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 X

Kidney Week

ASN / Education & Meetings / Kidney Week /

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: SA-PO973

Pre-ESKD Nephrology Care and Employment at the Start of Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Awan, Ahmed A., Baylor College of Medicine, Houston, Texas, United States
  • Zhao, Bo, Baylor College of Medicine, Houston, Texas, United States
  • Anumudu, Samaya Javed, Baylor College of Medicine, Houston, Texas, United States
  • Ho, Vivian, Baker Institute for Public Policy, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Erickson, Kevin F., Baylor College of Medicine, Houston, Texas, United States

Group or Team Name

  • Baylor College of Medicine
Background

Employment is associated with improved sense of well-being in general population and higher quality of life in patients with kidney disease. Patients who receive nephrology care prior to onset of End-Stage Kidney Disease (ESKD) experience better health outcomes, perhaps due to smoother transitions to ESKD. We examine whether pre-ESKD nephrology care can also help patients to remain employed when starting dialysis.

Methods

We used a national ESKD registry to identify all patients in the United States between the ages of 18 and 54 who initiated dialysis from January 1st, 2006 to December 31st, 2014 and who were employed 6 months prior to ESKD. Using a multivariable (Modified Poisson) regression model, we examined the independent association between > 6 months of pre-ESKD nephrology care and employment at the start of dialysis. Additionally, we measured geographic variation in pre-ESKD nephrology care by county-level population quintiles among patients who were excluded from the primary cohort due to age or pre-ESKD employment status. We then examined whether geographic variation in pre-ESKD care is associated with employment at dialysis initiation.

Results

Of the 75,700 patients included in study cohort, 36,940 (49%) reported receiving pre-ESKD care for > 6 months. At the individual patient level, >6 months of pre-ESKD care was associated with a 21 % increase in the relative risk (RR) of remaining employed at dialysis initiation (95% CI: 20% to 23%). While geographic variation in pre-ESKD care was strongly correlated with a patient’s likelihood of receiving pre-ESKD care, there was no association between geographic measures of pre-ESKD care and the likelihood of employment at initiation of dialysis

Conclusion

Despite there is a strong association between pre-ESKD care of > 6 months and employment at the time of dialysis onset, geographic variation in pre-ESKD care is not associated with the likelihood of remaining employed. This suggests that while pre-ESKD care may be necessary for some patients to remain employed, it may not, by itself, be sufficient to foster employment.

Funding

  • Private Foundation Support