Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study

Background: To assess the impact of kidney replacement therapy (KRT) on employment status among patients with chronic kidney disease. Methods: Retrospective analysis of a prospective registry database of the Federation of Associations of Renal Patients (ALCER). Study participants completed a structured questionnaire gathering information on their employment status before being diagnosed before and throughout the study follow-up. For statistical purposes, patients were grouped according to their initial KRT in: Kidney-transplant (KTX) Group; In-center hemodialysis (ICHD); and home-based dialysis (HBD) Group. Results: Among the 402 patients surveyed, 307 (76.4%) were employed at diagnosed (before starting KRT), while 95 (23.6%) were unemployed. Following the initial KRT, 197 (49.0%) subjects were employed and 205 (51.0%) were unemployed. Whereas, at the conclusion of data collection, 132 (32.8%) had a job, while 270 (67.2%) were unemployed. Patients who initiated KRT with KTX (21/38, 55.3%) or with HBD (47/120, 39.2%) had significantly higher employment rates than those who started on ICHD (64/244, 26.2%) (p=0.0024 and p=0.0356, respectively). Among patients who were employed at diagnosis, patients who underwent KTX as initial KRT or were on HBD showed significantly higher current employment rates than those who started on ICHD (P=0.0070 and p=0.0174, respectively). Conclusions: According to the results of this study, CKD had a negative impact on patients' employment status. Despite a decline in employment rates over time, patients starting KRT on HBD or KTX exhibited higher employment rates compared to those starting on ICHD.