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Nie Y, Witten B, Schatell D, Assari S, Ding X, Saran R, Bragg-Gresham JL. Changes in employment status prior to initiation of maintenance hemodialysis in the USA from 2006 to 2015. Clin Kidney J 2020; 13:434-441. [PMID: 32699624 PMCID: PMC7367129 DOI: 10.1093/ckj/sfz077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/13/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) patients have high unemployment rates associated with higher mortality and poor quality of life. Changes in employment status prior to dialysis initiation may predict subsequent patient outcomes. We sought to examine US national trends in employment status prior to and at HD initiation, risk factors for job loss and their association with transplantation and mortality. METHODS Employment was defined as working full-time or part-time for 496 989 patients initiating maintenance HD from 2006 to 2015. Associations between patient and dialysis facility characteristics and employment change were analyzed using multivariable logistic regression. Cox regression was used to assess job loss with mortality and transplantation. RESULTS About 26% (n = 129 622) of patients were employed 6 months prior compared with 15% (n = 75 719) at HD initiation. Employment rates 6 months prior to HD initiation decreased from 29% in 2006 to 23% in 2014. Employed patients who maintained employment 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. Facility characteristics associated with employment maintenance included nonprofit status, more stations, dialysis availability after 5 p.m. and home dialysis training. Patients maintaining employment during the 6 months prior to HD had lower mortality and higher transplantation rates than patients who became unemployed. CONCLUSIONS Employment rates among HD patients are low and employment changes common during the 6 months prior to HD. Maintaining employment status was associated with key patient and facility characteristics, kidney transplantation and survival.
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Affiliation(s)
- Yuxin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Beth Witten
- Medical Education Institute, Madison, WI, USA
| | | | - Shervin Assari
- Department of Psychiatry, Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Kidney and Dialysis Institute of Shanghai, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Rajiv Saran
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.,Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer L Bragg-Gresham
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.,Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA
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Manen van JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT. Changes in Employment Status in End-Stage Renal Disease Patients during Their First Year of Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100610] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess employment status in new end-stage renal disease (ESRD) patients at the start of dialysis and after 1 year, and to determine whether demographic and clinical variables and physical and psychosocial functioning at the start of dialysis are risk factors for loss of employment after 1 year of dialysis. Design Prospective follow-up study in which 38 of 48 Dutch dialysis centers participate. Patients 659 patients who had started on dialysis and who were between 18 and 65 years old were included. Patients were re-examined after 12 months. Main Outcome Measures Demographic data, physical and psychosocial functioning with the Short-Form Health Survey (SF-36), and data on employment status were obtained using questionnaires. Nephrologists provided the clinical data. Results At the start of dialysis, 35% of patients were employed, in contrast to 61% of the general Dutch population. Within 1 year, the proportion of employed patients decreased from 31% to 25% of hemodialysis patients, and from 48% to 40% of peritoneal dialysis patients. In patients who were working at the start of dialysis, independent risk factors for loss of work within 1 year were impaired physical and psychosocial functioning [odds ratio physical: 3.4, 95% confidence interval (%CI), 1.0 – 11.2; odds ratio psychosocial: 4.2, 95% CI, 1.2 – 14.2]. Conclusions As the percentage of employed patients at the start of dialysis is about half the expected percent-age, loss of work is an important issue in both predialysis and dialysis patients. Improvements in physical and psychosocial functioning are potentially preventive of loss of work in patients who are employed when they start dialysis.
