Abstract
BackgroundPatients 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 and posttransplant.MethodsThis systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross-sectional or cohort studies published in English between January 1966 and August 2020 in the PubMed, Embase, and Cochrane Library databases. Data on employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted.Quality assessment was performed using the Newcastle–Ottawa Scale. Meta-analysis for predictors for employment, with odds ratios and confidence intervals, and tests for heterogeneity, using chi-square and I2 statistics, were calculated. PROSPERO registration number: CRD42020188853.ResultsThirty-three studies included 162,059 participants receiving dialysis, and 31 studies included 137,742 participants who received kidney transplantation. Dialysis patients were on average 52.6 years old (range: 16–79; 60.3% male), and kidney transplant patients were 46.7 years old (range: 18–78; 59.8% male). The employment rate (weighted mean) for dialysis patients was 26.3% (range: 10.5–59.7%); the employment rate was 36.9% pretransplant (range: 25–86%) and 38.2% posttransplant (range: 14.2–85%). Predictors for employment during dialysis and posttransplant were male, gender, age, being without diabetes, peritoneal dialysis, and higher educational level, and predictors of posttransplant: pretransplant employment included transplantation with a living donor kidney, and being without depression.ConclusionsPatients with kidney failure had a low employment rate during dialysis and pre- and posttransplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure that they remain working.
Highlights
Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment
Kidney failure reduces quality of life, increases psychosocial problems and has profound implications for the maintenance of normal employment [3, 4]. This is a consequence of disease-related comorbidity and uraemia-related symptoms, but it is due to time-consuming treatments with haemodialysis or peritoneal dialysis
The first aim of this study was to conduct a systematic review focusing on the employment rate before and after the initiation of dialysis and after kidney transplantation
Summary
Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. According to National Kidney Foundation statistics, more than 2 million people worldwide receive chronic dialysis treatment or are living with a functioning kidney transplant [1, 2]. Kidney failure reduces quality of life, increases psychosocial problems and has profound implications for the maintenance of normal employment [3, 4]. Kidney failure entails high costs because of the treatment itself and results in lost productivity due to a reduced labour force. A Canadian study stated that kidney diseases cost more than 217 billion Canadian dollars annually in health care services alone [5]. In addition to this comes loss of labour force
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