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Employment status in last 6 months before haemodialysis linked to better survival

Employment status in last 6 months before haemodialysis linked to better survival

Washington: Employment not only provides social and financial support but is also a key determinant of quality of life for all people including haemodialysis patients, claims a recent study.

“It is important that patients with chronic kidney disease can maintain the work, especially when they reach the end stage of renal disease and are in need of dialysis treatment,” explained Professor Alberto Ortiz, editor-in-chief of Clinical Kidney Journal (CKJ), in which the study was published.

The study analysed the employment status of 496,989 US patients initiating maintenance haemodialysis from 2006-2015.

The results showed 26 per cent of patients were employed 6 months prior to dialysis initiation – but dropped to only 15 per cent when dialysis treatment was initiated. It is not surprising that patients who were older and had more comorbidities were less likely to maintain employment, but there was also a social dimension: females, Hispanic, African Americans, and people living in low-income zip codes lost their jobs more often.

The study showed that being made redundant was associated with mortality: Compared to those who were employed from 6 months prior to dialysis initiation, people who became unemployed in this phase had a significantly higher death rate (p<0.0001), even after adjustment for multiple co-variables.

Conversely, those who continued to work were more likely to receive a transplant (p<0.0001).
Thus, maintaining employment during the final 6 months prior to haemodialysis was associated with protection against mortality and with higher rates of transplantation.

"But of course we have to be careful with the interpretation of these data because we are faced with a chicken-or-egg question. Was the survival benefit really due to the positive effect of work on body and mind of our patients – or did it simply show that those patients with lower survival rates were unemployed because they had already been severely ill before the initiation of the dialysis treatment?" said Ortiz.

"Nevertheless, we know from the general population, that being unemployed impacts health negatively.

Therefore, we should strive to offer opportunities to combine employment and dialysis to patients who are able to work, whenever it is possible. We should further strengthen peritoneal dialysis as well as home haemodialysis, which are often better dialysis modalities for patients who want to continue working. We should encourage our patients to stay employed while on dialysis and support them to balance job and treatment," concluded Ortiz.

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