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Patients employed 6 months before dialysis have lower mortality, more transplants
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Patients who maintained employment 6 months prior to initiating dialysis had a lower risk for death and a higher likelihood of receiving a kidney transplant than those who left their jobs, according to a new study. Likewise, not-for-profit dialysis centers offered patients the best chance of maintaining employment through their dialysis treatments.
Yuxin Nie, MD, and colleagues from China and the U.S., including from the University of Michigan’s Kidney Epidemiology and Cost Center, used the U.S. Renal Data System database to review the employment status of 496,989 patients who initiated maintenance hemodialysis (HD) from 2006 to 2015. Demographic variables – age, sex, ethnicity, race, health insurance and employment history 6 months prior to first HD –, were reviewed, as well as whether patients had pre-ESRD care, fistula as the initial vascular access and relevant clinical data (eg, comorbid conditions and laboratory values).
Researchers also tracked whether patients were treated at a not-for-profit vs. a for-profit dialysis facility. Clinic-related characteristics included the percentage of patients with a catheter greater than 90 days, those using a fistula, hemoglobin less than 10 mg/dL, phosphorus greater than 7 mg/dL, calcium greater than 10.2 mg/dL, the number of dialysis stations, availability of home HD or peritoneal dialysis (PD), and in-center shifts beginning after 5:00 p.m.
In reviewing employment status, working full-time or part-time was recorded.
Data showed that about 26% (n = 129, 622) of patients in the study group were employed 6 months prior to dialysis, compared with only 15% (n = 75, 719) at HD initiation.
“Employment rates 6 months prior to HD initiation decreased from 29% in 2006 to 23% in 2014,” the researchers wrote. “Employed patients who maintained employment (after dialysis initiation) increased from 57% in 2006 to 64% in 2015. Patients who were older, female, Hispanic, Black, with more comorbidities or living in low-income zip codes were less likely to maintain employment,” they wrote.
Those patients who maintained employment also tended to be dialyzing in not-for-profit clinics. “Facility characteristics associated with employment maintenance included non-profit status, more stations, dialysis availability after 5 p.m. and home dialysis training,” the investigators wrote.
Employment rates among HD patients are usually low and employment changes are common during the 6 months prior to hemodialysis. “Maintaining employment status was associated with key patient and facility characteristics, kidney transplantation and survival,” Nie and colleagues concluded. “The results showed that those patients who maintained employment during the 6 months prior to HD had lower mortality and higher transplantation rates than patients who became unemployed.” – by Mark E. Neumann
Disclosure: The authors report no relevant financial disclosures.
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