The unemployment rate among working-age patients with chronic kidney disease and end-stage renal disease (ESRD) is high compared with that in the general population—71% versus 9.9%—according to a retrospective study published in the Clinical Journal of the American Society of Nephrology (2011;6:489-496).
“The purpose of this study was to examine 10 years of data from the USRDS to identify non-modifiable and modifiable factors affecting a person's ability to maintain their level of employment after initiating dialysis,” wrote the authors, who were led by Rebecca J. Muehrer, PhD, RN, of the Section on Nephrology at the University of Wisconsin–Madison School of Medicine and Public Health.
Included in the study were all 102,104 patients from the 1992-2003 United States Renal Data System (USRDS) who were working age and had been employed six months before dialysis initiation. Various factors were examined for an association with maintaining employment status, including demographics, comorbid conditions, ESRD cause, insurance, pre-dialysis erythropoietin use, and dialysis modality.
Maintaining employment at the same level during the final six months before dialysis initiation was more common among white men between ages 30 and 49, patients with glomerulonephritis or with cystic or urologic causes of renal failure, those choosing peritoneal dialysis for their first treatment, patients with employer group or other health plans, and patients receiving erythropoietin before ESRD, the researchers reported. Additionally, those with congestive heart failure, cardiovascular disease, cancer, and other chronic illnesses were less likely to maintain employment status.
Patients with employer group health plans may have more comprehensive coverage and lower out–of-pocket costs, which could motivate them to stay at their current jobs, the researchers noted. Pre-dialysis anemia treatment and education about home dialysis options might improve job retention, they added.
“Further research is needed to determine whether interventions based on the findings of our study would be effective in helping patients with advancing chronic kidney disease maintain employment,” the authors wrote.
“Finally, the effect of job loss on ESRD patients and their families as well as the effect on government-run programs such as Medicare needs further analysis.”