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Sugisawa H, Shimizu Y, Kumagai T, Shishido K, Koda Y, Shinoda T. Employment rates for working-age patients receiving hemodialysis increasing: Changing economic environment. Ther Apher Dial 2024; 28:632-647. [PMID: 38647125 DOI: 10.1111/1744-9987.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION This study explored employment trends among working-age patients undergoing hemodialysis using 5-year surveys from 1996 to 2021. Policy changes affecting individuals with disabilities, the economic environment, and employment status among the general population in Japan were considered. Differences in trends by gender and health status were examined. METHODS Employment status was categorized into employment and nonemployment; and regular, nonregular, and self. Analytical data with similar characteristics were generated over the six surveys using the propensity score method. RESULTS The employment rate, especially among women, increased from 1996 to 2021. However, the employment rate ratio to the general population was approximately 80% for men and 50% for women, even in 2021. The employment rate increased with an expansion in nonregular employment. Women's employment trends could be explained by changes in real gross domestic product and employment quotas for individuals with disabilities. CONCLUSION Employment trends differ by gender and by regular versus nonregular employment.
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Affiliation(s)
- Hidehiro Sugisawa
- J. F. Oberlin University Graduate School of International Studies, Shibuya-ku, Tokyo, Japan
| | - Yumiko Shimizu
- The Jikei University School of Nursing, Chofu, Tokyo, Japan
| | - Tamaki Kumagai
- School of Health Sciences, International University of Health and Welfare, Odawara, Kanagawa, Japan
| | | | - Yutaka Koda
- Koda Medical and Dialysis Clinic, Tsubame, Niigata, Japan
| | - Toshio Shinoda
- Department of Clinical Engineering Advanced Course, Teikyo University Junior College, Shibuya, Tokyo, Japan
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Taylor KS, Novick TK, Santos SR, Chen Y, Smith OW, Perrin NA, Crews DC. Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use. KIDNEY360 2023; 4:1590-1597. [PMID: 37943037 PMCID: PMC10695650 DOI: 10.34067/kid.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023]
Abstract
Key Points Food insecurity and housing instability may affect dialysis outcomes through health behaviors like treatment adherence and their effect on access to transplantation or home dialysis therapies. People on hemodialysis who were younger, with less educational attainment, with lower incomes, or experiencing financial strain were more likely to experience material need insecurities. Participant race was not associated with material need insecurities, although residential segregation moderated associations between age, sex, and food insecurity. Background Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population. Methods We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington, DC metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual-level and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models. Results Of the 305 participants who completed study surveys, 57% were men and 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes, or experiencing financial strain were more likely to have material need insecurities (P < 0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared with women (odds ratio 3.7; 95% confidence interval, 1.61 to 8.53); younger participants (age <55 years) had increased odds of food insecurity compared with older participants (odds ratio 3.3; 95% confidence interval, 1.49 to 7.32). Associations between sex or younger age category and food insecurity were not statistically significant in less segregated counties (P interaction for residential segregation×sex: P = 0.006; residential segregation×younger age category: P = 0.12). Conclusions Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3
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Affiliation(s)
| | - Tessa K. Novick
- University of Texas at Austin Dell Medical School, Austin, Texas
| | - Sydney R. Santos
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Owen W. Smith
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nancy A. Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Caballero-Castañeda L, Flores-Méndez YL, Juárez-Sánchez JO, Nieves-Ruiz ER. [Sleep quality in patients with chronic kidney disease on hemodialysis]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S213-S219. [PMID: 38011707 PMCID: PMC10776180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 11/29/2023]
Abstract
Background Chronic kidney disease (CKD) is a serious condition that impairs sleep quality, which compromises quality of life, cardiovascular function and increases the risk of mortality; however, limited information is available on sleep quality in hemodialysis (HD) patients. Objective To determine the sleep quality in patients with CKD on renal replacement therapy with HD. Material and methods Cross-sectional analytical study. The population included patients with CKD on HD, either sex, who answered the Pittsburgh questionnaire in a tertiary hospital. A 19-item self-administered survey was applied, assessing 7 components of sleep quality, where overall scores ≤ 5 and > 5 indicated respectively good and poor sleep quality. Socio-demographic, anthropometric, self-reported lifestyle and CKD history-related characteristics were assessed. Results A total of 83 patients were included with a mean age of 45.3 (15.9), 63% (52) were male and 37% (31) female; of these, 63% (52) had poor sleep quality and 37% (31) had good sleep quality. Conclusion Sleep quality is poor in patients with CKD on renal replacement therapy with HD. Variables influencing sleep quality are age, occupation, body mass index, sleep duration, and use of hypnotic medications. Therefore, HD patients should be evaluated to detect sleep problems in order to develop strategies to improve their sleep quality.
