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Flow chart illustrating the systematic search for studies examining employment outcomes in patients with kidney failure receiving dialysis or transplantation
Source publication
Background
Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and kidney transplantation and to identify predictors of employment during dialysis...
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Objective: Although renal transplantation (RT) is the first treatment option for children with end-stage renal failure, the number of transplanted chil- dren remains low compared to adults. Experience of the individual pediatric transplant center is very important in the prognosis of pediatric transplant recipients. In this study, our pediatric RT...
Citations
... The employment rate among patients on dialysis is generally very low (1). A meta-analysis of 31 studies published in the last 24 years that included data on the employment of patients with endstage kidney disease found a weighted mean employment rate of 26% for patients on dialysis and 38.2% for patients after transplant (2). The employment rate decreased to 21.6% when only the 16 studies that excluded > 65-year-old patients were considered. ...
... Another study suggested a better return to work when late afternoon/evening dialysis shifts are available (5). In the meta-analysis by Kirkeskov et al, employment rates were higher in patients who started with peritoneal dialysis (PD) than in patients who started with hemodialysis (HD) (2). To our knowledge, the effect on work and life participation of Automated PD (APD), Daily Home HD (DHHD), Long Nocturnal HD (LNHD), and HD in Self-Care units (SCHD), which can also be performed in the evening, has never been compared. ...
... Possibly as a consequence of fatigue and other symptoms, in our survey, only 32% of patients had a paid job. In a meta-analysis of 33 studies (162,059 participants on dialysis), Kirkeskov et al found a 26.9% employment rate, lower than in our study (2). However, in this review, the dialysis modality was restricted only to PD/HD without mentioning more autonomous techniques. ...
Introduction. End-stage kidney disease radically alters the patients’ lives. The aim of this study was to compare the levels of employment, financial assistance, global activities, quality of life, and energy expenditure in patients according to the autonomous dialysis modality: Long Nocturnal Hemodialysis (LNHD), Daily Home Hemodialysis (DHHD), Automated Peritoneal Dialysis (APD), and hemodialysis in a self-care unit.
Methods. Voluntary patients (n = 182) treated with an autonomous dialysis modality completed an anonymous e-questionnaire that included items on type of paid employment, voluntary work and leisure activities, and three self-report questionnaires (SONG-Fatigue, Recent Physical Activity Questionnaire, and EuroQol EQ-5D-5L).
Results. Overall, 33% of patients had a remunerated activity, 10% of patients were considered as sedentary and 39.6% reported an important physical activity. The SONG-Fatigue median score was 3 (IQR 2–5). Moreover, 54%, 89% and 56% of patients did not report any problem with mobility, self-care, and usual activities, respectively. In addition, 35% of patients did not complain about pain or discomfort and 59% had no anxiety or depression symptoms. Patients estimated their global health status at 60 (IQ 50–80). The LNHD group had more often a remunerated activity and the DHHD group reported fewer problems with usual activities. The APD and LNHD groups experienced pain more often.
Conclusion. This study showed a significant overall impact of dialysis on the patients’ daily life with some differences according to the dialysis modality.
... The influence of gender, age, education, marital status, employment, and income level was studied. (6)(7)(8) When studying the influence of marital status on selfassessment of QOL, Ryu et al. (5) concluded that married КTRs have better QOL scores than unmarried ones. At the same time, Junchotikul et al. (9) and Chisholm et al. (10) obtained the opposite result -family КTRs showed lower rates on QOL scales than did single patients. ...
Background: Currently, compared to program hemodialysis and peritoneal dialysis, kidney transplantation is considered to be the preferred method of renal replacement therapy in patients with end-stage chronic kidney disease (CKD) in terms of patient survival and improvement in their quality of life (QOL). This study aimed to investigate the influence of the post-transplantation period and marital status on the health-related QOL of patients with CKD who underwent kidney transplantation.Methods and Results: A cross-sectional study was conducted among 78 patients who had received a kidney transplant from living related donors in the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation between January and April 2022. Kidney transplant recipients (KTRs) were divided into four groups depending on the time after kidney transplantation: 3, 6, 12 months, and 2 years or more after surgery. The study used 2 questionnaires. The first included questions about the sociodemographic data of patients; the second was the standardized health-related QOL questionnaire SF-36. This study of the QOL of KTRs, residents of the Republic of Uzbekistan, showed an improvement in most scales of physical and mental health components 12 months and 2 years or more after kidney transplantation. On the scales of physical and mental health components, unmarried KTRs had a higher self-assessment of QOL than married KTRs, and among married KTRs, those with children had higher QOL indicators.Conclusion: Clarifying how the time after kidney transplantation and individual sociodemographic and medical factors influence QOL indicators requires further research (including longitudinal studies) in a wider КTR population.
