How to Tell Your Boss You're Starting Dialysis

Starting dialysis brings plenty of hard conversations, and the one with your boss can feel like one of the riskiest. You may worry about your job, your reputation, or being treated differently. The good news is that you control most of this conversation: what you share, when you share it, and what you ask for. A little preparation makes it much easier.

Quick answer

You do not have to share your diagnosis with coworkers, and you can keep the conversation with your manager focused on your schedule and what you need to keep doing your job. If you need a change, like a shifted schedule or time off for treatment, you can ask for a reasonable accommodation. According to the EEOC, a request does not have to be in writing or use special legal words, though putting it in writing protects you. Your employer may ask for limited medical documentation, not your full records. Talking to HR about leave options such as FMLA at the same time is often smart.

Before the conversation

Know your schedule. Which days, what times, and how long you typically need afterward. If you don’t have a chair time yet, say when you expect to know.
Know what you need. Leaving early three days a week? Starting earlier? Working from home after treatment?
Bring a proposal. Managers react better to “here’s how I’ll cover my work” than to an open question.
Check your company’s policies on leave and accommodations, often in the employee handbook.
Talk to your social worker. They help patients with work questions and may have seen many versions of this conversation.

Usually helpful to share:

That you are starting a regular medical treatment
The days and times it affects
What you are asking for, and how you’ll keep work covered
That you’ll keep them updated if anything changes

Usually fine to skip:

Your full medical history or what caused your kidney failure
Lab results, medications, or treatment details
Guesses about how long you’ll be on dialysis or whether you’ll get a transplant

Some people are very open and others are very private. Both are fine. You can always share more later.

Talk to your manager, HR, or both?

Your manager controls your daily schedule, so they usually need to know about time changes. HR handles formal leave and accommodation requests and keeps medical information more tightly controlled. Many people talk to HR first about their options, then have a shorter, schedule-focused conversation with their manager.

A sample script

“I wanted to let you know I’m starting a regular medical treatment that’s three times a week, Monday, Wednesday, and Friday afternoons. I want to keep doing my job well, so here’s what I’m proposing: I’ll start at 7 on those days and leave at 1, and I’ll make sure my reports are done before I leave. I’m also talking with HR about the formal paperwork. Can we try this and check in after a month?”

Notice what it does: it names the schedule, offers a solution, and doesn’t mention a diagnosis. You can adapt it to your job.

Asking for a reasonable accommodation

Under the Americans with Disabilities Act (ADA), covered employers must consider reasonable accommodations for qualified employees with disabilities, unless an accommodation would cause undue hardship. The federal ADA generally applies to employers with 15 or more employees, and California’s own law reaches smaller employers. According to the U.S. Equal Employment Opportunity Commission (EEOC):

A request does not have to be in writing or use the words “reasonable accommodation.” You need to connect what you’re asking for to a medical condition.
Modified schedules, such as adjusted arrival or departure times or shifted hours, are examples of possible accommodations.
Leave for medical treatment can also be an accommodation.

Even though writing isn’t required, a short email afterward (“Following up on our conversation, I’m requesting…”) creates a record and helps avoid misunderstandings. If you need protected time off, also see FMLA and Dialysis.

What medical information your employer can ask for

The EEOC says an employer may ask for documentation when the need for accommodation isn’t obvious, but it should be limited to what establishes the disability and the need for the accommodation. Your employer generally cannot demand your complete medical records. Ask your nephrologist’s office or dialysis social worker to help with any forms.

If this sounds familiar

You’ve been putting off the conversation for weeks, telling coworkers you have “appointments.” Your first treatment is Monday. You don’t need a perfect speech. Pick a 15-minute slot, bring your schedule and one proposal, and follow up with a short email. Most of the anxiety comes from the waiting, not the talk itself.

What about coworkers?

You decide what coworkers know. “I have a standing medical appointment those afternoons” is a complete answer. If you’re comfortable sharing more, people are often supportive. If you notice comments or treatment that feel unfair because of your health, write down what happened and talk to HR.

Questions to ask HR

How do I request a schedule accommodation, and is there a form?
Am I eligible for FMLA or California CFRA leave?
What medical documentation do you need, and who sees it?
Can I use paid time off for treatment hours?
How will this affect my health insurance?

Have your schedule ready

Keep your treatment schedule and care team contacts organized before you talk with your employer.

My Dialysis Care Team & Contacts →

Questions for My Dialysis Team →

Want it all in one place? The 90-Day Dialysis Planner keeps treatment notes, patterns, and questions together for three months.

Where to go next

The bigger picture on work: Working While on Dialysis
You need protected leave: FMLA and Dialysis
Your chair time is the problem: Evening and Nocturnal Dialysis Shifts
You’re unsure whether to keep working: Working vs. Disability When You Start Dialysis

The main thing to remember

Keep the conversation about your schedule and your work, not your diagnosis. Bring a proposal, follow up in writing, and use HR for the formal pieces like accommodations and leave. You decide how much to share, and you can always share more later.

Sources

General education only. This guide offers general information about workplace conversations and disability accommodation laws as of October 2026. Your rights depend on your employer, state, and situation. Renal Care Planner does not provide legal or employment advice. For your situation, talk with HR, the EEOC, the California Civil Rights Department, or an employment attorney.

How to Tell Your Boss You’re Starting Dialysis (What to Say and What to Skip)