Employment of Patients With Kidney Failure Treated With Dialysis or Kidney Transplantation - A Systematic Review and Meta-Analysis

Abstract

Background: Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employ­­ment due to the condition itself as well as the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and after kidney transplantation and to identify predictors of employment during dialysis and post-transplant.Methods: This systematic review and meta-analysis was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA, for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross sectional or cohort studies published in English in the period from January 1966 to August 2020 in the databases PubMed, Embase, and Cochrane Library. Data of employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment and odds ratio; confidence intervals; and test for heterogeneity were calculated using Chi-squared statistics and I2. PROSPERO registration number: CRD42020188853.Results. 33 studies with 162,059 participants during dialysis and 31 studies with 137,742 participants receiving kidney transplantation. Dialysis patients were on average 52.6 years old (range 16-79), 60.3% males and kidney transplant patients 46.7 years old (range 18-78), 59.8% males. The employment rate (weighted mean) for dialysis patients was 26.3% (range 10.5-59.7%); pre-transplant 36.9% (range 25-86%), and post-transplant 38.2% (range 14.2-85%). Predictors for employment during dialysis and post-transplant were male, non-diabetic, peritoneal dialysis, and higher educational level, and post-transplant: pre-transplant employment, younger age, transplantation with a living donor kidney, and without depression.Conclusions: Patients with kidney failure had a low employment rate during dialysis, pre- and post-transplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure they remain in work.

Employment and ability to work after kidney transplantation in the Netherlands: The impact of preemptive versus non‐preemptive kidney transplantation

“…Work gives meaning, purpose and structure to everyday lives, and has a positive influence on physical and mental health 1,2 ; also in people having kidney disease 3 . However, the ability of many people with end‐stage kidney disease (ESKD) to work or remain employed is limited by physical and mental issues and their intensive medical treatment, which puts them at risk for long‐term sickness absenteeism and withdrawal from the labor force 4–8 …”

“…There are multiple factors associated with employment of kidney transplantation recipients (KTR) that fall into four main categories: sociodemographic, clinical, health‐related and work‐related. Sociodemographic factors, such as younger age, being white and a higher educational level, are consistent predictors of employment 8,18–21 . Clinical and health‐related characteristics related to employment include type of primary kidney disease, 11,22 comorbidity, 4 a shorter time on dialysis, 20,21 peritoneal dialysis, 23 time since transplantation, 11,24 living versus deceased donor transplantation, 19,20 and physical and mental health 4,25,26 .…”

“…3 However, the ability of many people with end-stage kidney disease (ESKD) to work or remain employed is limited by physical and mental issues and their intensive medical treatment, which puts them at risk for long-term sickness absenteeism and withdrawal from the labor force. [4][5][6][7][8] Kidney transplantation is the preferred treatment for people with ESKD. Transplantation is not only associated with better survival, better quality of life and lower use of healthcare resources 9,10 ; it also optimizes persons' possibilities to work compared with dialysis 11,12 which will have a positive influence on physical and mental health.…”

“…16 The per-country employment rate 1 year or longer after kidney transplantation ranges between 14 and 85%. 8,17 A large part of this variation can be explained by differences in the definition of employment, by heterogeneity in clinical and demographic characteristics of the study populations and social safety net in a country.…”

“… 3 However, the ability of many people with end‐stage kidney disease (ESKD) to work or remain employed is limited by physical and mental issues and their intensive medical treatment, which puts them at risk for long‐term sickness absenteeism and withdrawal from the labor force. 4 , 5 , 6 , 7 , 8 …”