Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study

Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study Juan Carlos Julián-Mauro, Daniel Gallego Zurro, José Emilio Sánchez Álvarez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8007798/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To assess the impact of kidney replacement therapy (KRT) on employment status among patients with chronic kidney disease. Methods: Retrospective analysis of a prospective registry database of the Federation of Associations of Renal Patients (ALCER). Study participants completed a structured questionnaire gathering information on their employment status before being diagnosed before and throughout the study follow-up. For statistical purposes, patients were grouped according to their initial KRT in: Kidney-transplant (KTX) Group; In-center hemodialysis (ICHD); and home-based dialysis (HBD) Group. Results: Among the 402 patients surveyed, 307 (76.4%) were employed at diagnosed (before starting KRT), while 95 (23.6%) were unemployed. Following the initial KRT, 197 (49.0%) subjects were employed and 205 (51.0%) were unemployed. Whereas, at the conclusion of data collection, 132 (32.8%) had a job, while 270 (67.2%) were unemployed. Patients who initiated KRT with KTX (21/38, 55.3%) or with HBD (47/120, 39.2%) had significantly higher employment rates than those who started on ICHD (64/244, 26.2%) (p=0.0024 and p=0.0356, respectively). Among patients who were employed at diagnosis, patients who underwent KTX as initial KRT or were on HBD showed significantly higher current employment rates than those who started on ICHD (P=0.0070 and p=0.0174, respectively). Conclusions: According to the results of this study, CKD had a negative impact on patients' employment status. Despite a decline in employment rates over time, patients starting KRT on HBD or KTX exhibited higher employment rates compared to those starting on ICHD. Chronic Kidney Disease Home Dialysis Employment Kidney Replacement Therapy Work performance Figures Figure 1 Figure 2 Figure 3 Background Spain is a country with a high life expectancy at birth, but a low birth rate [ 1 ]. The unemployment rate in Spain is high, and, in many cases, the job offer does not match the qualifications of the unemployed, making their integration difficult, although this problem is not exclusive to Spain [ 2 , 3 ]. It is crucial to take advantage of the work capacity of people with experience in the labor market [ 3 ]. Hence the importance of programs such as Chrodis + from the European Union, which advocate for offering better job opportunities to chronic patients. New technologies and changes in work habits can facilitate this integration [ 4 ]. Embracing emerging technologies and evolving work paradigms can facilitate the seamless integration of such individuals into the workforce [ 5 ]. Loss of renal function detrimentally impacts employment in physically and psychological terms Kidney replacement therapies (KRT), notably dialysis, frequently coincide with diminished workforce engagement [ 6 , 7 ]. While transplantation offers hope for returning to work, a significant portion of recipients remain jobless [ 8 ]. In addition to medical interventions, kidney failure itself imposes disability, prompting alterations in employment status, with even individuals in advanced stages of chronic kidney disease (CKD) ceasing to participate in the workforce [ 9 , 10 ]. Past research on work involvement among CKD patients primarily concentrated on employment rates [ 9 , 10 ]. In recent decades, advancements in kidney failure treatment, such as home-based dialysis methods like automated peritoneal dialysis and home hemodialysis, have enhanced patient flexibility [ 11 , 12 ]. Moreover, kidney transplant rates are rising (Spain has a transplantation rate of 100 transplants per million inhabitants [pmp] along with over 50 donors pmp) [ 13 ], with continous impromevent post-transplant survival rates. However, global studies indicate that a significant number of kidney failure patients remain unemployed [ 8 – 12 ]. Several studies have found that subjects who initiated home dialysis or underwent transplantation had a higher likelihood of remaining employed, compared to those receiving in-center hemodialysis [ 11 , 12 , 14 , 15 ]. Even in countries with high rates of peritoneal dialysis initiation, the highest employment rates are observed in patients on automated peritoneal dialysis (APD) [ 16 ]. Our hypothesis posits that sustaining employment during the onset and duration of dialysis treatment correlates positively with the likelihood of post-kidney transplant employment and that could be affected by the type of KRT and work disability. Given Spain's notable transplantation rate, this investigation presents valuable insights for patients and healthcare systems alike. This study aimed to provide further insight into the employment challenges faced by individuals with CKD in KRT, with particular focus on the influence of CKD and KRT on employment retention. Additionally, it evaluates the effect of initiating KRT on work engagement, as well as the potential enhancement in employability following transplantation after dialysis initiation. Methods Study Design Retrospective analysis of a prospective registry database of the Federation of Associations of Renal Patients (ALCER). The study protocol received approval from the Ethics Committee of the Autonomous University of Madrid (Protocol CEI-127- 2622). It adhered to the principles outlined in the Good Clinical Practice/International Council for Harmonization Guidelines, the Declaration of Helsinki, and all relevant country-specific regulations governing clinical research, with a priority given to those regulations offering greater protection to individual participants. Written informed consent was obtained from all patients prior to their inclusion in the study. Additionally, any potentially identifying information has been encrypted or removed to ensure participant anonymity. Study Participants The current study included patients of working age (between 16 and 65 years old) diagnosed with CKD undergoing KRT who accessed social care services during the second quarter of 2022, regardless of whether they were members of ALCER or not. Methodology A structured questionnaire was developed, encompassing inquiries pertaining to the sociodemographic profile of participants, including variables such as age, educational attainment, income, and sex. Moreover, the questionnaire collected data regarding employment status prior to CKD diagnosis (S1), the type of initial KRT (T1) received, employment status following initiation of the initial KRT (S2), any subsequent change (if any) in KRT (T2), and the corresponding employment status thereafter (S3). Potential participants filled out a form with the help of an ALCER social worker, who collected and recorded their responses on the form. The KRTs were initially divided into 6 categories, namely, automated peritoneal dialysis (APD); continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (ICHD), Home hemodialysis (HHD), cadaveric kidney transplant (CKT), and living-donor kidney transplant (LDKT). To analyze the impact of choosing the KRT option, 2 probability trees were obtained, the first with the entire sample and the second only with those who were employed before starting KRT. Statistical analysis Statistical analysis was conducted using MedCalc® Statistical Software version 22.023 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org ; 2024) and SPSS IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Descriptive statistics were presented as numbers (percentages), mean [standard deviation (SD)], mean [95% confidence interval (95% CI)], mean (range), or median [Interquartile range (IqR)], as deemed appropriate. There was detected a 1.7% of missing values in patients age that were allocated by means an algorithm of multiple imputation [ 16 ]. For statistical purposes, patients were grouped according to their initial KRT in: KTX Group, patients who had undergone a kidney transplant (CKT + LDKT). ICHD Group, Patients on ICHD; and HBD Group, patients on APD, or on CAPD, or on HHD. The Shapiro-Wilks test was employed to assess the normality of quantitative variables. For continuous normally distributed data, a two-tailed independent samples t-test was used to assess differences before CKD diagnosis between patients who were employed and those who were unemployed. Conversely, for non-normally distributed data, the Mann-Whitney test was utilized. Categorical variables were compared using a Chi-square test and a Fisher`s exact test, as needed. Results Demographic and clinical characteristics at diagnosis Out of the 402 patients who participated in the survey, 307 (76.4%) were employed at the time of CKD diagnosis, while 95 (23.6%) were unemployed. In the overall study sample, the mean age at diagnosis was 49.3±9.8 years (95%CI: 48.3 to 50.2 years; range: 21 to 65 years), without significant differences between employed and unemployed patients (mean difference: -0.19±9.8 years, 95%CI: -2.9 to 2.5 years; p=0.8848). Table 1 summarizes the main demographic and clinical characteristics of the study sample. Kidney replacement therapy throughout the study The initial treatment for CKD patients was kidney