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Affiliation(s)
- Luis Caballero-Castañeda
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Servicio de Nefrología. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Yareli Lizet Flores-Méndez
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 56, Coordinación de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - José Oscar Juárez-Sánchez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Servicio de Nefrología. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Efrén René Nieves-Ruiz
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 56, Coordinación de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
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AbiFaraj F, Lee D, Lacovara M, Kapoor T, Seshasai R, Bansal S, Greevy R, Guide A, Sharma S, Uribarri J, El Shamy O. Survey of Peritoneal Dialysis Patients' Challenges and Experiences during the COVID-19 Pandemic: A Multicenter Study in the United States. KIDNEY360 2023; 4:e1276-e1285. [PMID: 37357350 PMCID: PMC10547227 DOI: 10.34067/kid.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
Key Points The adjustments made by the dialysis units during the peak of the pandemic were effective in maneuvering the challenges faced by our patients during the COVID-19 pandemic. Patients who remained on PD were satisfied with the quality of care, felt supported by the unit staff, and did not report feeling anxious or depressed. Background During the coronavirus disease 2019 (COVID-19) pandemic, adjustments were made to peritoneal dialysis (PD) practices in the outpatient units. These were decisions made by dialysis providers, clinical staff, and governments with input from patient organizations in some instances. The patient perspective regarding these changes during the pandemic has not been explored. We sought to evaluate patient experiences and perceptions of the challenges they faced, institutional adjustments, and their mental health during the height of the COVID-19 pandemic in the United States. Methods We conducted a cross-sectional survey of PD patients across four home dialysis units affiliated with four large academic centers, who were on PD between March 2020 and March 2021. Results Ninety-eight participants completed the survey across the four outpatient PD clinics. Over 95% of patients did not have to change their home accommodations during the pandemic, and over 80% did not have issues getting their dialysis supplies and medications delivered. Ninety-three percent of patients felt comfortable coming to the dialysis unit if they needed to during the pandemic. Almost all patients (98%) felt supported by their dialysis staff during the peak of COVID-19 and had modified Patient Health Questionnaire 2 (91%) and Generalized Anxiety Disorder 2-item (96%) scores not consistent with depression or anxiety. Less than 10% of patients considered changing their dialysis modality. Conclusions The adjustments made by the dialysis units during the peak of the pandemic were effective in maneuvering the challenges faced by our patients during the COVID-19 pandemic. Overall, patients who remained on PD were satisfied with the quality of care, felt supported by the unit staff, and did not report feeling anxious or depressed.
