ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO303

Employment 6 Months Prior to and at Dialysis Start: Validation Evidence for CMS-2728 Data

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kutner, Nancy G., Emory University School of Medicine, Atlanta, Georgia, United States
  • Zhang, Rebecca H., Emory University, Atlanta, Georgia, United States
Background

The CMS-2728 is a unique source of patient employment status 6 months prior and at dialysis start. A USRDS analysis of patients 18-54 initiating in-center hemodialysis (HD) or home dialysis 1996-2013 showed a persistent pattern of job loss in the 6-month pre-dialysis interval (CJASN 2018). The CMS-2728 employment field has not been independently validated, however. We compared incident patients’ interview responses obtained approximately 2 months after dialysis start with corresponding employment information from their CMS-2728 report.

Methods

Patients who began in-center HD or home dialysis July 1996-August 1997, English- or Spanish-speaking and without documented cognitive impairment, were recruited for a study of health behaviors/quality of life from 26 dialysis clinics serving the Atlanta GA 23-county area. Participants represented eligible patients in age, race and functional status but the cohort included fewer women. Structured in-person interviews were conducted at a non-dialysis facility location convenient for the patient 67.3 + 19.5 days after dialysis start. 95/226 study participants were ages 20-54 (median 43) with women 47%; blacks 58%; non-Hispanic whites 35%; and Hispanic, Asian, other 7%. CMS-2728 employment status options include: unemployed, employed full time (FT), employed part time (PT), homemaker, retired (age/preference), retired (disability), medical leave of absence, and student. The patient interview asked: Are you working now (hours/week)? job being held? retired or stopped working; when? keeping house? student (FT, PT)? Using FT, PT, or student to define employment (CJASN 2018), we identified the unadjusted proportion of patients employed 6 months prior and at dialysis start, reported by the CMS-2728 and by patients.

Results

Compared with their CMS-2728 data, 8% more patients reported being employed 6 months prior, while 6% fewer patients reported current employment. Potential job maintenance opportunities were suggested by patients who reported having switched from FT to PT work, said their prior job was “being held,” cited a medical leave of absence, or reported being “let go” from their job (in all, 14% of the cohort).

Conclusion

Our study suggests that CMS-2728 employment fields have good validity. Effective interventions are needed to help patients remain in the workforce as they transition to dialysis.

Funding

  • NIDDK Support