transplantation in 38 cases (9.5%) and dialysis in 364 cases (90.5%) (See table 1). The median (IqR) follow-up duration for the initial KRT was 24.0 (11.8 to 48.0) months, while the median (IqR) time on the second KRT was 72.0 (36.0 to 101.3) months. During the study follow-up period, 204 patients (50.7%) required a modification in KRT, while 198 patients (49.3%) maintained their initial KRT without changes. Among the 402 patients, throughout the study follow-up, 152 (37.8%) underwent kidney transplantation, 137 (34.1%) patients underwent a CKT, and 15 (3.7%) underwent a LDKT. Among the 244 patients who were initially on ICHD, 117 (48.0%) remained on ICHD; 114 (46.7%) underwent kidney transplantation (either CKT or LDKT); and 13 (5.3%) patients received treatment with HBD. On the other hand, among the 120 patients who received HBD as their first KRT, 57(47.5%) continued on HBD; 25 (20.8%) were changed to ICHD; and 38 (31.7%) patients underwent kidney transplantation. Table 2 illustrates the changes in KRT based on the initial modality of KRT. Employment status after KRT At diagnosis, 307 (76.4%) patients were employed and 95 (23.6%) unemployed. Following the first KRT, 197 (49.0%) subjects were employed and 205 (51.0%) were unemployed. Finally, at the conclusion of data collection, 132 (32.8%) had a job, while 270 (67.2%) were unemployed. The likelihood (95% CI) of employment following the first KRT was 0.490 (0.424 to 0.564) in the overall study sample; 0.511 (0.435 to 0.598) for those employed at diagnosis; and 0.421 (0.301 to 0.573) for those unemployed at diagnosis (p=0.2716). On the other hand, the likelihood (95% CI) of employment at the end of data collection was 0.328 (0.275 to 0.389) in the overall study population; 0.332 (0.271 to 0.403) for subjects employed at diagnosis; and 0.316 (0.213 to 0.451) for those unemployed at diagnosis (p=0.8067). Figure 1 illustrates the employment rates in the overall population following the initiation of the first KRT and at the end of the study. Although employment rate has decreased over time, at the end of the study, patients who started KRT with kidney transplantation (21/38, 55.3%) or with HBD (47/120, 39.2%) had higher employment rates than those who started on ICHD (64/244, 26.2%) (p=0.0024 and p=0.0356, respectively). Table 3 displays the employment rates over time for the study cohort categorized by their KRT. Among the 402 patients enrolled in the cohort, 204 (50.7%) required a modification in their KRT. No significant differences in employment rates were observed between patients requiring a change in their KRT (0.353; 95% CI: 0.276 to 0.445) and those maintaining their initial KRT (0.303; 95% CI: 0.231 to 0.390) (Difference between employment rates: 0.05; 95% CI: -0.062 to 0.162; p=0.3826). Employment status following the first KRT significantly impact on the selection of the second KRT. Indeed, 52.5% of patients who selected PD (either APD or CAPD) as second KRT were employed as compared to the 37.3% of patients who chose HD (either ICHD or HHD) as second KRT (p=0.0430). Patients who were employed at the time of diagnosis At the time of CKD diagnosis, 307 (76.4%) subjects were employed. Following the initiation of the first KRT, 157 (51.1%) remained employed; 102 (33.2%) received work disability; and 48 (15.6%) were unable to continue with their previous work activity. There were no differences in employment status rates following first KRT among the patients who had undergone kidney transplantation and those starting on HBD (incidence rate difference: 6.4%; 95%CI: -26.2% to 39.1%; p=0.6991) or ICHD (Incidence rate difference: 16.2%; 95%CI: -12.0% to 44.3%; p=0.2614). Similarly, there were no difference between patients starting on HBD or on ICHD (Employment rate difference: 9.7%; 95%CI: -7.9% to 27.4%; p=0.2803) (Figure 2). As compared to the patients who started on ICHD, the current employment rate was significantly greater in patients initially treated with kidney transplantation (Incidence rate difference: 30.0%; 95%CI: 8.9% to 51.9%; p=0.0070) and in patients who started on HBD (Employment rate difference: 16.9%; 95%CI: 3.0% to 30.8%, p=0.0174). No differences were observed in current employment rates between patients who underwent kidney transplant as first KRT and those who started on HBD (Incidence rate difference: 13.2%; 95%CI: -15.7% to 42.1%; p=0.3719) (Figure 2). Patients who were unemployed at the time of diagnosis Ninety-Five (23.6%) patients were unemployed at diagnosis. Among them, 40 (42.1%) found a job following first KRT. Among the ninety-five patients (23.6%) who were unemployed at the time of diagnosis, 40 (42.1%) got a job following their first KRT; 31 (32.6%) were granted work disability, 23 (24.2%) were not capable to continue their previous work; and one (1.1%) went back to studying. There were no significant differences in employment rates among any of the study groups either following the initial KRT or at the end of the data collection.. The probability trees found that starting in KTX (CKT + LDKT) had the highest probability of remaining employed, not only ion the overall study sample (55.3%), but also among those subjects who were employed at the time of CKD diagnosis (42.1%) (Figure 3). Among patients who started their KRT on dialysis, those starting on HBD were more likely to maintain their jobs at the end of the follow-up (28.3%) as compared to those who started on ICHD (18.0) (p=0.0245). In patients who were employed at CKD diagnosis, the probability tree showed similar trends, with employment rates at the end of the study of 55.6% (p=0.0003 versus ICHD), 34.8% (p=0.0261 versus ICHD), and 22.3% in patients who started on KTX, HBD, and ICHD, respectively (Figure 3). Interestingly, in patients who were employed at CKD diagnosis; starting and maintaining KRT on HBD provided greater probability to remain employed (62.5%) than patients who started and remained on KTX (61.9%) and those who started and maintained on ICHD (51.5%), although these differences were no statistically significant (Figure 3). Discussion The results of this study showed that CKD and KRT negatively impact the work situation of patients. At diagnosis, 76.4% of patients were employed. However, the employment rates decreased to 49.0% after the first KRT and further reduced to 32.8% by the end of the study. Although employment rates declined over time, at the end of the study, patients who initiated treatment with kidney transplantation or HBD exhibited significantly higher employment rates compared to those who started on ICHD. Additionally, employment status following initial KRT significantly influenced selection of second KRT. Specifically, 51.4% of patients selecting HBD as second KRT were employed, as compared to 36.5% of patients choosing ICHD (p=0.0357). Probability trees have shown that, among subjects who were employed at the time of CKD diagnosis, starting on HBD offered greater probabilities of remaining employed, regardless the current KRT, than starting on ICHD. Patients who started KRT on HBD and underwent kidney transplant during the follow-up had better probabilities of maintained the job than those who started on kidney transplant and maintained on transplant (without the need to start dialysis) (61.9% versus 66.7%, respectively). Patients who started KRT on HBD and required a change to ICHD had greater likelihood to maintain the job than those who started and were maintained on ICHD (62.5% versus 51.5%). Patients with advanced CKD face multiple challenges in employment due to their medical, psychological, and social circumstances. Kidney function impairment impacts negatively on opportunities for employment involvement. KRT, such as dialysis, has been frequently associated with reduced work capacity [6,7]. It has been identified that unemployed patients on ICHD have a higher risk of poverty and social exclusion [8]. In our study, 39,8% of unemployed people have montly incomes ≤ €900 (they did not reach €1,000 of the Spanish guaranteed minimum wage for the year 2022). This proportion was slightly lower among patients who receive a disability pension (32,3%), as well as among those who are still employed (23,5%). Conversely, proportion of subjects with a monthly income ≥ €2000 was greater among employed subjects (21.2%) than among subjects with a disability pension (11.4%) or among those unemployed (4.8%). While transplantation holds promise recipients the potential to return to a productive working life, a notable portion of patients remain unemployed [8]. Besides medical interventions, kidney failure itself imposes disability, prompting shifts in employment status, with even late-stage CKD patients ceasing work [9]. Based on the patient's perspective, be engaged in paid employment has been highly valued, since it improved quality of life, fostered a sense of identity, and ensured financial stability [18]. Work participation ranks among the top ten priorities for patients with CKD [19]. While nephrology care has the potential to support CKD patients in maintaining employment, current practices may not adequately address work-related concerns [20]. A deeper understanding of the employment dynamics among CKD patients and identification of at-risk groups could inform targeted interventions, thereby bolstering the development of a supportive