Dialysis Non-Attendance Advice Sheet

  • Reference Number: HEY-870-2017
  • Departments: Renal Service

Why is it important for me to complete my prescribed haemodialysis sessions?

To achieve the best survival outcomes, haemodialysis should take place at least 3 times per week, 4 hours per session, in nearly all patients with end stage kidney disease. This is only to be reduced in exceptional circumstances following careful discussion with your kidney consultant.

What does dialysis do and why is it so important?

Like healthy kidneys, dialysis cleans the blood. It removes waste, salts and extra water to prevent them from building up in the body. It keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate.

The dialysis prescription provides instructions the nurse needs to carry out in order to deliver your haemodialysis.  To make sure that the dialysis is working for you we have to make sure that enough water and waste products are being cleaned from the blood.

The symptoms you may feel if you do not get enough dialysis include:

  • tiredness
  • weakness
  • nausea or poor appetite
  • loss of body weight

If you do not have proper dialysis, you may feel “OK” but be at increased risk of hospital admission or even death.

For a dialysis patient, getting the right amount of dialysis will usually make that person feel better and help lead a more active and healthy life.

To have good dialysis the patient will need 4 hours of dialysis, 3 times per week (or 12 hours per week).  As many litres of blood as possible need to be cleaned throughout these 12 hours therefore blood flow should be as high as possible.  The percentage of cleaning is measured from a monthly blood test. This is known as Urea Reduction Ratio (URR) and should be at least 70%. Good dialysis cannot be shortened below the twelve hours a week.

It is worth remembering that kidneys normally work 24 hours a day, 7 days a week and this provides between 90 -100% clearance of waste and fluids from the body. 12 hours of dialysis a week is like the kidneys working at only 15% and is a long way from the 168 hours a week that normal kidneys work.

Studies have shown that patients having a good dialysis do much better in the long term and usually live longer than those having inadequate dialysis.

What happens if I decide not to attend or shorten one of my prescribed haemodialysis sessions?

If you do not attend all of your full dialysis session you will be risking your health. You may encounter the following problems:

  • High potassium levels which can affect your heart rhythm and can be deadly
  • Too much fluid in the body leading to fluid in your lungs, breathlessness, swollen ankles, raised blood pressure and heart failure.
  • Itching, feeling tired and exhausted
  • Decreased appetite

What if I just missed one dialysis session a month?

  • Skipping 1 dialysis session a month (or more) increases your risk of death by 30%* compared to someone who regularly attends dialysis. Compared to someone who dialyses a full 4 hours, 3 times a week, those dialysing for shorter times have an increased risk of death.
  • 19% increased risk of death* – if dialysis is between 3½ to 4 hours of dialysis
  • 34% increased risk of death* – for less than 3½ hours of dialysis. This equates to losing 4 months per year of your life expectancy.

What if I decide not to attend my haemodialysis session?

If you do not attend for a prescribed haemodialysis session a dialysis nurse will ring you at home or on the number that we have recorded for you in your notes.

  • We will then ask for an explanation for your non-attendance
  • Explain to you why it is important for you to attend all prescribed sessions
  • Check that you understand fully the risks and possible consequences of not attending for your dialysis session.
  • Inform your kidney consultant and your GP of your decision.
  • It will be recorded in your notes your wish not to attend for your treatment and the actions taken and advice given to you.
  • You will be given another copy of this leaflet next time you attend. If we cannot contact you or a relative and you have not been admitted to hospital, we may contact the police to check that you are safe and well.

If you do not attend your dialysis regularly, you make this choice at your own risk. Alternative session times are not always available and as a result you may lose your regular time and dialysis slot.

Who should I contact if I want to discuss my dialysis?

You can either talk to your named dialysis nurse, team leader, the dialysis unit manager, your GP or an appointment will be made to see your kidney consultant.

Who should I contact if I feel unwell?

Contact your GP or local Emergency Department, especially if you have missed more than one dialysis session.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.