Employment status of patients receiving maintenance dialysis – peritoneal and hemodialysis: A cross-sectional study

Abstract

The long-term dialysis therapy for end-stage renal disease takes a heavy toll of quality of life of the patient. Several factors such as fatigue and decreased physical capability, impaired social and mental functioning, contribute to this forlorn state. To meld maintenance dialysis treatment with a regular employment can be a serious test. A cross-sectional study of employment of patients on hemodialysis and peritoneal dialysis in a state government tertiary institute in South India was performed between June 2015 and December 2015. Patients who completed 3 months of regular dialysis were only included in the study. The number of patients on hemodialysis was 157 and on peritoneal dialysis was 69. The employment status before the initiation of dialysis was 60% (93 out of 155) and 63.7% (44 out of 69) in hemodialysis and peritoneal dialysis, respectively. After initiation, the loss of employment was observed in 44% (41 out of 93) in hemodialysis and 51.2% (26 out of 44) in peritoneal dialysis (P = 0.2604). Even though there was fall of absolute number of job holders in both the blue and white collar jobs, the proportion of jobholders in the white collar job holders improved. On univariate analysis, the factors which influenced the loss of employment were males, age between 50 and 60 years, number of comorbidities >2, illiteracy and blue collar versus white collar job before the initiation of dialysis. The majority of patients had the scores above 80 on Karnofsky performance scale and the majority belonged upper and middle classes than lower classes on modified Kuppuswamy's socioeconomic status scale; however, the loss of employment was also disproportionately high. There appeared a substantial difference in the attitude of the patients toward the employment. There was no difference between hemodialysis and peritoneal dialysis in the loss of employment of our patients.

<p>Health-Related Quality of Life in Patients with Chronic Kidney Disease in Hemodialysis in Medellín (Colombia)</p>

“…Some of the factors that may explain this finding are as follows: i) the type of health system, procedures and access barriers for diagnostic tests, and therapy are time-consuming for the patients, ii) limitations on mobility and to perform daily activities can result in a feeling of heteronomy, and iii) losing their jobs makes individuals see themselves as an economic burden to their families. In this regard, it has been reported that the employment rates for patients undergoing hemodialysis are as low as 18.9% in the United States,40 33% in Finland,41 and 29.9% in India 42…”

Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan

“…Third, because the comorbidities, survival, life expectancies, and employment rates of dialysis populations in different countries are usually quite different, our results cannot be directly generalized to populations outside of Taiwan. For example, the life expectancies and employment rates are lower in several Western countries than in Taiwan (2,11 –16,29), which might result in a different magnitudes of loss of life expectancy and loss of lifetime employment duration. Therefore, the generalization of our study findings to other countries must be carried out with care.…”

“…Encouraging patients on dialysis to remain in or return to the workforce could potentially mitigate the financial burden these patients impose on society, at least through contributions to income taxes. Although quite a few studies have focused on this issue, no previous studies have comprehensively quantified lifetime loss of employment among patients undergoing dialysis (11 –16). In this study, we aimed to estimate the lifetime employment duration and loss of lifetime employment duration of patients undergoing dialysis until 65 years of age, which facilitates stakeholders in establishing appropriate policies for both patients and society as a whole.…”

“…Nevertheless, patients undergoing dialysis who are seeking employment face tremendous challenges, including adverse effects from medical procedures, high incidence of cardiovascular diseases and disability, transportation issues, cognitive impairment, scheduling conflicts with dialysis appointments, and employer concerns about absenteeism and dependability (8 –10). This inevitably leads to low employment rates in the dialysis population (11 –16). Encouraging patients on dialysis to remain in or return to the workforce could potentially mitigate the financial burden these patients impose on society, at least through contributions to income taxes.…”

Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients

“…There are no home hemodialysis patients in Korea. A recent study from India reported an employment rate of 29.9% among patients after the initiation of dialysis, with rates of loss of employment of 44% and 51% among patients beginning hemodialysis and peritoneal dialysis, respectively [ 8 ].…”