Factors Affecting Employment at Initiation of Dialysis

Abstract

SummaryBackground and objectives Half the individuals who reach ESRD are working age (Ͻ65 years old) and many are at risk for job loss. Factors that contribute to job retention among working-age patients with chronic kidney disease before ESRD are unknown. The purpose of the study is to understand factors associated with maintaining employment among working-age patients with advanced kidney failure.Design, setting, participants, & measurements In this retrospective study we reviewed the United States Renal Data System database (1992 through 2003) and selected all patients (n ϭ 102,104) who were working age and employed 6 months before dialysis initiation. Factors that were examined for an association with maintaining employment status included demographics, comorbid conditions, ESRD cause, insurance, predialysis erythropoietin use, and dialysis modality.Results Maintaining employment at the same level during the final 6 months before dialysis was more likely among (1) white men ages 30 to 49 years; (2) patients with either glomerulonephritis, cystic, or urologic causes of renal failure; (3) patients choosing peritoneal dialysis for their first treatment; (4) those with employer group or other health plans; and (5) erythropoietin usage before ESRD. Maintaining employment status was less likely among patients with congestive heart failure, cardiovascular disease, cancer, and other chronic illnesses. ConclusionsThe rate of unemployment in working-age patients with chronic kidney disease and ESRD is high compared with that of the general population. Treating anemia with erythropoietin before kidney failure and educating patients about work-friendly home dialysis options might improve job retention.

How to Overcome Barriers and Establish a Successful Home HD Program

“…Accordingly, advantages of any home dialysis therapy include encouraging patient independence, responsibility, and confidence; allowing them to set their own schedules; increasing comfort and convenience; and reducing the risk for infection (17). In addition, in a Finnish study, home HD allowed for continued employment compared with in-center HD (prevalence rate ratio, 2.14; 95% CI, 1.68-2.74) (55 ) Although similar data from the United States comparing home dialysis with in-center HD found PD to be associated with increased employment at initiation of dialysis, data were lacking for home HD (56).…”

Hemodialysis services: are public policies turned to guaranteeing the access?

“…In some European countries, up to 40% of patients receive this type of dialysis, with access to this modality increasing. Portugal is also expanding the service; in the United States and Canada, there are studies that have assessed the differences in costs and quality of life resulting from these different modalities of dialysis 31,35 .…”

“…Doctors may not offer patients the procedure due to this. In relation to patients, the level of schooling, understanding their health condition, family involvement, and the physical and hygienic conditions in the household need to be considered before deciding the appropriate treatment 31,32,35 .…”

A Matter of Choice

“…Peritoneal dialysis rather than hemodialysis makes employment easier for some, because it requires less time in the clinic (15). Similarly, home or nocturnal dialysis rather than centerbased dialysis provides greater flexibility to accommodate work schedules (16).…”