Obstacles to achieving adequate dialysis dose: compliance, education, transportation, and reimbursement

There are numerous barriers to delivering the prescribed quantity of dialysis. Noncompliance in terms of shortening and skipping treatments is common and negatively impacts on delivered dialysis. A significant number of shortened treatments are caused by reasons within the patient's control, whereas others, such as transportation, can be influenced by others. This article will review the prevalence of patient noncompliance with the dose of dialysis and the relationship to process and outcome measures. Educational and quality improvement programs resulting in increasing the delivered dialytic dose will also be explored.