Employment among people with end-stage renal disease (ESRD) who are receiving dialysis is already low and continues to decrease in the United States. But why is this? To help explore this question, researchers from Baylor College of Medicine examined trends in employment over time among patients initiating dialysis and in the six months before ESRD. The study appears in the Clinical Journal of the American Society of Nephrology.
To investigate, researchers analyzed information from a national ESRD registry, looking specifically at employment trends over time among patients aged 18 to 54 years who initiated dialysis in the United States between 1996 and 2013.
The researchers found that employment was low among patients starting dialysis throughout the study period at 23 to 24 percent, and 38 percent of patients who were employed six months prior to being diagnosed with kidney failure stopped working by the time they initiated dialysis.
After adjusting for patient characteristics and local unemployment rates in the general population, however, the probability of employment in dialysis patients increased over time. Patients starting dialysis between 2008 and 2013 had a 4.7 percent increase in the absolute probability of employment at the start of dialysis compared with patients starting dialysis between 1996 and 2001. Black and Hispanic patients were less likely to be employed than other patients starting dialysis, but this gap narrowed during the study period.
“ESRD is the only health condition that qualifies patients for federal Medicare coverage regardless of their age, and a major objective of the law that granted Medicare coverage to patients with ESRD was to help them to remain productive members of society,” said first author Dr. Kevin Erickson, assistant professor of medicine in the section of nephrology. “While the U.S. ESRD program has provided many patients with access to life-saving dialysis and transplant therapy, it has been less successful in helping patients to continue working. In addition to finding better ways to help patients to remain employed after they start dialysis, this our findings suggest that we also need to help patients before they develop ESRD.”
Erickson noted that the investigators did not have information available about individual patient financial and work-related circumstances, which prevented them from identifying the specific reasons for low employment at the start of dialysis.
Other contributors to this work include Dr. Bo Zhao, Dr. Vivian Ho and Dr. Wolfgang C. Winkelmayer. The researchers are affiliated with Baylor College of Medicine and/or Rice University.
This study was supported by grant 1K23DK101693-01 from the NIDDK and a National Kidney Foundation Southeast Texas Research Grant (to K.F.E.), W.C.W. receives research and salary support through the endowed Gordon A. Cain Chair in Nephrology at Baylor College of Medicine.