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Affiliation(s)
| | - Jeannette G. Manen van
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Johanna C. Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Margot C. Reuselaars
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Elisabeth W. Boeschoten
- Department of Nephrology, Academic Medical Center, University of Amsterdam
- Dianet Dialysis Centers, Amsterdam, The Netherlands
| | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center, University of Amsterdam
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Huang B, Lai B, Xu L, Wang Y, Cao Y, Yan P, Chen J. Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients. Ren Fail 2018; 39:607-612. [PMID: 28805490 PMCID: PMC6446148 DOI: 10.1080/0886022x.2017.1361834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIM Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients. METHODS Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients' employment status, current social functioning, hemodialysis modality, annual income and general health condition. Among current unemployed working-age patients, the reasons of quitting jobs and willingness of being reemployed were evaluated. RESULTS A total of 231 patients were studied, among which 114 patients were unemployed 1 year before hemodialysis. Among 117 employed patients, 16 patients quitted jobs before dialysis inception, while 49 patients quitted jobs at the initiation of HD, and 26 patients followed after a few months' HD. The main reasons for ceasing employment were physical insufficiency, conflict between dialysis and work schedules, lack of support from employers and resistance from family members. Among the 166 patients who were in their working age, 26 patients were employed. The unemployed patients had the characters of elder age, lower education level, higher annual family income, higher female ratio, lower blood flow, lower physical functioning, and social functioning and lower frequency of weekend hemodialysis and HDF/HF. Among the 140 unemployed patients, only 47 patients had the willingness of being reemployed. Their unemployment status was positively associated with elder age ((OR) 3.13, 95% CI, 1.08-9.1), lower education level ((OR) 1.97, 95% CI, 1.05-5.92), and higher family income ((OR) 7.75, 95% CI, 2.49-24.14). CONCLUSION Ratio of employment and willingness of being reemployed was low in MHD working-age patients. Lack of social and family's support also hampered patient's returning to society except for the HD treatment quality.
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Affiliation(s)
- Bihong Huang
- a Department of Nursing , Huashan Hospital Fudan University , Shanghai , China
| | - Bihong Lai
- b Department of Nursing , Pudong Hospital, Fudan University , Shanghai , China
| | - Ling Xu
- c Department of Nursing , Shanghai Fifth Hospital, Fudan University , Shanghai , China
| | - Ying Wang
- d Department of Nursing , The 455th Hospital of PLA , Shanghai , China
| | - Yanpei Cao
- a Department of Nursing , Huashan Hospital Fudan University , Shanghai , China
| | - Ping Yan
- e Department of Cardiology , Huashan Hospital Fudan University , Shanghai , China
| | - Jing Chen
- f Department of Nephrology , Huashan Hospital Fudan University , Shanghai , China
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Affiliation(s)
- Dominic S.C. Raj
- Department of Medicine, Louisiana State University School of Medicine, Shreveport, LA - USA
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Nakayama M, Ishida M, Ogihara M, Hanaoka K, Tamura M, Kanai H, Tonozuka Y, Marshall MR. Social functioning and socioeconomic changes after introduction of regular dialysis treatment and impact of dialysis modality: a multi-centre survey of Japanese patients. Nephrology (Carlton) 2016; 20:523-30. [PMID: 25854420 DOI: 10.1111/nep.12482] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/22/2022]
Abstract
AIM Patient socialization and preservation of socioeconomic status are important patient-centred outcomes for those who start dialysis, and retention of employment is a key enabler. This study examined the influence of dialysis inception and modality upon these outcomes in a contemporary Japanese cohort. METHODS We conducted a survey of prevalent chronic dialysis patients from 5 dialysis centres in Japan. All patients who had been on peritoneal dialysis (PD) since dialysis inception were recruited, and matched with a sample of those on in-centre haemodialysis (ICHD). We assessed patients' current social functioning (Short Form 36 Health Survey), and evaluated changes to patient employment status, annual income, and general health condition from the pre-dialysis period to the current time. RESULTS A total of 179 patients were studied (102 PD and 77 ICHD). There were no differences in social functioning by modality. Among them, 113 were employed in the pre-dialysis period with no difference by modality. Of these, 22% became unemployed after dialysis inception, with a corresponding decline in average working hours and annual income. The odds of unemployment after dialysis inception were 5.02 fold higher in those on ICHD compared to those on PD, after adjustment for covariates. There were no changes for those who were already unemployed in the pre-dialysis period. CONCLUSIONS Employment status is significantly hampered by dialysis inception, although PD was associated with superior retention of employment and greater income compared to ICHD. This supports a positive role for PD in preservation of socioeconomic status and potentially other patient-centred outcomes.