... A qualitative study revealed that patients with CKD frequently experience obstacles in sustaining employment, financial difficulties, and the stigma associated with the illness [12]. Furthermore, high unemployment rates among patients undergoing dialysis or transplant have been documented in various countries, such as the United States [13], England [14], Netherlands [15] indicating a global phenomenon. Demographic and socioeconomic disadvantages faced by patients with CKD can contribute to their heightened vulnerability to unemployment [16]. ...
... Prior investigations pertaining to CKD and unemployment have primarily focused on patients undergoing dialysis or kidney transplant, who represent the group with severe CKD grades, and compared unemployment rates among patients undergoing hemodialysis, peritoneal dialysis, and kidney transplantation [13][14][15]23]. In contrast, our study aimed to compare the unemployment rates between individuals with and without CKD. ...
... Particularly, individuals with the most severe form of CKD experienced a substantial increase in the risk of unemployment, although the number of participants in this specific subgroup was limited. Moreover, our study is significant because in contrast with previous research, which primarily focused on comparing job retention difficulties between patients undergoing dialysis and kidney transplant [13][14][15], we examined the association between CKD and employment status between patients with CKD and individuals without CKD. ...
Background
The prevalence of chronic kidney disease (CKD) is increasing globally, and understanding the association between CKD and employment status is crucial. This cross-sectional study aimed to investigate the association of CKD with employment and occupation type among patients with CKD.
Methods
We analyzed data from 36,732 Korean adults aged ≥ 30 years, who participated in the Korean National Health and Nutrition Examination Survey between 2014 and 2021. CKD was detected based on the estimated glomerular filtration rate, and the employment status of the participants was classified into distinct categories: full-time permanent employment, unemployment, self-employment, and precarious employment. We analyzed the data using multiple logistic regression.
Results
We observed a significant association between CKD and a higher likelihood of unemployment compared to that in individuals without CKD (odds ratio, 1.70; 95% confidence interval, 1.47–1.96). This association was more prominent in patients with severe CKD. In the multivariable logistic analysis, patients with CKD had a higher likelihood for precarious employment (odds ratio, 1.29; 95% confidence interval, 0.92–1.88), self-employment (odds ratio, 1.3; 95% confidence interval, 0.90–1.88), and unemployment (odds ratio, 2.10; 95% confidence interval, 1.51–2.92) compared to individuals without CKD.
Conclusions
Our study demonstrated that CKD is associated with a higher likelihood of unemployment and engagement in precarious employment. These findings highlight the challenges faced by patients with CKD in obtaining stable employment and emphasize the need for interventions to improve the employment outcomes of individuals with CKD.
... Several studies have also shown that ESRD patients on RRT find it challenging to maintain employment due to physical demands of the condition and need for regular medical follow-ups & treatment, as well as social inequalities often faced by ESRD patients regarding employment opportunities. [3][4] In addition, Kirkeskov 3 noted that the positive predictors for employment during dialysis and posttransplant were being male, of younger age, without diabetes, a higher educational level and being on peritoneal dialysis. This is particularly relevant in our index patient, who is male, non-diabetic, on peritoneal dialysis and a sole breadwinner to a family of four. ...
Renal Replacement Therapy (RRT), involving two modalities of dialysis, namely haemodialysis (HD) and/or peritoneal dialysis (PD) remain the mainstay of therapy for patients with End Stage Renal Disease (ESRD) worldwide. The goals of renal replacement therapy are multi-pronged. They are not only limited to ensuring patient survival, but also improving patient overall well-being and quality of life. The relationship between employment and quality of life are often closely linked. Peritoneal dialysis provides patients with greater flexibility, independence and control over their treatment. This is particularly advantageous to the working ESKD patients. On the other hand, HD sessions can often interfere with work schedules due to HD facility attendance and the duration of each session. This case report highlights PD and its impact on improved quality of life by specifically supporting the case patient ‘s ability to maintain employment as a commercial truck driver. In addition, it edifies both ESRD patients and clinicians, particularly in developing countries, on the advantages of PD. These advantages extend beyond the physiological preservation of residual renal function and patient survival, but also embody the improvement of the overall well-being and quality of patients’ lives by broadening the employment horizon of patients in even high-risk occupations such as commercial truck driving.
