Functional and vocational rehabilitation of hemodialysis patients

Abstract

End-stage renal disease, is unique in being the only major chronic illness whose cost of care is funded by the government with the criteria solely based on diagnosis [1]. At its inception in 1971 few demographers or policy makers anticipated that the program would grow to its current level in terms of cost [2–4]. In the seventies and eighties, a series of studies on the rehabilitation of hemodialysis patients was done, the results of which showed both suboptimal physical activity and low employment rate [5,6]. Then employment was used as a major index of rehabilitation, primarily because the policy makers who passed the bill were convinced that a great number of hemodialysis patients would be vocationally rehabilitated thereby contributing to the tax base [1]. While several studies have found that the latter objective has not been achieved, other investigators have found improved ‘quality of life’ especially with the controlled use of erythropoietin in study settings [7,8]. In the current atmosphere of health care reform and fiscal austerity we revisit the issue of functional and vocational rehabilitation of maintenance hemodialysis patients, by a multicenter survey of a large number of patients but this time under real life conditions of erythropoietin use.