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Affiliation(s)
- Masaaki Nakayama
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mari Ishida
- Nephrology, Kitasaito Hospital, Hokkaido, Japan
| | | | | | - Masahito Tamura
- Nephrology, University of Occupational and Environmental Health, Fukuoka, Japan
| | | | - Yukio Tonozuka
- Clinical Development and Medical Afairs, Baxter Limited, Tokyo, Japan
| | - Mark R Marshall
- Medical Affairs, Baxter Healthcare Asia-Pacific, Auckland, New Zealand
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Feder J, Nadel MV, Krishnan M. A Matter of Choice: Opportunities and Obstacles Facing People with ESRD. Clin J Am Soc Nephrol 2015; 11:536-8. [PMID: 26553796 DOI: 10.2215/cjn.04470415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kidney failure is an overwhelming, life-shattering event, but patients with ESRD do not see themselves as being at the end stage of their lives. On the contrary, patients opting for kidney dialysis are choosing to live. Ideally, then, public policy would support patients' choices about how to live-specifically, the choice to continue working. Many patients with ESRD faced with the limitations of their health status and the demands of their treatment understandably choose to leave their jobs, a choice that is facilitated by the availability of public disability and health insurance. However, other patients who have the desire and opportunity to continue working may not get the guidance and support that can actually make their employment possible. Specifically, current disability and health insurance may fail to provide timely treatment and employment counseling to help patients with ESRD remain in their jobs. We, therefore, propose that the Center for Medicare and Medicaid Services support ESRD Networks to initiate more timely employment and treatment counseling in both the ESRD and the late-stage pre-ESRD setting. Although it is too late to require such counseling in the new network scope of work for 2016-2020, active experimentation in the next few years can lay the groundwork for a subsequent contract.
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Affiliation(s)
- Judith Feder
- Georgetown University McCourt School of Public Policy, Washington, DC; and
| | - Mark V Nadel
- Georgetown University McCourt School of Public Policy, Washington, DC; and
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Aghakhani N, Sharif F, Molazem Z, Habibzadeh H. Content analysis and qualitative study of hemodialysis patients, family experience and perceived social support. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e13748. [PMID: 24829767 PMCID: PMC4005429 DOI: 10.5812/ircmj.13748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/02/2013] [Accepted: 12/09/2013] [Indexed: 11/19/2022]
Abstract
Background: Various treatments such as hemodialysis prolong the life of chronic renal failure disease patients who must tolerate many physical, emotional, social and economic difficulties. Therefore, social support is considered as a vital area of investigation for such patients. Objectives: In this qualitative research, a grounded theory approach was used and written as a content analysis form to study hemodialysis patients and family experience of perceived social support. Patients and Methods: Three nurses, 4 general practitioners, a specialist and two family members who participated were interviewed from April to September 2012 in Urmia, Iran. Interviews were guided to divulge the perception of changes in their lives, needs for social support for disease complications, and the type of treatment process. Purposive sampling continued up to data saturation. Data analysis was performed based on Strauss and Corbin Method. Constant comparison analysis was performed until data saturation. Results: The research results are shown in 3 steps. In the first step, 113 categories and four main themes from 993 first codes were explored. Social support was explored based on the implications of five general themes including “Perceived Threats Caused by Disease Complications”, “Searching for Social Support”, “Accessible Social Support”, “Beliefs and Values”, and “Perceived Social Support”. Conclusions: The core variable of our research is acceptance of the reality of the conditions caused by the disease. The research finalized our knowledge about patient problems regarding social support and revealed many problems of supporting patients by Health Team Members, family members and organizations. The findings suggest that individual aspects of patient experiences must be considered if social support is to be given and Healthcare Providers have to facilitate positive health services.
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Affiliation(s)
- Nader Aghakhani
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farkhondeh Sharif
- Department of Mental Health Nursing, Community Based Psychiatric Care Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Farkhondeh Sharif, Community Based Psychiatric Care Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, P.O. Box: 71345-1359, Shiraz, IR Iran. Tel: +98-4412752378, E-mail:
| | - Zahra Molazem
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hosein Habibzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, IR Iran
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Theofilou P, Synodinou C, Panagiotaki H. Undergoing Haemodialysis: A Qualitative Study to Investigate the Lived Experiences of Patients. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i1.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Palmieri B, Tremblay JP, Daniele L. Past, present and future of myoblast transplantation in the treatment of Duchenne muscular dystrophy. Pediatr Transplant 2010; 14:813-9. [PMID: 20963914 DOI: 10.1111/j.1399-3046.2010.01377.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
DMD is a genetic X-linked recessive disease that affects approximately one in 3500 male births. Boys with DMD have progressive and predictable muscle destruction because of the absence of Dys, a protein present under the muscle fiber membrane. Dys deficiency induces contraction-related membrane damages, activation of inflammatory-necrosis-fibrosis up to the cardiac-diaphragmatic failure and death. This review supports the therapeutic role of MT associated with immunosuppression in DMD patients, describing the history and the rationale of such approach. The authors underline the importance to evaluate a protocol of myoblast intradermal multi-injection to apply in young DMD patients
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.