... More than 2 million individuals worldwide are living with a working kidney transplant or are receiving chronic dialysis therapy, according to figures from the National Kidney Foundation. Kidney failure has significant effects on maintaining regular employment, lowers quality of life, and raises psychological difficulties [5]. ...
... Additionally, this study intends to identify predictors of employment. The predefined predictors, informed by the author's comprehensive understanding of the field and specific to RA, encompass socioeconomic factors such as age, gender, level of education, employment status prior to the disease, disease stage and duration, treatment modalities, and comorbidities, including depression, which are relevant both to RA and other chronic conditions [26]. ...
Background
Patients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA.
Methods
The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle–Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I²-statistics were calculated. This review was registered with PROSPERO (CRD42020189057).
Results
Ninety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4–100) at disease onset; 47.0% (range 18.5–100) at study entry, and 40.0% (range 4–88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities.
Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting.
Conclusions
The findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.
... Individuals who become dependent of dialysis after hospital discharge are more likely to have low employment rates, based on earlier research involving dialysis patients. 49 Surgery involving the ascending aorta is widely recognized as carrying a higher risk of perioperative complications, including bleeding and stroke, in comparison to aortic valve surgery. Previous studies have consistently highlighted these increased risks associated with AAS. ...
Aims
To estimate sick leave (SL) duration after first-time elective open-heart surgery and identify factors contributing to increased SL.
Methods and Results
A retrospective nationwide cohort study combined data from the Norwegian Register for Cardiac Surgery and SL data from the Norwegian Labour and Welfare Administrations. All able-bodied adults who underwent first-time elective open-heart surgery in Norway between 2012 and 2021 were followed until one year after surgery. The impact of socio-demographic and clinical factors on SL after surgery was analysed using logistic regression and odds ratios. Of 5456 patients, 1643 (30.1%), 1798 (33.0%), 971 (17.8%), 1035 (18.9%), and 9 (0.2%) had SL of <3, 3–6, 6–9, and 9–12 months, and one year, respectively. SL > 6 months was associated with female gender, primary education only, and average annual income. Postoperative stroke, postoperative renal failure, New York Heart Association Functional Classification system (NYHA) score > 3, earlier myocardial infarction, and diabetes mellitus increased the odds of SL > 6 months.
Conclusion
This study demonstrates that socio-demographic and clinical factors impact SL after first-time elective open-heart surgery. Patients who experience a stroke or develop renal failure after surgery have the highest odds of SL > 6 months. Females and patients with low education levels, earlier myocardial infarction, or NYHA scores III–IV have a twofold chance of SL > 6 months. The findings allow for future investigations of pre- and post-surgery interventions that can most effectively reduce SL and aid return to work.
... Publicly available costs were used to compile the cost library; however, this may not reflect actual costs paid by healthcare systems. The scope of this study excluded indirect costs, which are known to be significant in CKD [29,30], in part due to the poorer availability of data in published literature versus direct costs. Relatively few countries have accurate national registries of ESKD and KRT, and limited data are available for earlier stages of CKD. ...
Introduction:
Chronic kidney disease (CKD) is a progressive disease of growing prevalence, posing serious concerns for global public health. While the economic burden of CKD is substantial, data on the cost of CKD is limited, despite growing pressures on healthcare systems. In this review, we summarise the available evidence in 31 countries and regions and compile a library of costing methodology and estimates of CKD management and disease-associated complications across 31 countries/regions within the Inside CKD programme.
Methods:
We collected country/region-specific CKD costs via a pragmatic rapid literature review of local literature and engagement with local experts. We extracted cost data and definitions from identified sources for CKD stages G3a-5, kidney failure with replacement therapy by modality, covering haemodialysis, peritoneal dialysis, and kidney transplants, and disease-associated complications in local currency, converted to United States dollars (USD) and inflated to 2022.
Results:
Annual direct costs associated with CKD management rose by an average factor of 4 in each country/region upon progression from stage G3a to G5. Mean annual costs per patient increased considerably more from early stages versus dialysis (stage G3a, mean: $3060 versus haemodialysis, mean: $57,334; peritoneal dialysis, mean: $49,490); with estimates for annual costs of transplant also substantially higher (incident: $75,326; subsequent: $16,672). The mean annual per patient costs of complications were $18,294 for myocardial infarction, $8463 for heart failure, $10,168 for stroke and $5975 for acute kidney injury. Costing definitions varied widely in granularity and/or definition across all countries/regions.
