Predictors of missed hemodialysis in end-stage renal disease patients presenting to the emergency department

Christopher Payette, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Ryan Heidish, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Aditya Loganathan, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Isabella Lagunzad, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Haoling Wang, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
Taylor Bolden, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Tarun Loganathan, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Soroush Shahamatdar, UCLA School of Medicine, Los Angeles, CA, USA.
Pramita Bagchi, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
Marcee Wilder, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, NY, USA.
Meylakh Barshay, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Yan Ma, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
Andrew C. Meltzer, The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC, USA. Electronic address: ameltzer@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

12-19-2025

Journal

The American journal of emergency medicine

Volume

101

DOI

10.1016/j.ajem.2025.12.015

Keywords

Adherence; Emergency department; End-stage renal disease; Hemodialysis; Risk factors

Abstract

OBJECTIVES: Patients with end-stage renal disease (ESRD) often present to the emergency department (ED) after missing hemodialysis (HD) sessions, but it is unclear how these patients differ from those who are adherent. We compared ED patients with ESRD who recently missed HD versus those adherent to identify associated risk factors, and we explored differences in 12-month ED revisits. METHODS: We prospectively enrolled adult ED patients with ESRD on HD at a single urban academic ED and classified them as "HD-Missed" (≥1 missed session in the prior week) or "HD-Adherent." Participants completed a biopsychosocial survey, and ED course data were collected. A retrospective chart review assessed acute care utilization at 12 months. RESULTS: Among 129 enrolled patients, 66 were HD-Missed and 63 were HD-Adherent. Compared with adherent patients, HD-Missed patients were more likely to have prior ED visits for HD (58 % vs 37 %, p = 0.03), present with severe electrolyte abnormalities (30 % vs 6 %, p = 0.001), report ≥30-min travel times to dialysis (30 % vs 8 %, p = 0.004), and have multiple missed HD sessions in the prior month (43 % vs 17 %, p = 0.005). At 12 months, HD-Missed patients had numerically higher ED revisits, although this difference did not reach statistical significance. CONCLUSIONS: ED patients with ESRD who miss HD exhibit distinct clinical and social risk factors compared with adherent patients. Addressing modifiable barriers such as transportation and competing priorities may improve HD adherence and reduce acute care utilization.

Department

Emergency Medicine

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