SAN DIEGO – Being catheter free and having a serum albumin level of at least 4 g/dL were among the quality indicators associated with the ability of dialysis patients to return to work, judging from the results of a large study.
"There has been limited attention to employment issues in this patient population," Nancy G. Kutner, Ph.D., said in an interview during a poster session at Kidney Week 2012. "There has been a general impression that most people aren’t going to even try to resume employment – even those who were employed immediately before starting dialysis."
Doug Brunk/IMNG Medical Media
Nancy G. Kutner, Ph.D.
Dr. Kutner, professor of rehabilitation medicine at Emory University, Atlanta, and her associates enrolled 509 patients who were on hemodialysis treatment for 3 months or longer during 2009-2011 for a U.S. Renal Data System study conducted in seven outpatient clinics in San Francisco and seven in Atlanta. The patients were between the ages of 18 and 64 years, and they responded to the question: "Are you now able to work for pay (full-time or part-time)?"
Using a logistic regression model adjusted for age, gender, race, educational level, diabetes, congestive heart failure, presence of symptoms of depression, length of time on dialysis, and facility clustering, the researchers investigated whether incremental achievement of certain hemodialysis quality indicator (HD QI) goals were correlated with patient-reported ability to work. The HD QI goals were standardized Kt/V of 1.2 or greater; being catheter free; and having a hemoglobin level of 10-12 g/dL, a serum albumin level of 4 g/dL or greater, and a serum phosphorus level of 3.5 mg/dL to 5.5 mg/dL.
The mean age of the patients was 50 years, and 61% were male. Of the 509 patients, 36% said that they were able to work and 13% were actually employed. The mean number of HD QI goals met was 3.31, and the patients’ likelihood of reporting being able to work increased with an increasing number of QI goals met (odds ratio 1.28; P = .02). "Achieving a quality indicator goal is likely a joint process between the provider and the patient," said Dr. Kutner, who directs the USRDS Rehabilitation/QoL Special Studies Center at Emory.
"The end result seems to be that as more of these goals are met, it furthers the potential for work and rehabilitation. This is very encouraging," she said at the meeting, which was sponsored by the American Society of Nephrology.
Compared with their counterparts who reported being unable to work, a higher proportion of those who reported being able to work met the QI goals of Kt/V of 1.2 or greater (92% vs. 90%, respectively), being catheter free (84% vs. 74%), having a hemoglobin level of 10-12 g/dL (62% vs. 60%), and having a serum albumin of 4.0 g/dL or greater (59% vs. 49%). The proportion of those reporting a serum phosphorus level of 3.5-5.5 mg/dL was similar between the two groups (48% vs. 50%).
Dr. Kutner said that she had no relevant financial conflicts to disclose.