framework to help patients sustain employment and enhance their overall well-being [20,21]. Previous studies on work participation in CKD patients focused mainly on employment rates, while our study was mainly focused on assessing the ability of patients with CKD to maintain their employment. Several variables can influence the employment status of individuals with CKD [22-24]. Educational attainment has emerged as a significant factor affecting employment rates within the CKD demographic, favoring those with higher educational achievements [22]. However, although in our study a greater proportion of patients with elementary education were unemployed, we did not observe that patients with university education had a higher rate of employment. Furthermore, age and gender have been identified as pertinent determinants impacting employment rates. Usually, younger subjects are favored over older counterparts due to perceived advantages in productivity [23]. While in our study no age disparity existed between employed and unemployed patients at the time of diagnosis, following the initiation of the first KRT, employed patients tended to be younger than their unemployed counterparts (mean difference: -2.2 ± 9.7 years; 95%CI: -4.1 to -0.3 years; p=0.0239). This trend became more pronounced by the study's conclusion, with employed patients being 2.5 ± 9.7 years younger than unemployed patients (p=0.0190). In terms of gender, Bay et al. [24] found that female patients were 2.24 times more likely to be unemployed than males. However, our data did not confirm such finding, since employment rates were similar between men and women throughout the study. Current scientific evidence suggests that individuals who started home-based dialysis or underwent kidney transplantation were more likely to sustain employment compared to those undergoing ICHD [11,12,14,15]. The current study agrees with this finding. Despite a decline in employment rates over time, at the end of the study, employment rates were higher among patients who initiated KRT with kidney transplantation or HBD compared to those who started on ICHD. The main limitation of the current study primarily stems from its sole reliance on the registry database of the Federation of Associations of Renal Patients. Patients seeking social care at ALCER may possess a heightened level of disease awareness and understanding of their personal circumstances, but at the same time they are those who seek greater attention, are looking for employment or need help managing their disability, work incapacity, or both. Despite the stage of CKD at diagnosis was not recorded, the high percentage of employees at that time (76.4%) leads us to think that the challenge is maintaining employment at the beginning of KRT. Therefore, we cannot conclusively state that our study sample accurately represents all CKD patients and might underestimate the employment rates of the overall CKD patient population. Additionally, it should be noted the exclusion of other potential factors, such as depression and various psychological or clinical variables, which could potentially influence work impairment and employment status among CKD patients. Furthermore, both work coping style and emotional state could also be affecting employment rates. One of our strengths lies in the inclusion of patients from various regions across Spain, providing a sample that reflects the country's diverse reality. It turns out that HBD could be favoring more adaptive behaviors and, thereby, increasing employment rates and better progression with the disease. Being a self-management technique, it implies that the patient has to take charge of their illness, adapt it to their life and, thereby, encourage patients with greater adherence to medical treatments and recommendations. Although all home dialysis options seem to favor maintaining employment, the low sample size in our study of people on HBHD makes us focus our recommendations on PD. In conclusion, this study reveals the adverse impact of CKD on patients' employment status. While employment rates declined over time, patients starting treatment with kidney transplantation or HBD showed higher employment rates compared to those starting on ICHD. These findings emphasize the relevance of evaluating employment status when selecting KRT. HBD strategies, particularly PD (APD and CAPD), combine clinical advantages (i.e., conservation of vascular access or the maintenance of residual kidney function) with social advantages (greater probability of preserving employment, and lower risk of poverty and social exclusion). Abbreviations ALCER Federation of Associations of Renal Patients APD Automated peritoneal dialysis CAPD Continuous ambulatory peritoneal dialysis CKD Chronic kidney disease CKT Cadaveric kidney transplant HBD Home-based dialysis HBHD Home-based hemodialysis HHD Home hemodialysis ICHD In-center hemodialysis IqR Interquartile range KRT Kidney replacement therapy KTX Kidney-transplant LDKT Living-donor kidney transplant SD Standard deviation Declarations Statements Compliance with Ethics Guidelines The studies were conducted in accordance with the local legislation and institutional requirements. The study protocol was reviewed and approved by the Ethics Committee of the Autonomous University of Madrid (Protocol CEI-127- 2622). Informed Consent The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Acknowledgments Medical writing and Editorial assistant services have been provided by Ciencia y Deporte Ltd. Social workers from the ALCER entities of Alicante, Badajoz, Barcelona, Cáceres, Castellón (Castalia), Coruña, Granada, Islas Baleares (Illes Balears), Jaén, Las Palmas, León, Madrid, Málaga, Pontevedra, Toledo y Sevilla (Giralda) that have helped in the collection of the sample. Conflicts of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. JCJM: Consultancy: Astellas, Astrazeneca, Bayer, Boehringer-Ingelheim, GSK, Ipsen, MSD, Pfizer, Telix and Travere. Travel and expense: Astellas and Novartis. Invited speaker: Astellas, Astrazecena, Bayer, Vantive-Baxter, Ipsen, MSD and Pfizer. DGZ: Consultancy: Astrazeneca, Boehringer-Ingelheim, GSK, Pfizer, Novartis, Sobi, Hansa Biopharma and Travere. Travel and expense: Novartis, Astrazeneca and GSK. Invited speaker: Astrazecena, Fresenius Medical Care, Vantive-Baxter and Pfizer The rest of the authors do not have any conflict to declare. Funding Medical writing and editorial assistant were funded by Vantive. Vantive was not involved in the preparation of the recommendations nor did the company influence in any way the scientific consensus reached. Author Contributions Conceptualization: JCJM, DGZ, MARD; Methodology: JCJM, DGZ, MARD; Formal analysis: JESA, JCRP; Investigation: JCJM, DGZ, JMMC, JMCB, MARD; Supervision: JCJM, DGZ, MARD. All authors met the ICMJE authorship criteria. All authors made substantial contributions to conception, design, analysis, and interpretation of data, contributed to writing the article, provided critical revision of the manuscript, and approved the final version. Data availability The data are the property of the Federación Nacional de Asociaciones ALCER, a non-profit organization for kidney patients, which provides open access to this data for any interested researcher, with the data offered in an anonymized format for legal data protection reasons. Updated data may be requested by contacting [email protected] . References Instituto nacional de Estadística. Indicador Multidimensional de Calidad de Vida IMCV. Available in: https://www.ine.es/ss/Satellite?L=es_ES&c=INEPublicacion_C&cid=1259937499084&p=1254735110672&pagename=ProductosYServicios%2F PYSLayout¶m1=PYSDetalleGratuitas¶m2=1259944522462¶m4=Mostrar Last accessed October 30, 2025. Fernández R. [Unemployment rate in Spain 2000-2023]. Released April 12, 2024. Available in: https://es.statista.com/estadisticas/500987/prevision-tasa-de-paro-en-espana/ Last accessed October 30, 2025. Hernández de Cos P. The Spanish labour market: recent developments and the challenges ahead. Released February 12, 2024. Available in: The Spanish labour market: recent developments and the challenges ahead (bde.es) Last accessed October 30, 2025. Leonardi M, Silvaggi F, Scaratti C, Guastafierro E, Toppo, Eigenmann M, Lindstrom J, Rantala E. Promoting inclusiveness and work ability for people with chronic health conditions. Available in: https://www.epicentro.iss.it/igea/appuntamenti/pdf/WP8-documenti/A%20training%20tool %20for%20managers.pdf Last accessed October 30, 2025. Deep G. Digital transformation's impact on organizational culture. International Journal of Science and Research Archive. International Journal of Science and Research Archive, 2023, 10(0), 396–401. Doi:10.30574/ijsra.2023.10.2.0977. van Manen JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT; NECOSAD Study Group. Netherlands Cooperative Study on Adequacy of Dialysis. Changes in employment status in end-stage renal disease patients during their first year of dialysis. Perit Dial Int. 2001;21(6):595-601. Tappe K, Turkelson C, Doggett D, Coates V. Disability under Social Security for patients with ESRD: an evidence-based review. Disabil Rehabil. 2001 Mar 20;23(5):177-85. doi: 10.1080/09638280151080522. D'Egidio V, Mannocci A, Ciaccio D, Sestili C, Cocchiara RA, Del Cimmuto A, et al. Return to work after kidney transplant: a systematic review. Occup Med (Lond). 