Conclusion:
Globally, CKD carries a significant economic burden, which increases substantially with increasing disease severity. We identified significant gaps in published costs and inconsistent costing definitions. Cost-effective interventions that target primary prevention and disease progression are essential to reduce CKD burden. Our results can be used to guide cost collection and facilitate better comparisons across countries/regions to inform healthcare policy.
... Previous studies have also investigated changes in socioeconomic status after KT, particularly focusing on the employment rate [10][11][12]. A large-scale meta-analysis of cross-sectional and cohort studies summarized that the overall employment rate of KT recipients before and after transplantation remained low, at 36.9% and 38.2% in the pre-and posttransplantation periods, respectively [13]. Another large cohort study analyzing 29,809 KT recipients in the United States reported that 23.1% of KT recipients received private insurance while employed, and those who only received public health insurance had a lower employment rate (<10%), which did not improve after KT [14]. ...
... Regarding this objective, our study has particular strengths: (1) we assessed nationwide kidney transplant events using a large number of samples; (2) we analyzed objective data on economic or employment status extracted from the claims database; (3) we assessed (4) we observed associations between changes in socioeconomic status and patient prognosis. Our study, which included recent KT recipients in Korea, found that the overall employment rate of KT recipients was comparable to that reported previously [13]. We also observed significant changes in recipients' economic and employment status, which varied according to the period after KT. ...
Background:
Socioeconomic status is an important factor affecting the accessibility and prognosis of kidney transplantation. We aimed to investigate changes in kidney transplant recipients' socioeconomic status in South Korea and whether such changes were associated with patient prognosis.
Methods:
This retrospective nationwide observational cohort study in South Korea included kidney transplant recipients between 2007 and 2016. South Korea provides a single-insurer health insurance service, and information on the socioeconomic status of the recipients is identifiable through the claims database. First, a generalized linear mixed model was used to investigate changes in recipients' socioeconomic status as an outcome. Second, the risk of graft failure was analyzed using Cox regression as another outcome to investigate whether changes in socioeconomic status were associated with patient prognosis.
Results:
Among the 15,215 kidney transplant recipients included in the study, economic levels (defined based on insurance fee percentiles) and employment rates declined within the first 2 years after transplantation. Beyond 2 years, the employment rate increased significantly, while no significant changes were observed in economic status. Patients whose economic status did not improve 3 years after kidney transplantation showed a higher risk of death than those whose status improved. When compared to those who remained employed after kidney transplantation, unemployment was associated with a significantly higher risk of death-censored graft failure.
Conclusions:
The socioeconomic status of kidney transplant recipients changed dynamically after kidney transplantation, and these changes were associated with patient prognosis.
... 25 Additionally, patients with kidney failure had a low employment rate both during ongoing hemodialysis and after KTx. 26 Socioeconomic disparities in T1DM patients are likely to lead to worse outcomes, such as high mortality and morbidity. 27,28 Even after PTx, including SPK, socio-economic issues could be a burden for T1DM patients, and continuous support is necessary for post-PTx patients. ...
Objectives:
Type 1 diabetes mellitus (T1DM) patients with diabetic kidney disease-induced kidney failure have a significantly impaired quality of life (QOL), resulting in a high level of physical, mental, and social anxiety. In this study, we evaluated the QOL of T1DM patients on the list for pancreas transplantation (PTx) at their registration, and determined whether PTx improved their QOL.
Methods:
There were 58 patients (men/women, 22/36; mean age, 42.8±8.0 years) with T1DM and who were registered on the waiting list for PTx. Quantitative QOL assessment was performed using the Medical Health Survey Short Form (SF-36) version 2. Changes in the QOL before and after PTx were also examined in 24 of these patients.
Results:
The mean value of each endpoint and the summary score of the SF-36 physical (PCS), mental (MCS), and role (RCS) components were all below the national normal level at PTx registration. No significant difference in QOL scores was observed in the intergroup comparison of 35 patients on dialysis, 13 patients without dialysis, and ten patients after kidney transplantation. The 24 patients who underwent PTx showed improvement in PCS, MCS, and most SF-36 scores.
Conclusion:
T1DM patients waiting for PTx had a decreased QOL, regardless of dialysis, and PTx improved their QOL.
