Reducing Missed Dialysis Treatments to Improve Outcomes

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More direct intervention is showing promise in reducing missed dialysis treatments, a critical goal for improving the health of patients living with chronic kidney failure. These efforts include setting clearer expectations with patients and their families as well as implementing ongoing monitoring by the clinical care teams.

“We set the expectation up front that patients come to each treatment and stay the entire time,” said Cheryl Derflinger, the clinical manager at Fresenius Kidney Care Tar River in Louisberg, North Carolina. “And to make that happen everyone on the team has to be onboard.”

Clinic care teams explain to patients the critical need to complete all their scheduled treatments and get the most out of their time on dialysis. The Tar River clinic recently celebrated going a full year with no missed treatments by any patient, a milestone celebrated and shared with other Fresenius Kidney Care clinics.

“We know that there are things going on in our patient’s lives, and we offer options, ways for our patients to complete their treatments and still be able to do the other important things in their lives,” Derflinger said.

The Tar River Clinic staff.

The link between missed treatments and health complications for patients with kidney failure has been clearly documented in previous studies.

In a 2014 study of more than 180,000 patients, researchers from Fresenius Medical Care North America (FMCNA) found that a missed treatment led directly to increases in emergency room visits and hospitalizations. The analysis published in the Journal of the American Society of Nephrology, also concluded that patients who miss a treatment have poorer outcomes and much higher rates of depression.

“Our study found that patients with private transportation to dialysis were far less likely to miss an appointment and had significantly better outcomes when compared to patients relying on public transportation,” said Dr. Frank Maddux, Chief Medical Officer at FMCNA and co-author of the study.

FMCNA researchers have since found that patients are also more likely to miss dialysis and end up in the hospital when their treatment is scheduled on a holiday, on their birthday, during a major sporting event or when the weather is bad.

“These study results gave us a new way to speak with our patients and care teams about the importance of regular treatments and some of the potential barriers to treatment,” said Dr. Maddux. “It also helped improve the way we use predictive analytics to identify when patients are at risk of missing a treatment to foster their keeping to the disciplines of their schedule.”

The study has helped inform many new strategies implemented at the clinic level that are now showing promising results through early intervention and better understanding of the complex challenges patients often face.

“We’re here to support our patients and help them live their lives, but they can only live their lives well if they get good dialysis,” Derflinger said.