2019;69(6):412-18. doi: 10.1093/occmed/kqz095. van der Mei SF, Kuiper D, Groothoff JW, van den Heuvel WJ, van Son WJ, Brouwer S. Long-term health and work outcomes of renal transplantation and patterns of work status during the end-stage renal disease trajectory. J Occup Rehabil. 2011;21(3):325-34. doi: 10.1007/s10926-011-9317-1. Julian Mauro JC, Molinuevo Tobalina JA, Sánchez González JC. Employment in the patient with chronic kidney disease related to renal replacement therapy. Nefrologia. 2012;32(4):439-45. English, Spanish. doi: 10.3265/Nefrologia.pre2012.Apr.11366. Kirkeskov L, Carlsen RK, Lund T, Buus NH. Employment of patients with kidney failure treated with dialysis or kidney transplantation-a systematic review and meta-analysis. BMC Nephrol. 2021;22(1):348. doi: 10.1186/s12882-021-02552-2.. de Jong RW, Boezeman EJ, Chesnaye NC, Bemelman FJ, Massy ZA, Jager KJ, et al. Work status and work ability of patients receiving kidney. replacement therapy: results from a European survey. Nephrol Dial Transplant. 2022;37(10):2022-33. doi: 10.1093/ndt/gfab300 Organización Nacional de Trasplantes. REGISTRO ESPAÑOL DE ENFERMOS RENALES. Available in: https://www.ont.es/informacion-a-los-profesionales-4/registros-de-donacion-de-trasplantes-4-9/registro-espanol-de-enfermos-renales-4-9-4/ Last accessed October 30, 2025. Muehrer RJ, Schatell D, Witten B, Gangnon R, Becker BN, Hofmann RM. Factors affecting employment at initiation of dialysis. Clin J Am Soc Nephrol. 2011;6(3):489-96. doi: 10.2215/CJN.02550310. Erickson KF, Zhao B, Ho V, Winkelmayer WC. Employment among Patients Starting Dialysis in the United States. Clin J Am Soc Nephrol. 2018;13(2):265-73. doi: 10.2215/CJN.06470617. Lakshmi BS, Kumar ACV, Reddy HK, Gopal J, Chaitanya V, Chandra VS, et al. Employment Status of Patients Receiving Maintenance Dialysis - Peritoneal and Hemodialysis: A Cross-sectional Study. Indian J Nephrol. 2017;27(5):384-88. doi: 10.4103/ijn.IJN_151_16. Lang KM, Little TD (2018). Principled Missing Data Treatments. Prev Sci 19:284-94. doi: 10.1007/s11121-016-0644-5. Rajkumar R, Baumgart A, Martin A, Tong A, Evangelidis N, Manera KE, et al; SONG-HD and SONG-PD initiativesfor the SONG-HD and SONG-PD initiatives. Perspectives on ability to work from patients' receiving dialysis and caregivers: analysis of data from the global SONG initiative. J Nephrol. 2022;35(1):255-66. doi: 10.1007/s40620-021-01105-y. Carter SA, Gutman T, Logeman C, Cattran D, Lightstone L, Bagga A, et al; SONG-GD Investigators. Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers. Clin J Am Soc Nephrol. 2020;15(5):673-84. doi: 10.2215/CJN.13101019. Awan AA, Zhao B, Anumudu SJ, Winkelmayer WC, Ho V, Erickson KF. Pre-ESKD Nephrology Care and Employment at the Start of Dialysis. Kidney Int Rep. 2020;5(6):821-30. doi: 10.1016/j.ekir.2020.03.004. Feder J, Nadel MV, Krishnan M. A Matter of Choice: Opportunities and Obstacles Facing People with ESRD. Clin J Am Soc Nephrol. 2016 Mar 7;11(3):536-8. doi: 10.2215/CJN.04470415. Burnes D, Sheppard C, Henderson CR Jr, Wassel M, Cope R, Barber C, et al. Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis. Am J Public Health. 2019;109(8):e1-e9. doi: 10.2105/AJPH.2019.305123. Alma MA, van der Mei SF, Brouwer S, Hilbrands LB, van der Boog PJM, Uiterwijk H, et al. Sustained employment, work disability and work functioning in CKD patients: a cross-sectional survey study. J Nephrol. 2023;36(3):731-743. doi: 10.1007/s40620-022-01476-w. Bay SS, Kamaruzaman L, Mohd R, Azhar Shah S. Work disability and employment status among advanced chronic kidney disease patients. PLoS One. 2024;19(3):e0297378. doi: 10.1371/journal.pone.0297378. Tables Table 1. Mean demographic and clinical features of the study cohort at diagnosis of the chronic kidney disease (CKD). Overall (n=402) Employed (n=307) Unemployed (n=95) p a Age, years Mean±SD Median (IqR) 49.3±9.8 50.0 (43.0 to 57.0) 49.2±8.9 50.0 (43.3 to 56.0) 49.4±12.1 52.0 (39.3 to 59.0) 0.8848 b Gender, n (%) Women Men 171 (42.5) 231 (57.5) 131 (42.7) 176 (57.3) 40 (42.1) 55 (57.9) 1.0000 c Education level, n (%) Without studies Elementary school Middle/High school Professional training Associated/bachelor degree Master/Doctorate degree 10 (2.5) 95 (23.6) 106 (26.4) 94 (23.4) 61 (15.2) 36 (9.0) 5 (1.6) 65 (21.2) 92 (30.0) 73 (23.8) 45 (14.7) 27 (8.8) 5 (5.3) 30 (31.6) 14 (14.7) 21 (22.1) 16 (16.8) 9 (9.5) 0.0162 Type of job, n (%) Salaried employment in the private sector Salaried employment in the public sector Self-employment/Entrepreneurship with employed staff Self-employment/Entrepreneurship without employees Assistance in family-owned or company business Sick leave 254 (63.2) 81 (20.1) 21 (5.2) 41 (10.2) 3 (0.7) 2 (0.5) 192 (62.5) 58 (19.9) 17 (5.5) 35 (11.4) 3 (1.0) 2 (0.7) 62 (65.3) 23 (24.2) 4 (4.2) 6 (6.3) 0 (0.0) 0 (0.0) 0.4491 Income level, n (%)* ≤ 500 > 500 ≤ 700 > 700 ≤ 900 > 900 ≤ 1200 > 1200 ≤ 1500 > 1500 ≤ 2000 > 2000 ≤ 2500 > 2500 ≤ 3000 > 3000 DK/NA/REF 42 (10.4) 35 (8.7) 54 (13.4) 90 (22.4) 52 (12.9) 33 (8.2) 25 (6.2) 9 (2.2) 18 (4.5) 44 (10.9) 30 (9.8) 24 (7.8) 41 (13.4) 74 (24.1) 43 (14.0) 26 (8.5) 21 (6.8) 3 (1.0) 14 (4.6) 31 (10.1) 12 (12.6) 11 (11.6) 13 (13.7) 16 (16.8) 9 (9.5) 7 (7.4) 4 (4.2) 6 (6.3) 4 (4.2) 13 (13.7) 0.0749 Initial KRT, n (%) APD CAPD ICHD HHD CKT LDKT 43 (10.7) 63 (15.7) 244 (60.7) 14 (3.5) 24 (6.0) 14 (3.5) 32 (10.4) 51 (16.6) 188 (61.2) 9 (2.9) 16 (5.2) 11 (3.6) 11 (11.6) 12 (12.6) 56 (58.9) 5 (5.3) 8 (8.4) 3 (3.2) 0.6525 Initial KRT, n (%) KTX ICHD HBD 38 (9.5) 244 (60.7) 120 (29.9) 27 (8.8) 188 (61.2) 92 (30.0) 11 (11.6) 56 (58.9) 28 (29.5) 0.7176 a Chi-squared test. b Independent sample Student t test. c Fisher exact test. *Euros per month before taxes. SD: Standard deviation; IqR: Interquartile range; DK/NA/REF: Do not know/Not applicable/Refuse; APD: Automated peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis; ICHD: In-center Hemodialysis; HHD: Home hemodialysis; CKT: Cadaveric kidney transplant; LDKT: Living-donor kidney transplant; KTX: CKT+LDKT; HBD: Home-based dialysis (APD+CAPD+HHD). Table 2. Overview of the second renal replacement therapy administered based on the initial kidney replacement therapy (KRT) undergone. Significant changes were observed between the first and second RKRT (p<0.0001, Chi-squared test). Initial KRT, n (%)* Second KRT, n (%) Total KTX 1 ICHD HBD 2 KTX 1 30 (78.9) 6 (15.8) 2 (5.3) 38 (9.5) ICHD 114 (46.7) 117 (48.0) 13 (5.3) 244 (60.7) HBD 2 38 (31.7) 25 (20.8) 57 (47.5) 120 (29.9) Total 182 (45.3%) 148 (36.8%) 72 (17.9%) 402 (100.0) *The percentages have been computed based on the data from the initial treatment. KTX: Kidney transplant 1 ; ICHD: In-center Hemodialysis; HBD: Home-based dialysis. 1 It included Cadaveric kidney transplant (CKT) and Living-donor kidney transplant (LDKT). 2 It included Automated peritoneal dialysis (APD) and Continuous ambulatory peritoneal dialysis (CAPD) and Home hemodialysis (HHD). Table 3. Overview of the employment rates over time of the study cohort based on their initial renal replacement therapy. KRT assigned Employed at diagnosis Employed following first RRT Currently employed Yes, n (%) No, n (%) Yes, n (%) No, n (%) Yes, n (%) No, n (%) PD APD CAPD 83 (78.3) 32 (74.4) 51 (81.0) 23 (21.7) 11 (25.6) 12 (19.0) 57 (53.8) 26 (60.5) 31 (49.2) 49 (46.2) 17 839.5) 32 (50.8) 41 (38.7) 18 (41.9) 23 (36.5) 65 (61.3) 25 (58.9) 40 (63.5) HD ICHD HHD 197 (76.4) 188 (77.0) 9 (64.3) 61 (23.6) 56 (23.0) 5 (35.7) 117 (45.3) 110 (45.1) 7 (50.0) 141 (54.7) 134 (54.9) 7 (50.0) 70 (27.1) 64 (26.2) 6 (42.9) 188 (72.9) 180 (73.8) 8 (57.1) HBD* 92 (76.7) 28 (23.3) 64 (53.3) 56 (46.7) 47 (39.2) 73 (60.8) KTX CKT LDKT 27 (71.1) 16 (66.7) 11 (78.6) 11 (28.9) 8 (33.3) 3 (21.4) 23 (60.5) 15 (62.5) 8 (57.1) 15 (39.5) 9 (37.5) 6 (42.9) 21 (55.3) 13 (54.2) 8 (57.1) 17 (44.7) 11 (45.8) 6 (42.9) * HBD: (APD + CAPD + HHD) APD: Automated peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis; ICHD: In-center Hemodialysis; HHD: Home hemodialysis; HBD: Home-based dialysis; CKT: Cadaveric kidney transplant; LDKT: Living-donor kidney transplant. