Association between Access to Alternatives to Daytime In-Center Hemodialysis and Employment among Patients with Kidney Failure

Key Points – While maintaining employment is a priority for patients with kidney disease, many stop working when they develop kidney failure.We examined the association between access to alternative dialysis schedules (home dialysis and evening shifts) and employment.Access to alternative dialysis schedules was associated with a 6%–10% higher rate of employment among patients receiving dialysis.Background – Maintaining employment is a priority for many patients with kidney disease. Yet, only 30% to 35% of working aged patients with advanced CKD in the United States (US) report employment before starting dialysis, and many patients stop working at the onset of ESKD. While access to a dialysis treatment schedule outside of working hours may help patients to remain employed, the effects of alternative dialysis options on employment after starting dialysis are not well understood.Methods – Using the US Renal Disease System national registry, we identified dialysis facilities from 2016 to 2019. We examined the associations of access to alternative dialysis schedules (home dialysis and/or evening dialysis shifts) with rates of employment among working aged (18–54 years) adults at each dialysis facility. Access to alternative dialysis was defined as receiving dialysis at a facility that offered home dialysis and/or evening shifts. Multivariable regression models adjusted for patient, dialysis facility, socioeconomic, and geographic characteristics, including information about individual patient employment at the onset of dialysis.Results – We identified 7246 US dialysis facilities with patient employment information in 2016–2019. In adjusted models, access to home dialysis was associated with a 10% (95% confidence interval, 8% to 12%) higher rate of employment. Access to a facility offering an evening dialysis shift was significantly associated with a 6% (95% confidence interval, 4% to 8%) higher rate of employment.Conclusion – Access to alternative dialysis options, such as in-home dialysis or evening schedules, was associated with higher employment among patients with ESKD.