# Missed Dialysis: Ask What Prevented Attendance

Track whether the barrier was reduced and whether the patient can sustain the plan. Reliable access to care is part of treatment quality.

![Infographic: Missed Dialysis: Ask What Prevented Attendance](https://urinenephrology.org/visual-reference/images/mastery-hd-missed.png?v=20261003c)

## Risk accumulates between sessions

Missed or shortened treatment can increase electrolyte, fluid, and uremic burden, particularly across a longer interval.

## Triage before simply rescheduling

Ask about dyspnea, chest symptoms, weakness, confusion, swelling, and time since the last completed treatment. Concerning symptoms or suspected dangerous potassium need urgent assessment. The catch-up prescription depends on accumulated fluid/solute burden and tolerance, not just the slot available.

## Find the barrier

Transportation, cost, housing, work, caregiving, depression, symptoms, communication, and treatment experience can all interfere with attendance.

## Convert the barrier into a specific action

If the ride failed, arrange the next transport and a backup contact before ending the conversation. If treatment symptoms caused avoidance, request a prescription review. Name who owns the next step, confirm the treatment time, and use teach-back to check whether the plan will work.

## Coordinate the next treatment

Rescheduling and prescription decisions should consider time missed, clinical status, fluid gain, and tolerance rather than simply repeating a routine session.

## Measure improvement meaningfully

Track whether the barrier was reduced and whether the patient can sustain the plan. Reliable access to care is part of treatment quality.

## Source lessons

- [missed treatments health related social needs](https://urinenephrology.org/mastery/maintenance-hd/missed-treatments-health-related-social-needs.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.