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8007798","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546583754,"identity":"37be9d32-f8fd-4eb7-a226-c3da325d330e","order_by":0,"name":"Juan Carlos Julián-Mauro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACxgaGBIYHBgwM/AzMDSRoSQBqkWxgJFILGCQAscEBYrUwtx94JpFQYJdnfPxg44ePexjkzPsXEHBYT0KaRIJBcrHZmcRmyRnPGIxlbjwgoGUGA0gLc+K2A4ltzDwHGBJnSBwgSkt94ub+h23Mf0jQcjhxgwTQFgaQFv4Ggn5JtkgwOJ4448bDZsmeAxLGEhL4dTAYtp9JvPHhT3Vif3/ywQ8/DtjISfATcJhhA08CMh9ohUQCdqUwIM/Ajm4oIVtGwSgYBaNgxAEA8vBG6Rg9TDcAAAAASUVORK5CYII=","orcid":"","institution":"Fundación Renal ALCER España","correspondingAuthor":true,"prefix":"","firstName":"Juan","middleName":"Carlos","lastName":"Julián-Mauro","suffix":""},{"id":546583755,"identity":"961ce388-8d54-4477-bddf-3c09ffcaf73f","order_by":1,"name":"Daniel Gallego Zurro","email":"","orcid":"","institution":"Fundación Renal ALCER España","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"Gallego","lastName":"Zurro","suffix":""},{"id":546583756,"identity":"ddda644e-3c0c-423b-a055-cb9b0faa2e48","order_by":2,"name":"José Emilio Sánchez Álvarez","email":"","orcid":"","institution":"Hospital Universitario Central de Asturias","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Emilio Sánchez","lastName":"Álvarez","suffix":""},{"id":546583757,"identity":"a7a1f71b-4418-4764-ae38-0c5675702549","order_by":3,"name":"José Carlos Rodríguez Pérez","email":"","orcid":"","institution":"Universidad Fernando Pessoa","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Carlos Rodríguez","lastName":"Pérez","suffix":""},{"id":546583758,"identity":"04408879-97b9-4f5f-91af-a72c233078aa","order_by":4,"name":"Miguel Ángel Ruiz Díaz","email":"","orcid":"","institution":"Universidad Autónoma de Madrid","correspondingAuthor":false,"prefix":"","firstName":"Miguel","middleName":"Ángel Ruiz","lastName":"Díaz","suffix":""}],"badges":[],"createdAt":"2025-11-01 20:38:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8007798/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8007798/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96285805,"identity":"ae302c12-ba78-4c1f-8384-19771cf42c89","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"tif","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":102734,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/01dbae6cfd2fffdfbaca34b8.tif"},{"id":96285811,"identity":"45aa0f8f-b72d-4ab3-b2c5-3976b0e1fcb2","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45536,"visible":true,"origin":"","legend":"","description":"","filename":"MainDocumentworkwithKRTandPESBMCNephrology1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/4bea3d8fb4fcf3e38a187a5f.docx"},{"id":96285814,"identity":"6f59b87b-e178-4288-920b-34613440daad","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"tif","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103190,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/fccc79e7c7ef3db22670056f.tif"},{"id":96363900,"identity":"d1f99e5d-8cf7-4700-b75d-88b1e4fc151b","added_by":"auto","created_at":"2025-11-20 10:08:22","extension":"tif","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128142,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/da6734bee83ebb9ab5c45647.tif"},{"id":96363933,"identity":"a46dd0c0-df8c-4f56-a72b-4b9fd6550613","added_by":"auto","created_at":"2025-11-20 10:08:28","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18972,"visible":true,"origin":"","legend":"","description":"","filename":"Table1workwithKRTBMC1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/f18e3365fdd81e9e79f6b740.docx"},{"id":96285815,"identity":"ed504b86-9a6c-4c65-9383-f1483ee29a84","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17194,"visible":true,"origin":"","legend":"","description":"","filename":"Table2workwithBMC1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/d578bf6c17fea2ec94ed107e.docx"},{"id":96363924,"identity":"7b855300-edc2-4f8b-a967-440bdac721e9","added_by":"auto","created_at":"2025-11-20 10:08:27","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16626,"visible":true,"origin":"","legend":"","description":"","filename":"Table3workwithKRTBMC1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/bf5fa19580e272fb77c6a6f4.docx"},{"id":96364685,"identity":"194041b3-0d4c-448f-93ab-ae8736ed4f52","added_by":"auto","created_at":"2025-11-20 10:09:33","extension":"json","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7553,"visible":true,"origin":"","legend":"","description":"","filename":"1b782fbf2ea94c689dd60dfd51b774ce.json","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/fab720203e06a1c86a482726.json"},{"id":96363630,"identity":"c56eb1c4-7d83-42e3-9f9e-c69525912bb2","added_by":"auto","created_at":"2025-11-20 10:07:35","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103096,"visible":true,"origin":"","legend":"","description":"","filename":"1b782fbf2ea94c689dd60dfd51b774ce1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/b9c289f3090c1ea9a6ee53d9.xml"},{"id":96364973,"identity":"90a9de76-2823-48ce-9c03-123c699d1090","added_by":"auto","created_at":"2025-11-20 10:09:51","extension":"tif","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":102734,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/9e07ae5b2d60f73b665f187d.tif"},{"id":96285820,"identity":"c606b825-e7d1-4585-a5f4-694897d5878a","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"tif","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103190,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/40f82b94e71d11b435ddbede.tif"},{"id":96285823,"identity":"cdbfc55c-f82d-451a-b20f-0c52558ac362","added_by":"auto","created_at":"2025-11-19 11:59:46","extension":"tif","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128142,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3KRTandPESBMCNephrology1.0.tif","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/28998086a0bdf2d2cd9f5007.tif"},{"id":96285821,"identity":"a233e3db-f36c-4004-a298-666cdb4ef53b","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12569,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure1KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/c13d87365b55dad370015c46.png"},{"id":96285817,"identity":"c5eb30de-8923-422a-a124-4f6b974d56a7","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12169,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/9895d0ab780da1b15e5fb468.png"},{"id":96364467,"identity":"93d8ef05-1107-45d1-bd70-023a3d09b3de","added_by":"auto","created_at":"2025-11-20 10:09:20","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35320,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/c24e429492057d9b14fd2dcf.png"},{"id":96285822,"identity":"92216edd-902c-4d00-9d6b-1f1b9967fe23","added_by":"auto","created_at":"2025-11-19 11:59:46","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100568,"visible":true,"origin":"","legend":"","description":"","filename":"1b782fbf2ea94c689dd60dfd51b774ce1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/ccd5b5d0f93ae63867681e0b.xml"},{"id":96364936,"identity":"55fd57ae-6987-4445-9acb-af2a19199df1","added_by":"auto","created_at":"2025-11-20 10:09:48","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110892,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/c4a0ef66fc8df40c51b0e665.html"},{"id":96364987,"identity":"28733c5c-8add-4133-a011-eab935f81061","added_by":"auto","created_at":"2025-11-20 10:09:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106477,"visible":true,"origin":"","legend":"\u003cp\u003eEmployment status of the overall study population over the course of the study.\u003c/p\u003e\n\u003cp\u003eAt the end of data collection, the employment rate was significantly greater among subjects who underwent kidney transplantation and those who received home-based dialysis as initial KRT compared to those who started on ICHD.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.005 as compared to ICHD.\u003c/p\u003e\n\u003cp\u003e**p\u0026lt;0.05 as compared to ICHD.\u003c/p\u003e\n\u003cp\u003eKTX: Patients who had undergone either cadaveric or liver donor kidney transplantation\u003c/p\u003e\n\u003cp\u003eICHD: Patients on in-center HD.\u003c/p\u003e\n\u003cp\u003eHBD: Patients on home-based dialysis (either automated PD or continuous ambulatory PD or home-based HD).\u003c/p\u003e\n\u003cp\u003eKRT: Kidney replacement therapy; PD: Peritoneal dialysis; HD: hemodialysis; ICHD: In-center hemodialysis.\u003c/p\u003e","description":"","filename":"Figure1KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/0454ce5374a06cd3fa5ddfa5.png"},{"id":96285807,"identity":"57fe59f6-bf56-4f2c-9704-4799a6631795","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109385,"visible":true,"origin":"","legend":"\u003cp\u003eEmployment status of patients who were employed at diagnosis.\u003c/p\u003e\n\u003cp\u003eAt the end of data collection, the employment rate was significantly greater among subjects who underwent kidney transplantation and those who received home-based dialysis as initial KRT compared to those who started on ICHD.\u003c/p\u003e\n\u003cp\u003eKTX: Patients who had undergone either cadaveric or liver donor kidney transplantation\u003c/p\u003e\n\u003cp\u003eICHD: Patients on in-center HD.\u003c/p\u003e\n\u003cp\u003eHBHD: Patients on home-based hemodialysis.\u003c/p\u003e\n\u003cp\u003eKRT: Kidney replacement therapy; PD: Peritoneal dialysis; HD: hemodialysis; ICHD: In-center hemodialysis, HBHD; home-based hemodialysis\u003c/p\u003e","description":"","filename":"Figure2KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/32a1b715d9c87ed9ac1365cf.png"},{"id":96285809,"identity":"a92a6e59-90e8-4d0f-b388-0f315cb555c6","added_by":"auto","created_at":"2025-11-19 11:59:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":236451,"visible":true,"origin":"","legend":"\u003cp\u003eProbability tree of the patients who were working at the time of chronic kidney disease (CKD) diagnosis based on initial kidney replacement therapy (KTR) and the changes in KTR over follow-up.\u003c/p\u003e\n\u003cp\u003eDashed ellipse: Total population; Grey ellipse: Employment status following the initial KRT; Empty ellipse: Current Employment status.\u003c/p\u003e\n\u003cp\u003eKTX: Kidney transplant; ICHD: In center hemodialysis; HBD: Home base dialysis.\u003c/p\u003e\n\u003cp\u003eHBD: includes either automated peritoneal dialysis (PD)+ continuous ambulatory PD (CAPD) + home-based hemodialysis (HBHD).