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Affiliation(s)
- Farah AbiFaraj
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dale Lee
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meghan Lacovara
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tarun Kapoor
- Department of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Seshasai
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Guide
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shuchita Sharma
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jaime Uribarri
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Osama El Shamy
- Department of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
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Le LTH, Tran TT, Duong TV, Dang LT, Hoang TA, Nguyen DH, Pham MD, Do BN, Nguyen HC, Pham LV, Nguyen LTH, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Nguyen TTP, Nguyen KT, Yang SH. Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study. Nutrients 2023; 15:nu15102292. [PMID: 37242175 DOI: 10.3390/nu15102292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Treatment adherence (TA) is a critical issue and is under-investigated in hemodialysis patients. A multi-center study was conducted from July 2020 to March 2021 on 972 hemodialysis patients in eight hospitals in Vietnam to explore the factors associated with TA during the COVID-19 pandemic. Data were collected, including socio-demographics, an End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), 12-item short-form health literacy questionnaire (HLS-SF12), 4-item digital healthy diet literacy scale (DDL), 10-item hemodialysis dietary knowledge scale (HDK), 7-item fear of COVID-19 scale (FCoV-19S), and suspected COVID-19 symptoms (S-COVID19-S). Bivariate and multivariate linear regression models were used to explore the associations. Higher DDL scores were associated with higher TA scores (regression coefficient, B, 1.35; 95% confidence interval, 95%CI, 0.59, 2.12; p = 0.001). Higher FCoV-19S scores were associated with lower TA scores (B, -1.78; 95%CI, -3.33, -0.24; p = 0.023). In addition, patients aged 60-85 (B, 24.85; 95%CI, 6.61, 43.11; p = 0.008) with "very or fairly easy" medication payment ability (B, 27.92; 95%CI, 5.89, 44.95; p = 0.013) had higher TA scores. Patients who underwent hemodialysis for ≥5 years had a lower TA score than those who received <5 years of hemodialysis (B, -52.87; 95%CI, -70.46, -35.28; p < 0.001). These findings suggested that DDL and FCoV-19S, among other factors, should be considered in future interventions to improve TA in hemodialysis patients.
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Affiliation(s)
- Lan T H Le
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Tu T Tran
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
| | - Loan T Dang
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, Vietnam
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan
| | - Trung A Hoang
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
| | - Dung H Nguyen
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
| | - Minh D Pham
- Department of Nutrition, Military Hospital 103, Hanoi 121-08, Vietnam
- Department of Nutrition, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Binh N Do
- Department of Military Science, Vietnam Military Medical University, Hanoi 121-08, Vietnam
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Hoang C Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Lien T H Nguyen
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam
| | - Hoi T Nguyen
- Director Office, Hai Phong International Hospital, Hai Phong 047-08, Vietnam
| | - Nga T Trieu
- Hemodialysis Division, Hai Phong International Hospital, Hai Phong 047-08, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Ha Long 011-21, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Ha Long 011-08, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam
| | - Thao T P Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
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Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant. Kidney Int Rep 2022; 8:282-293. [PMID: 36815100 PMCID: PMC9939357 DOI: 10.1016/j.ekir.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/09/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Older adults (65 years or older) constitute a substantial and increasing proportion of patients with kidney failure, potentially needing kidney replacement therapy. Living donor kidney transplant (LDKT) offers superior outcomes for suitable patients of all ages. However, exploring LDKT and finding a living donor could be challenging for older adults. Here, we assessed the association between age and utilization of LDKT and assessed effect modification of key variables such as ethnicity and language. Methods This is a retrospective cohort study of patients with kidney failure referred for kidney transplant (KT) assessment in Toronto between January 2006 and December 2013. The association between age and having a potential living donor identified was assessed using logistic regression and the association between age and the receipt of LDKT was assessed using Cox proportional hazards models. Results Of the 1617 participants, 50% were middle-aged (45-64 years old), and 17% were ≥65 years old. In our final multivariable adjusted models, compared to young adults, middle-aged and older adults had lower odds of having a potential living donor identified (odds ratio [OR], 0.47; confidence interval [CI], [0.35-0.63]; OR, 0.30; CI, [0.20-0.43]; P < 0.001, for middle-aged and older adults, respectively), and were less likely to receive LDKT (hazard ratio [HR], 0.79; CI, [0.63-0.99]; P = 0.04; HR, 0.47; CI, [0.30-0.72]; P = 0.001, for middle-aged and older adults, respectively.). Conclusion Age is an independent predictor of receiving LDKT. Considering that nearly 90% of patients with kidney failure in Canada are >45 years of age, these results point to important and potentially modifiable age-related barriers to LDKT.
