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等。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等。had a similar percentage (23-24%) among patients starting dialysis in the United States between 1996 and 2013. Kirkeskov等。also examined employment around the time of transplant. They found the employment rate was 36.9% pre-transplant and 38.2% post-transplant.
在本文中，透析和移植后的就业预测因素是男性，缺乏糖尿病，腹膜透析和更高的教育水平。这与1996年的一项旧研究相关Curtin等。在这项研究中,他们进行了一项调查的透析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 theBMC肾脏病文章, 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?
评论