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Abstract: TH-PO274

The Health and Economic Consequences of Missed Dialysis at the Robley Rex Veterans Affairs Medical Center

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Cholin, Liza, University of Louisville, Louisville, Kentucky, United States
  • Burlen, Jordan, University of Louisville, Louisville, Kentucky, United States
  • Harden, Farrah, University of Louisville, Louisville, Kentucky, United States
  • Murthy, Nevin, University of Louisville, Louisville, Kentucky, United States
  • Brier, Michael E., University of Louisville, Louisville, Kentucky, United States
  • Lederer, Eleanor D., University of Louisville; Robley Rex VA Medical Center, Louisville, Kentucky, United States

Non-adherence to hemodialysis (HD) is associated with increased morbidity and mortality risk, as well as increased health care costs. These patients frequently present to the emergency department (ED) needing urgent HD for volume overload, hyperkalemia, or uremic symptoms. At present, the Robley Rex VAMC does not offer outpatient HD, necessitating full hospital admission for patients who present with urgent need for HD. We hypothesized that offering outpatient HD to patients who missed their scheduled appointments would reduce costs attributed to missed HD hospital admissions, even taking into account increased dialysis nurse overtime utilization.


We conducted a retrospective analysis of established HD patients evaluated in the ED of the Robley Rex VAMC, between October 2015 and May 2017, for complications secondary to missed dialysis. Individuals that were admitted for any reason other than urgent HD were excluded. The costs for ED evaluation, hospitalization, and dialysis labor costs were obtained. We calculated costs of the full inpatient admission including dialysis and compared those results with the projected cost providing a single outpatient dialysis treatment for each presentation.


There were 92 individual admissions resulting in 209 inpatient dialysis treatments, indicating that patients were often kept for additional HD treatments. The total cost for these admissions was $729,360.93, which roughly equates to $7,927.84 spent per admission. The cost for an outpatient dialysis session (including ED cost) ranges between $1,032.12 and $1,177 accounting for standard labor versus time-and-a-half labor, respectively. Thus, the total expected range for an equivalent 209 HD sessions, if they were to be done as an outpatient, would be between $215,713.08 and $245,993. This results in total savings ranging from $483,367.93 to $513,647.85.


Forming outpatient dialysis capabilities in an acute dialysis unit would help reduce health-care spending in patients being admitted to VA hospitals for missed HD. Further research is still needed in identifying possible reversible barriers in non-adherent patients.