When patients start dialysis, the overall goal is for these treatments to become part of their lives and try to maintain as much of their daily routine including family commitments and employment. Unfortunately, this situation is not the norm. It is known that end-stage kidney disease impacts quality of life and is often associated with feelings of loss of control or loss of their previous routines. Employment has a role in feelings of self-sufficiency and productiveness beyond the financial impact. Maintaining employment can be difficult with the time-consuming treatments, disease-related symptoms, or the physical requirements of previous employment. Kirkeskov et al. conducted a systematic review and meta-analysis regarding employment rates in adults receiving dialysis or a kidney transplant. They found between January 1966 and August 2020 the employment rate for dialysis patients was 26.3%. This is similar to what is seen in individual countries. Erickson et al. had a similar percentage (23-24%) among patients starting dialysis in the United States between 1996 and 2013. Kirkeskov et al. also examined employment around the time of transplant. They found the employment rate was 36.9% pre-transplant and 38.2% post-transplant.
In this article, the predictors for employment during dialysis and post-transplant were male gender, absence of diabetes, peritoneal dialysis, and higher educational level. This correlates with an older study from 1996 by Curtin et al. In this study, they conducted a survey of dialysis patients to identify characteristics of those employed vs unemployed. They found that pre-dialysis employment and higher educational level are associated with a significantly higher likelihood of employment rates. Those patients with higher education usually have white-collar jobs, receive salaries greater than disability benefits, often do not have physical requirements related to their work, and have jobs that can provide accommodations for disabilities. While there may be some options such as disability, this often will not provide the same income level as before.
Looking at the dialysis population, many are on disability because they find it too difficult to continue working because of symptoms from end-stage kidney disease, post-dialysis fatigue, or the inability to be able to take on a different role at work. There are several jobs that individuals are not eligible for once they are on certain medications or have certain conditions. Currently, there are not many options for vocational rehabilitation for individuals that can no longer perform their job duties due to having kidney disease. This further puts a burden on those with reduced resources. Home dialysis modalities may help with some of the challenges by allowing patients for flexibility with the timing of treatments to maintain a routine work schedule. In the BMC Nephrology article, peritoneal dialysis was associated with employment and most likely similar patterns would be seen with home hemodialysis. But, this won’t address all the challenges that impact employment. Advocacy for vocational rehab or for work accommodations such as part-time schedules or to adjust for individuals’ physical limitations needs to be part of the discussion.
Posttransplantation, there is an expectation that individuals can return to more normal routines as they are freed up from dialysis treatments. For those that had been on dialysis for many years prior to transplantation or had to stop working, there may be some challenges of re-entering the workforce. These are considerations that should be part of discussions with health care providers and patients.
What can we do as a nephrology community to help patients stay employed or rejoin the workforce? What resources do patients need?