I am a renal nurse in the UK and also a key worker for teenagers with renal disease. Non compliance with hemodialysis is complex, and seems to me to be partly due to control issues. They have no control over dialysis, they have to attend or they die. This produces a great deal of resentment and frustration. Often not attending dialysis is a way to try and gain some control. In the UK, we are trialing a Shared Care initiative, encouraging patients to take a more active role in their treatment by programming the machine etc, I am not sure if you already have this in the US but initial results are encouraging.