Psychosocial factors in patients who miss hemodialysis sessions: a single-center retrospective review

Background Nonattendance at scheduled hemodialysis (HD) sessions is a frequent form of treatment nonadherence. Psychosocial factors are known contributors, yet the psychological profiles of frequent non-attenders remain underexplored. We conducted a retrospective analysis of patients with recurrent HD nonattendance, defined as missing more than four dialysis sessions during the two-year study period, who were referred to renal psychology services.Methods Data were extracted from psychological case notes using a structured pro forma designed by the renal psychology team, and included reason for referral, preexisting mental health issues and history of adverse childhood experiences (ACEs). Information recorded by the dialysis nurses on the electronic patient record on the day of nonattendance for all patients referred to psychology was retrieved and analyzed to identify and categorize recurring themes. Descriptive analysis was conducted for both datasets.Results Of 464 patients in the original cohort, 54 met criteria for frequent nonattendance. Twenty-two (40.7%) were referred to psychology, of whom 17 engaged with at least one session. Fifteen out of 17 (88%) of these patients had preexisting mental health conditions, primarily depression (n = 12, 71%) and anxiety (n = 8, 47%). Confirmed or possible adverse childhood experiences were identified in 88% of assessed patients. Nursing records cited concurrent illness, limited disease understanding, family obligations, and logistical barriers as common reasons for missed sessions.Conclusions This study underscores the need for early, integrated psychological assessment within the dialysis care pathway. A trauma-informed, multidisciplinary model may improve access to support and sustain adherence over time and should be prospectively investigated.