\u003c/p\u003e","description":"","filename":"Figure3KRTandPESBMCNephrology1.0.png","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/0c82d3a9ed63eee3a1f50304.png"},{"id":97336089,"identity":"13d23671-1fed-4007-9771-78368dfac43c","added_by":"auto","created_at":"2025-12-03 10:09:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1179387,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8007798/v1/9c4af6dc-0f03-4323-a2af-8035746e6ea1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eSpain is a country with a high life expectancy at birth, but a low birth rate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The unemployment rate in Spain is high, and, in many cases, the job offer does not match the qualifications of the unemployed, making their integration difficult, although this problem is not exclusive to Spain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is crucial to take advantage of the work capacity of people with experience in the labor market [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Hence the importance of programs such as Chrodis\u0026thinsp;+\u0026thinsp;from the European Union, which advocate for offering better job opportunities to chronic patients. New technologies and changes in work habits can facilitate this integration [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmbracing emerging technologies and evolving work paradigms can facilitate the seamless integration of such individuals into the workforce [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLoss of renal function detrimentally impacts employment in physically and psychological terms Kidney replacement therapies (KRT), notably dialysis, frequently coincide with diminished workforce engagement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While transplantation offers hope for returning to work, a significant portion of recipients remain jobless [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition to medical interventions, kidney failure itself imposes disability, prompting alterations in employment status, with even individuals in advanced stages of chronic kidney disease (CKD) ceasing to participate in the workforce [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Past research on work involvement among CKD patients primarily concentrated on employment rates [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In recent decades, advancements in kidney failure treatment, such as home-based dialysis methods like automated peritoneal dialysis and home hemodialysis, have enhanced patient flexibility [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, kidney transplant rates are rising (Spain has a transplantation rate of 100 transplants per million inhabitants [pmp] along with over 50 donors pmp) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], with continous impromevent post-transplant survival rates. However, global studies indicate that a significant number of kidney failure patients remain unemployed [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies have found that subjects who initiated home dialysis or underwent transplantation had a higher likelihood of remaining employed, compared to those receiving in-center hemodialysis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Even in countries with high rates of peritoneal dialysis initiation, the highest employment rates are observed in patients on automated peritoneal dialysis (APD) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur hypothesis posits that sustaining employment during the onset and duration of dialysis treatment correlates positively with the likelihood of post-kidney transplant employment and that could be affected by the type of KRT and work disability. Given Spain's notable transplantation rate, this investigation presents valuable insights for patients and healthcare systems alike.\u003c/p\u003e\u003cp\u003eThis study aimed to provide further insight into the employment challenges faced by individuals with CKD in KRT, with particular focus on the influence of CKD and KRT on employment retention. Additionally, it evaluates the effect of initiating KRT on work engagement, as well as the potential enhancement in employability following transplantation after dialysis initiation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eRetrospective analysis of a prospective registry database of the Federation of Associations of Renal Patients (ALCER).\u003c/p\u003e\u003cp\u003e The study protocol received approval from the Ethics Committee of the Autonomous University of Madrid (Protocol CEI-127- 2622). It adhered to the principles outlined in the Good Clinical Practice/International Council for Harmonization Guidelines, the Declaration of Helsinki, and all relevant country-specific regulations governing clinical research, with a priority given to those regulations offering greater protection to individual participants. Written informed consent was obtained from all patients prior to their inclusion in the study. Additionally, any potentially identifying information has been encrypted or removed to ensure participant anonymity.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eThe current study included patients of working age (between 16 and 65 years old) diagnosed with CKD undergoing KRT who accessed social care services during the second quarter of 2022, regardless of whether they were members of ALCER or not.\u003c/p\u003e\n\u003ch3\u003eMethodology\u003c/h3\u003e\n\u003cp\u003eA structured questionnaire was developed, encompassing inquiries pertaining to the sociodemographic profile of participants, including variables such as age, educational attainment, income, and sex. Moreover, the questionnaire collected data regarding employment status prior to CKD diagnosis (S1), the type of initial KRT (T1) received, employment status following initiation of the initial KRT (S2), any subsequent change (if any) in KRT (T2), and the corresponding employment status thereafter (S3).\u003c/p\u003e\u003cp\u003ePotential participants filled out a form with the help of an ALCER social worker, who collected and recorded their responses on the form.\u003c/p\u003e\u003cp\u003eThe KRTs were initially divided into 6 categories, namely, automated peritoneal dialysis (APD); continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (ICHD), Home hemodialysis (HHD), cadaveric kidney transplant (CKT), and living-donor kidney transplant (LDKT).\u003c/p\u003e\u003cp\u003eTo analyze the impact of choosing the KRT option, 2 probability trees were obtained, the first with the entire sample and the second only with those who were employed before starting KRT.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was conducted using MedCalc\u0026reg; Statistical Software version 22.023 (MedCalc Software Ltd, Ostend, Belgium; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medcalc.org\u003c/span\u003e\u003cspan address=\"https://www.medcalc.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; 2024) and SPSS IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.\u003c/p\u003e\u003cp\u003eDescriptive statistics were presented as numbers (percentages), mean [standard deviation (SD)], mean [95% confidence interval (95% CI)], mean (range), or median [Interquartile range (IqR)], as deemed appropriate. There was detected a 1.7% of missing values in patients age that were allocated by means an algorithm of multiple imputation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor statistical purposes, patients were grouped according to their initial KRT in: KTX Group, patients who had undergone a kidney transplant (CKT\u0026thinsp;+\u0026thinsp;LDKT). ICHD Group, Patients on ICHD; and HBD Group, patients on APD, or on CAPD, or on HHD.\u003c/p\u003e\u003cp\u003eThe Shapiro-Wilks test was employed to assess the normality of quantitative variables.\u003c/p\u003e\u003cp\u003eFor continuous normally distributed data, a two-tailed independent samples t-test was used to assess differences before CKD diagnosis between patients who were employed and those who were unemployed. Conversely, for non-normally distributed data, the Mann-Whitney test was utilized.\u003c/p\u003e\u003cp\u003eCategorical variables were compared using a Chi-square test and a Fisher`s exact test, as needed.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographic and clinical characteristics at diagnosis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 402 patients who participated in the survey, 307 (76.4%) were employed at the time of CKD diagnosis, while 95 (23.6%) were unemployed.\u003c/p\u003e\n\u003cp\u003eIn the overall study sample, the mean age at diagnosis was 49.3±9.8 years (95%CI: 48.3 to 50.2 years; range: 21 to 65 years), without significant differences between employed and unemployed patients (mean difference: -0.19±9.8 years, 95%CI: -2.9 to 2.5 years; p=0.8848).\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the main demographic and clinical characteristics of the study sample.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eKidney replacement therapy throughout the study\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe initial treatment for CKD patients was kidney transplantation in 38 cases (9.5%) and dialysis in 364 cases (90.5%) (See table 1). The median (IqR) follow-up duration for the initial KRT was 24.0 (11.8 to 48.0) months, while the median (IqR) time on the second KRT was 72.0 (36.0 to 101.3) months.