Related Experiment Video
Updated: May 23, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Hemodialysis Nonattendance: Patient Characteristics and Outcomes in a Single Renal Center in North West England
Rajkumar Chinnadurai1,2, Jessica Dean1, Sharmilee Rengarajan1
1Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Insights
Skipping hemodialysis (HD) sessions is common and linked to mental health issues, leading to increased hospitalizations and lower transplant rates. Understanding these factors is crucial for improving patient outcomes.
Area of Science:
- Nephrology
- Public Health
- Clinical Medicine
Background:
- Nonattendance for hemodialysis (HD) compromises life-sustaining therapy.
- HD nonadherence is associated with significant morbidity and mortality.
- Understanding nonattender characteristics is vital for improving care.
Purpose of the Study:
- To assess characteristics of hemodialysis nonattenders.
- To evaluate outcomes associated with HD nonattendance.
- To identify predictors of dialysis nonattendance.
Main Methods:
- Retrospective analysis of 464 HD patients from Dec 2020 to Sep 2022.
- Categorization into no, two or fewer, and more than two nonattendance episodes.
- Logistic regression used to identify predictors of nonattendance.
Main Results:
- 32% of patients (149/464) exhibited dialysis nonattendance.
- Patients with >2 nonattendances had higher hospitalization rates (4 vs. 1 day) and lower transplant rates (4.3% vs. 13%).
- Younger age, smoking, alcohol excess, and mental health illness history predicted nonattendance.
Conclusions:
- Hemodialysis nonattendance is prevalent and linked to mental health conditions.
- Nonadherence significantly increases morbidity.
- Further research into psychosocial determinants and interventions is needed to improve outcomes.
Introduction:
Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England.
Methods:
HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression.
Results:
Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, p < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, p = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95-0.98; p = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12-3.62; p = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87-6.49; p < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61-5.62; p = 0.001) were significant predictors of dialysis nonattendance.
Conclusion:
Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:22Heart Failure Drugs: Diuretics
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:45Kidney Structure