Background: The population of dialysis patients is ageing. Dialysis nurses are confronted with geriatric patients with multiple comorbidities. Nurses are confronted with an increasing burden of care. Objectives: The present study focused on the question of whether, over time, the increasing age and comorbidities of the haemodialysis population increased nursing care time. Furthermore, we studied potential changes in the predictors of the required nursing time. Design: Observational study. Participants: A total of 980 dialysis patients from 12 dialysis centres were included. Measurements: Nurses filled out the classification tool for each patient and completed a form for reporting patient characteristics for groups of relevant haemodialysis patients at baseline and after 1 and four years. Changes in patient and dialysis characteristics were analysed, as well as the estimated nursing care time needed. Results: An increase in the nursing time needed for dialysis was largely due to decreased mobility, closing of the vascular access and a greater need for psychosocial attention and was most strongly present in incident dialysis patients. The time needed for dialysis decreased as patient participation increased and vascular access changed from catheters to fistulae. Over the four-year period, the average overall needed nursing care time per haemodialysis session did not change. Conclusions: Our study shows that the average nursing time needed per patient did not change in the four-year observation period. However, more time is required for incident patients; thus, if a centre has high patient turnover, more nursing care time is needed.

Our study shows that it is possible to predict the burden of nursing care of patients undergoing dialysis by means of a classification model.

Differences in care burden were observed between academic and other centres, with more time required for treatment in academic centres. Contribution of patient characteristics to the time difference was minimal. The only patient characteristics that predicted care time were previous transplantation, which reduced the time required, and gender, with women requiring more care time.

■ dialysis ■ nursing care time ■ chronic kidney disease Do differences in clinical conditions affect the nursing care time of dialysis patients? T he number of patients in western societies with chronic kidney disease has slowly increased in recent years (Divo et al, 2014). However, the number of in-centre haemodialysis patients in the Netherlands has stabilised (Hoekstra et al, 2017;, partly due to a higher number of renal transplants in the Netherlands. As a result of increased renal transplants, the dialysis population has changed in recent years to an older population with multimorbidity, which means that nurses who work in dialysis centres are working with older patients who need more nursing care time (Kleijn et al, 2020). Furthermore, older patients (over 75 years) with end-stage renal disease are at increased risk for cognitive decline (Berkhout-Byrne et al, 2017) and, additionally, there is an increasing shortage of (renal) nurses.These challenges mean that generally applicable planning tools for nursing resources are needed.