\u003c/p\u003e\n\u003cp\u003eDuring the study follow-up period, 204 patients (50.7%) required a modification in KRT, while 198 patients (49.3%) maintained their initial KRT without changes.\u003c/p\u003e\n\u003cp\u003eAmong the 402 patients, throughout the study follow-up, 152 (37.8%) underwent kidney transplantation, 137 (34.1%) patients underwent a CKT, and 15 (3.7%) underwent a LDKT.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the 244 patients who were initially on ICHD, 117 (48.0%) remained on ICHD; 114 (46.7%) underwent kidney transplantation (either CKT or LDKT); and 13 (5.3%) patients received treatment with HBD.\u003c/p\u003e\n\u003cp\u003eOn the other hand, among the 120 patients who received HBD as their first KRT, 57(47.5%) continued on HBD; 25 (20.8%) were changed to ICHD; and 38 (31.7%) patients underwent kidney transplantation.\u003c/p\u003e\n\u003cp\u003eTable 2 illustrates the changes in KRT based on the initial modality of KRT.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmployment status after KRT\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt diagnosis, 307 (76.4%) patients were employed and 95 (23.6%) unemployed. Following the first KRT, 197 (49.0%) subjects were employed and 205 (51.0%) were unemployed. Finally, at the conclusion of data collection, 132 (32.8%) had a job, while 270 (67.2%) were unemployed.\u003c/p\u003e\n\u003cp\u003eThe likelihood (95% CI) of employment following the first KRT was 0.490 (0.424 to 0.564) in the overall study sample; 0.511 (0.435 to 0.598) for those employed at diagnosis; and 0.421 (0.301 to 0.573) for those unemployed at diagnosis (p=0.2716).\u003c/p\u003e\n\u003cp\u003eOn the other hand, the likelihood (95% CI) of employment at the end of data collection was 0.328 (0.275 to 0.389) in the overall study population; 0.332 (0.271 to 0.403) for subjects employed at diagnosis; and 0.316 (0.213 to 0.451) for those unemployed at diagnosis (p=0.8067).\u003c/p\u003e\n\u003cp\u003eFigure 1 illustrates the employment rates in the overall population following the initiation of the first KRT and at the end of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough employment rate has decreased over time, at the end of the study, patients who started KRT with kidney transplantation (21/38, 55.3%) or with HBD (47/120, 39.2%) had higher employment rates than those who started on ICHD (64/244, 26.2%) (p=0.0024 and p=0.0356, respectively).\u003c/p\u003e\n\u003cp\u003eTable 3 displays the employment rates over time for the study cohort categorized by their KRT.\u003c/p\u003e\n\u003cp\u003eAmong the 402 patients enrolled in the cohort, 204 (50.7%) required a modification in their KRT. No significant differences in employment rates were observed between patients requiring a change in their KRT (0.353; 95% CI: 0.276 to 0.445) and those maintaining their initial KRT (0.303; 95% CI: 0.231 to 0.390) (Difference between employment rates: 0.05; 95% CI: -0.062 to 0.162; p=0.3826).\u003c/p\u003e\n\u003cp\u003eEmployment status following the first KRT significantly impact on the selection of the second KRT. Indeed, 52.5% of patients who selected PD (either APD or CAPD) as second KRT were employed as compared to the 37.3% of patients who chose HD (either ICHD or HHD) as second KRT (p=0.0430).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePatients who were employed at the time of diagnosis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAt the time of CKD diagnosis, 307 (76.4%) subjects were employed. Following the initiation of the first KRT, 157 (51.1%) remained employed; 102 (33.2%) received work disability; and 48 (15.6%) were unable to continue with their previous work activity.\u003c/p\u003e\n\u003cp\u003eThere were no differences in employment status rates following first KRT among the patients who had undergone kidney transplantation and those starting on HBD (incidence rate difference: 6.4%; 95%CI: -26.2% to 39.1%; p=0.6991) or ICHD (Incidence rate difference: 16.2%; 95%CI: -12.0% to 44.3%; p=0.2614). Similarly, there were no difference between patients starting on HBD or on ICHD (Employment rate difference: 9.7%; 95%CI: -7.9% to 27.4%; p=0.2803) (Figure 2).\u003c/p\u003e\n\u003cp\u003eAs compared to the patients who started on ICHD, the current employment rate was significantly greater in patients initially treated with kidney transplantation (Incidence rate difference: 30.0%; 95%CI: 8.9% to 51.9%; p=0.0070) and in patients who started on HBD (Employment rate difference: 16.9%; 95%CI: 3.0% to 30.8%, p=0.0174). No differences were observed in current employment rates between patients who underwent kidney transplant as first KRT and those who started on HBD (Incidence rate difference: 13.2%; 95%CI: -15.7% to 42.1%; p=0.3719) (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePatients who were unemployed at the time of diagnosis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNinety-Five (23.6%) patients were unemployed at diagnosis. Among them, 40 (42.1%) found a job following first KRT. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the ninety-five patients (23.6%) who were unemployed at the time of diagnosis, 40 (42.1%) got a job following their first KRT; 31 (32.6%) were granted work disability, 23 (24.2%) were not capable to continue their previous work; and one (1.1%) went back to studying.\u003c/p\u003e\n\u003cp\u003eThere were no significant differences in employment rates among any of the study groups either following the initial KRT or at the end of the data collection..\u003c/p\u003e\n\u003cp\u003eThe probability trees found that starting in KTX (CKT + LDKT) had the highest probability of remaining employed, not only ion the overall study sample (55.3%), but also among those subjects who were employed at the time of CKD diagnosis (42.1%) (Figure 3).\u0026nbsp;Among patients who started their KRT on dialysis, those starting on HBD were more likely to maintain their jobs at the end of the follow-up (28.3%) as compared to those who started on ICHD (18.0) (p=0.0245).\u003c/p\u003e\n\u003cp\u003eIn patients who were employed at CKD diagnosis, the probability tree showed similar trends, with employment rates at the end of the study of 55.6% (p=0.0003 versus ICHD), 34.8% (p=0.0261 versus ICHD), and 22.3% in patients who started on KTX, HBD, and ICHD, respectively (Figure 3).\u003c/p\u003e\n\u003cp\u003eInterestingly, in patients who were employed at CKD diagnosis; starting and maintaining KRT on HBD provided greater probability to remain employed (62.5%) than patients who started and remained on KTX (61.9%) and those who started and maintained on ICHD (51.5%), although these differences were no statistically significant (Figure 3).\u003c/p\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study showed that CKD and KRT negatively impact the work situation of patients. At diagnosis, 76.4% of patients were employed. However, the employment rates decreased to 49.0% after the first KRT and further reduced to 32.8% by the end of the study.\u0026nbsp;Although employment rates declined over time, at the end of the study, patients who initiated treatment with kidney transplantation or HBD exhibited significantly higher employment rates compared to those who started on ICHD.\u0026nbsp;\u003c/p\u003e\u003cp\u003eAdditionally, employment status following initial KRT significantly influenced selection of second KRT. Specifically, 51.4% of patients selecting HBD as second KRT were employed, as compared to 36.5% of patients choosing ICHD (p=0.0357).\u003c/p\u003e\u003cp\u003eProbability trees have shown that, among subjects who were employed at the time of CKD diagnosis, starting on HBD offered greater probabilities of remaining employed, regardless the current KRT, than starting on ICHD. Patients who started KRT on HBD and underwent kidney transplant during the follow-up had better probabilities of maintained the job than those who started on kidney transplant and maintained on transplant (without the need to start dialysis) (61.9% versus 66.7%, respectively). Patients who started KRT on HBD and required a change to ICHD had greater likelihood to maintain the job than those who started and were maintained on ICHD (62.5% versus 51.5%).\u003c/p\u003e\u003cp\u003ePatients with advanced CKD face multiple challenges in employment due to their medical, psychological, and social circumstances.\u0026nbsp;Kidney function impairment impacts negatively on opportunities for employment involvement. KRT, such as dialysis, has been frequently associated with reduced work capacity [6,7].\u0026nbsp;\u003c/p\u003e\u003cp\u003eIt has been identified that unemployed patients on ICHD have a higher risk of poverty and social exclusion [8]. In our study, 39,8% of unemployed people have montly incomes ≤ €900 (they did not reach €1,000 of the Spanish guaranteed minimum wage for the year 2022). This proportion was slightly lower among patients who receive a disability pension (32,3%), as well as among those who are still employed (23,5%). \u0026nbsp;Conversely, proportion of subjects with a monthly income ≥ €2000 was greater among employed subjects (21.2%) than among subjects with a disability pension (11.4%) or among those unemployed (4.8%).