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Sabariego C, Grill E, Brach M, Fritschka E, Mahlmeister J, Stucki G. Incremental cost-effectiveness analysis of a multidisciplinary renal education program for patients with chronic renal disease. Disabil Rehabil 2010; 32:392-401. [DOI: 10.3109/09638280903171584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lopes AA, Bragg-Gresham JL, Goodkin DA, Fukuhara S, Mapes DL, Young EW, Gillespie BW, Akizawa T, Greenwood RN, Andreucci VE, Akiba T, Held PJ, Port FK. Factors associated with health-related quality of life among hemodialysis patients in the DOPPS. Qual Life Res 2007; 16:545-57. [PMID: 17286199 DOI: 10.1007/s11136-006-9143-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 10/18/2006] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify modifiable factors associated with health-related quality of life (HRQOL) among chronic hemodialysis patients. METHODS Analysis of baseline data of 9,526 hemodialysis patients from seven countries enrolled in phase I of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Using the Kidney Disease Quality of Life Short Form (KDQOL-SF(TM)), we determined scores for 8 generic scale summaries derived from these scales, i.e., the physical component summary [PCS] and mental component summary [MCS], and 11 kidney disease- targeted scales. Regression models were used to adjust for differences in comorbidities and sociodemographic and treatment factors. The Benjamini-Hochberg procedure was used to correct P-values for multiple comparisons. RESULTS Unemployment and psychiatric disease were independently and significantly associated with lower scores for all generic and several kidney disease-targeted HRQOL measures. Several other comorbidities, lower educational level, lower income, and hypoalbuminemia were also independently and significantly associated with lower scores of PCS and/or MCS and several generic and kidney disease-targeted scales. Hemodialysis by catheter was associated with significantly lower PCS scores, partially explained by the correlation with covariates. CONCLUSION Associations of poorer HRQOL with preventable or controllable factors support a greater focus on psychosocial and medical interventions to improve the well-being of hemodialysis patients.
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Raj DS, Charra B, Pierratos A, Work J. In search of ideal hemodialysis: is prolonged frequent dialysis the answer? Am J Kidney Dis 1999; 34:597-610. [PMID: 10516338 DOI: 10.1016/s0272-6386(99)70382-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Advances in technology have made it possible to deliver a high Kt/V in a shorter time. The realization that duration of dialysis may be an important predictor of survival independent of dialysis dose has resulted in the popularity of prolonged slow dialysis (PHD). The longer duration and increased frequency of dialysis achieve excellent small- and middle-molecular weight solute clearance and also attenuate the peak concentration of uremic toxins. The slow dialysis process enables the equilibration of tissue and vascular compartments, resulting in better clearance and decreased postdialysis rebound increase in solutes. Gentle, persistent ultrafiltration allows the control of hypertension with minimal antihypertensive use. The intense and more frequent dialysis improves appetite and permits liberalization of diet. This greater dietary protein intake results in a progressive increase in serum albumin level and dry weight. Nocturnal hemodialysis achieves control of hyperphosphatemia without phosphate binders and a significant reduction in serum beta(2)-microglobulin levels. Normalization of extracellular volume, better clearance of uremic toxins, and improved nutrition result in a significant improvement in survival. The flexible time schedule with home hemodialysis and improvement of sleep and neurocognitive function allow better rehabilitation. The available evidence indicates PHD may be closer to the concept of an ideal dialysis, but there is lingering uncertainty about the consequence of prolonged immune stimulation, catabolism, and loss of essential solutes with these therapies.
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Affiliation(s)
- D S Raj
- Department of Medicine, Louisiana State University School of Medicine, Shreveport, LA 71103, USA.
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