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Nardelli L, Scalamogna A, Messa P, Gallieni M, Cacciola R, Tripodi F, Castellano G, Favi E. Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice? Medicina (B Aires) 2022; 58:medicina58020214. [PMID: 35208541 PMCID: PMC8875254 DOI: 10.3390/medicina58020214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 12/28/2022] Open
Abstract
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.
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Affiliation(s)
- Luca Nardelli
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Antonio Scalamogna
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Piergiorgio Messa
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy;
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Roberto Cacciola
- Department of Surgical Sciences, Università di Tor Vergata, 00133 Rome, Italy;
| | - Federica Tripodi
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Evaldo Favi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-3666036167
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Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189541. [PMID: 34574463 PMCID: PMC8464840 DOI: 10.3390/ijerph18189541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
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Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
- Correspondence: ; Tel.: +852-3943-8165
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
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O'Hare AM, Rodriguez RA, van Eijk M. Supporting the Employment Goals of People With Kidney Disease. Am J Kidney Dis 2021; 78:772-773. [PMID: 34312057 DOI: 10.1053/j.ajkd.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ann M O'Hare
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Departments of Medicine, University of Washington, Seattle, WA.
| | - Rudolph A Rodriguez
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Departments of Medicine, University of Washington, Seattle, WA
| | - Marieke van Eijk
- Department of Anthropology, University of Washington, Seattle, WA; Center for Workforce Studies, University of Washington, Seattle, Washington
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Rajkumar R, Baumgart A, Martin A, Tong A, Evangelidis N, Manera KE, Cho Y, Johnson DW, Viecelli A, Shen J, Guha C, Scholes-Robertson N, Howell M, Craig JC. Perspectives on ability to work from patients' receiving dialysis and caregivers: analysis of data from the global SONG initiative. J Nephrol 2021; 35:255-266. [PMID: 34241814 DOI: 10.1007/s40620-021-01105-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients receiving dialysis have low employment rates, which compounds poorer health and socioeconomic outcomes. Reasons for under- and unemployment remain underexplored. We aimed to describe the perspectives of patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and their caregivers on ability to work. METHODS Data was derived from adult patients' and caregivers' responses from 26 focus groups, two international Delphi surveys and two consensus workshops conducted through the Standardized Outcomes in Nephrology (SONG-HD) and SONG-PD programs. Our secondary thematic analysis identified concepts around ability to work. RESULTS Five hundred four patients and 146 caregivers from 86 countries were included. We identified five themes: financial pressures and instability (with subthemes of rationing the budget with increased expenditure, losing financial independence and threatened job security); struggling to meet expectations (burdened by sociocultural norms and striving to protect independence); contending with upheaval of roles and responsibilities (forced to establish a new routine to accommodate work, symptoms disrupting work, prioritizing work and other duties, and adjusting to altered capacity to work); enabling flexibility and control (employment driving decisions about dialysis modality and schedule, workplace providing occupational safety and adaptability, requiring organizational support and planning for a future career); and finding purpose and value (accepting and redefining identity, pride and fulfillment, and protecting mental well-being). CONCLUSIONS Employment enabled patients to maintain their identity, independence, financial security and mental health. Symptom burden, workplace inflexibility and juggling roles are major challenges. Interventions addressing motivation, workplace flexibility and safety, and establishing goals and routines could support patients' capacities to work, thereby improving overall well-being and productivity.
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Affiliation(s)
- Ramya Rajkumar
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia.
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Adam Martin
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Yeoungjee Cho
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - David W Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Andrea Viecelli
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Jenny Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, USA
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead , Sydney, NSW, 2145, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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11
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van der Mei SF, Alma MA, de Rijk AE, Brouwer S, Gansevoort RT, Franssen CFM, Bakker SJL, Hemmelder MH, Westerhuis R, van Buren M, Visser A. Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD. Am J Kidney Dis 2021; 78:780-792. [PMID: 34118302 DOI: 10.1053/j.ajkd.2021.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE & OBJECTIVE Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD. STUDY DESIGN Qualitative study using semistructured interviews. SETTING & PARTICIPANTS 27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands. ANALYTICAL APPROACH Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework. RESULTS Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators. LIMITATIONS The study sample of Dutch patients may limit the transferability of these findings to other countries. CONCLUSIONS The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.
