trouble breathing (41%), hospitalization (37%), or heart problems (34%).¹

Proactive Center Outreach Associated With Greater Rescheduling

Only approximately 1 in 3 respondents indicated an intention to make up a missed dialysis treatment. Reported rescheduling was more common when the dialysis center reached out proactively (54%) than when no such contact occurred (38%).¹

Despite patients' concerns about the health consequences of missed treatments, fear of health problems was not associated with a greater likelihood of rescheduling. Investigators suggested these findings support tailoring outreach to individual patient concerns rather than relying on uniform messaging.¹

The survey's low response rate limits the generalizability of the findings, and the observational comparison does not establish that proactive outreach caused greater rescheduling. Nevertheless, the results point to opportunities for dialysis centers to better understand the circumstances behind missed treatments and respond to patients' individual needs.

“We need to understand what concerns a particular patient, tailor that reach out message to them in a way that meets them where they are, and is most effective at helping them,” Brunelli said. “Patients are not a monolith.”

Editor's Note: Disclosures for Brunelli include DaVita, Inc.

References

1. Eaton KM, Gonzalez Rodriguez H, Weinhandl ED, et al. Exploring patient perspectives on reasons for missing dialysis treatments. Abstract presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Poster SA-PO0992. doi:10.1681/ASN.20262j48mt5r

2. Cohen DE, Gray KS, Colson C, Van Wyck DB, Tentori F, Brunelli SM. Impact of rescheduling a missed hemodialysis treatment on clinical outcomes. Kidney Med. 2020;2(1):12-19. doi:10.1016/j.xkme.2019.10.007