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Affiliation(s)
| | - Manna A Alma
- Department of Health Sciences, Applied Health Research, Groningen
| | - Angelique E de Rijk
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, Groningen
| | | | | | | | - Marc H Hemmelder
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden
| | - Ralf Westerhuis
- University Medical Center Groningen, University of Groningen; Dialysis Center Groningen, Groningen
| | - Marjolijn van Buren
- Department of Internal Medicine, HagaHospital, The Hague; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, Applied Health Research, Groningen
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12
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Chang YT, Wang F, Huang WY, Hsiao H, Wang JD, Lin CC. Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan. Clin J Am Soc Nephrol 2021; 16:746-756. [PMID: 33858826 PMCID: PMC8259483 DOI: 10.2215/cjn.13480820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES An accurate estimate of the loss of lifetime employment duration resulting from kidney failure can facilitate comprehensive evaluation of societal financial burdens. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients undergoing incident dialysis in Taiwan during 2000-2017 were identified using the National Health Insurance Research Database. The corresponding age-, sex-, and calendar year-matched general population served as the referents. The survival functions and the employment states of the index cohort (patients on dialysis) and their referents for each age strata were first calculated, and then extrapolated until age 65 years, where the sum of the product of the survival function and the employment states was the lifetime employment duration. The difference in lifetime employment duration between the index and referent cohort was the loss of lifetime employment duration. Extrapolation of survival function and relative employment-to-population ratios were estimated by the restricted cubic spline models and the quadratic/linear models, respectively. RESULTS A total of 83,358 patients with kidney failure were identified. Men had a higher rate of employment than women in each age strata. The expected loss of lifetime employment duration for men with kidney failure was 11.8, 7.6, 5.7, 3.8, 2.3, 1.0, and 0.2 years for those aged 25-34, 35-40, 41-45, 46-50, 51-55, 56-60, and 61-64 years, respectively; and the corresponding data for women was 10.5, 10.1, 7.9, 5.6, 3.3, 1.5, and 0.3 years, respectively. The values for loss of lifetime employment duration divided by loss of life expectancy were all >70% for women and >88% for men across the different age strata. The sensitivity analyses indicated that the results were robust. CONCLUSIONS The loss of lifetime employment duration in patients undergoing dialysis mainly originates from loss of life expectancy.
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Affiliation(s)
- Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fuhmei Wang
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsuan Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chang-Ching Lin
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
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13
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Weinhandl ED. Economic Impact of Home Hemodialysis. Adv Chronic Kidney Dis 2021; 28:136-142. [PMID: 34717859 DOI: 10.1053/j.ackd.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/12/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
Home hemodialysis (HD) is growing in the United States, but the economics of the modality are largely unknown, especially considering the unique aspects of home HD in the United States . In this review, I focus on details of Medicare coverage, which directly applies to most patients on dialysis and influences the policies of private insurers. Key details in Medicare comprise the relationship between home dialysis training and initial Medicare eligibility, reimbursement for home HD training, coverage of additional HD treatments (ie., in excess of 3 treatments per week), and monthly capitated payments to nephrologists. The overarching narrative is that frequent home HD directly increases Medicare costs for outpatient dialysis, but these added costs can be mitigated by lower inpatient expenditures if increased HD treatment frequency lowers the risk of cardiovascular hospitalization and infection control is emphasized. I also review recent international literature; conventional home HD exhibits a superior cost profile, whereas frequent home HD is generally cost-effective over multiple treatment years (ie, if early technique failure is avoided). Out-of-pocket expenses for patients should be considered. The future economics of home HD in the United States will be determined by new equipment, new adaptations of the modality, and new payment models.
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14
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Alshraifeen A, Al-Rawashdeh S, Herth K, Alnuaimi K, Alzoubi F, Khraim F, Ashour A. The association between hope and quality of life in haemodialysis patients. ACTA ACUST UNITED AC 2020; 29:1260-1265. [DOI: 10.12968/bjon.2020.29.21.1260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Hope is important for patients with end-stage renal disease receiving haemodialysis (HD) and hope is associated with quality of life (QoL). Studies examining hope among the HD population are limited and, as far as the authors know, have not been undertaken in Jordan. Aims: To examine levels of hope and QoL and to examine the association between hope and QoL in HD patients in Jordan. Methods: A cross-sectional design was used. A convenience sample of 202 patients from six different dialysis centres was recruited. The World Health Organization QOL-BREF and the Herth Hope Index were used. Findings: Moderate levels of hope (M=32.3±4.1) were reported. Respondents reported low mean scores for the physical domain of QoL (M=48.3±21.1) but not for the psychological and social relationship domains. Higher hope scores were associated with better QoL. Conclusion: The findings suggest a positive relationship between the level of hope and QoL in people receiving HD. Encouraging hope while caring for HD patients in clinical settings may improve their QoL. Understanding the relationship between hope and QoL may help healthcare providers to improve the quality of care for patients and their families.
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Affiliation(s)
- Ali Alshraifeen
- Assistant Professor, Adult Health Nursing Department, Faculty of Nursing, the Hashemite University, Zarqa, Jordan
| | - Sami Al-Rawashdeh
- Assistant Professor, Department of Community and Mental Health, Faculty of Nursing, the Hashemite University, Zarqa, Jordan
| | - Kaye Herth
- Dean Emerita, College of Allied Health and Nursing, Minnesota State University, Mankato, USA
| | - Karimeh Alnuaimi
- Associate Professor, Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Fatmeh Alzoubi
- Associate Professor, Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi Khraim
- Assistant Professor, Faculty of Nursing, University of Calgary, Al-Rayyan Campus, Doha, Qatar
| | - Ala Ashour
- Assistant Professor, Faculty of Nursing, University of Calgary, Al-Rayyan Campus, Doha, Qatar
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15
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Lee JY, Jin DC. Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients. Kidney Res Clin Pract 2020; 39:356-364. [PMID: 32868495 PMCID: PMC7530362 DOI: 10.23876/j.krcp.20.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022] Open
Abstract
Background While the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics correlated with better rehabilitation status among hemodialysis patients. Methods A total of 29,865 hemodialysis patients who were registered with rehabilitation status information in the Korean Society of Nephrology end-stage renal disease registration program from January 2017 to April 2019 were included and divided into five groups according to their rehabilitation status. Results About half (47%) of enrolled patients belonged to the “independent but without a job” group and 21% of patients belonged to the “employed with a full-time job” group. Analysis revealed significantly younger mean age, longer mean hemodialysis duration, a higher proportion of male sex, and a lower proportion of diabetic nephropathy cases in the full-time job group than in the other hemodialysis patient groups. Also, hemoglobin, albumin, and phosphorus levels were higher but the urea reduction ratio was lower in the full-time job group. Conclusion A better rehabilitation and employment state of hemodialysis patients was associated with younger age, male sex, and underlying chronic glomerulonephritis. Patients with full-time jobs generally have better laboratory data but lower dialysis efficacy.
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Affiliation(s)
- Jong Yun Lee
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Dong-Chan Jin
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
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16
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Jain G. Rationing of Medical Supplies, Including Ventilators, for Patients With Kidney Disease. Mayo Clin Proc 2020; 95:1550-1551. [PMID: 32423642 PMCID: PMC7190515 DOI: 10.1016/j.mayocp.2020.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Gaurav Jain
- Division of Nephrology, University of Alabama at Birmingham
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17
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Kutner NG, Zhang R. A Validation Study of Employment Status in Late-Stage CKD. Clin J Am Soc Nephrol 2019; 14:1651-1652. [PMID: 31399418 PMCID: PMC6832059 DOI: 10.2215/cjn.04260419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Nancy G Kutner
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia; and
| | - Rebecca Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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