\u003c/p\u003e\u003cp\u003eWhile transplantation holds promise recipients the potential to return to a productive working life, a notable portion of patients remain unemployed [8]. Besides medical interventions, kidney failure itself imposes disability, prompting shifts in employment status, with even late-stage CKD patients ceasing work [9].\u003c/p\u003e\u003cp\u003eBased on the patient's perspective, be engaged in paid employment has been highly valued, since it improved quality of life, fostered a sense of identity, and ensured financial stability [18]. Work participation ranks among the top ten priorities for patients with CKD [19]. While nephrology care has the potential to support CKD patients in maintaining employment, current practices may not adequately address work-related concerns [20]. A deeper understanding of the employment dynamics among CKD patients and identification of at-risk groups could inform targeted interventions, thereby bolstering the development of a supportive framework to help patients sustain employment and enhance their overall well-being [20,21].\u003c/p\u003e\u003cp\u003ePrevious studies on work participation in CKD patients focused mainly on employment rates, while our study was mainly focused on assessing the ability of patients with CKD to maintain their employment.\u003c/p\u003e\u003cp\u003eSeveral variables can influence the employment status of individuals with CKD [22-24]. Educational attainment has emerged as a significant factor affecting employment rates within the CKD demographic, favoring those with higher educational achievements [22]. However, although in our study a greater proportion of patients with elementary education were unemployed, we did not observe that patients with university education had a higher rate of employment. Furthermore, age and gender have been identified as pertinent determinants impacting employment rates. Usually, younger subjects are favored over older counterparts due to perceived advantages in productivity [23]. While in our study no age disparity existed between employed and unemployed patients at the time of diagnosis, following the initiation of the first KRT, employed patients tended to be younger than their unemployed counterparts (mean difference: -2.2 ± 9.7 years; 95%CI: -4.1 to -0.3 years; p=0.0239). This trend became more pronounced by the study's conclusion, with employed patients being 2.5 ± 9.7 years younger than unemployed patients (p=0.0190).\u003c/p\u003e\u003cp\u003eIn terms of gender, Bay et al. [24] found that female patients were 2.24 times more likely to be unemployed than males. However, our data did not confirm such finding, since employment rates were similar between men and women throughout the study.\u003c/p\u003e\u003cp\u003eCurrent scientific evidence suggests that individuals who started home-based dialysis or underwent kidney transplantation were more likely to sustain employment compared to those undergoing ICHD [11,12,14,15].\u0026nbsp;The current study agrees with this finding. Despite a decline in employment rates over time, at the end of the study, employment rates were higher among patients who initiated KRT with kidney transplantation or HBD compared to those who started on ICHD.\u003c/p\u003e\u003cp\u003eThe main limitation of the current study primarily stems from its sole reliance on the registry database of the Federation of Associations of Renal Patients. Patients seeking social care at ALCER may possess a heightened level of disease awareness and understanding of their personal circumstances, but at the same time they are those who seek greater attention, are looking for employment or need help managing their disability, work incapacity, or both. Despite the stage of CKD at diagnosis was not recorded, the high percentage of employees at that time (76.4%) leads us to think that the challenge is maintaining employment at the beginning of KRT.\u0026nbsp;Therefore, we cannot conclusively state that our study sample accurately represents all CKD patients and might underestimate the employment rates of the overall CKD patient population.\u003c/p\u003e\u003cp\u003eAdditionally, it should be noted the exclusion of other potential factors, such as depression and various psychological or clinical variables, which could potentially influence work impairment and employment status among CKD patients. Furthermore, both work coping style and emotional state could also be affecting employment rates.\u003c/p\u003e\u003cp\u003eOne of our strengths lies in the inclusion of patients from various regions across Spain, providing a sample that reflects the country's diverse reality. It turns out that HBD could be favoring more adaptive behaviors and, thereby, increasing employment rates and better progression with the disease. Being a self-management technique, it implies that the patient has to take charge of their illness, adapt it to their life and, thereby, encourage patients with greater adherence to medical treatments and recommendations.\u0026nbsp;Although all home dialysis options seem to favor maintaining employment, the low sample size in our study of people on HBHD makes us focus our recommendations on PD.\u003c/p\u003e\u003cp\u003eIn conclusion, this study reveals the adverse impact of CKD on patients' employment status. While employment rates declined over time, patients starting treatment with kidney transplantation or HBD showed higher employment rates compared to those starting on ICHD. These findings emphasize the relevance of evaluating employment status when selecting KRT. HBD strategies, particularly PD (APD and CAPD), combine clinical advantages (i.e., conservation of vascular access or the maintenance of residual kidney function) with social advantages (greater probability of preserving employment, and lower risk of poverty and social exclusion).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALCER\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFederation of Associations of Renal Patients\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAutomated peritoneal dialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCAPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContinuous ambulatory peritoneal dialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic kidney disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCadaveric kidney transplant\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome-based dialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBHD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome-based hemodialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHHD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome hemodialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICHD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn-center hemodialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIqR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney replacement therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKTX\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney-transplant\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLDKT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLiving-donor kidney transplant\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethics Guidelines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies were conducted in accordance with the local legislation and institutional requirements. The study protocol was reviewed and approved by the Ethics Committee of the Autonomous University of Madrid (Protocol\u0026nbsp;CEI-127- 2622).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical writing and Editorial assistant services have been provided by Ciencia y Deporte Ltd.\u003c/p\u003e\n\u003cp\u003eSocial workers from the ALCER entities of Alicante, Badajoz, Barcelona, Cáceres, Castellón (Castalia), Coruña, Granada, Islas Baleares (Illes Balears), Jaén, Las Palmas, León, Madrid, Málaga, Pontevedra, Toledo y Sevilla (Giralda) that have helped in the collection of the sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003eJCJM: Consultancy: Astellas, Astrazeneca, Bayer, Boehringer-Ingelheim, GSK, Ipsen, MSD, Pfizer, Telix and Travere. Travel and expense: Astellas and Novartis. Invited speaker: Astellas, Astrazecena, Bayer, Vantive-Baxter, Ipsen, MSD and Pfizer.\u003c/p\u003e\n\u003cp\u003eDGZ: Consultancy: Astrazeneca, Boehringer-Ingelheim, GSK, Pfizer, Novartis, Sobi, Hansa Biopharma and Travere. Travel and expense: Novartis, Astrazeneca and GSK. Invited speaker: Astrazecena, Fresenius Medical Care, Vantive-Baxter and Pfizer\u003c/p\u003e\n\u003cp\u003eThe rest of the authors do not have any conflict to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical writing and editorial assistant were funded by Vantive. Vantive was not involved in the preparation of the recommendations nor did the company influence in any way the scientific consensus reached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: JCJM, DGZ, MARD; Methodology: JCJM, DGZ, MARD; Formal analysis: JESA, JCRP; Investigation: JCJM, DGZ, JMMC, JMCB, MARD; Supervision: JCJM, DGZ, MARD. All authors met the ICMJE authorship criteria. All authors made substantial contributions to conception, design, analysis, and interpretation of data, contributed to writing the article, provided critical revision of the manuscript, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are the property of the Federación Nacional de Asociaciones ALCER, a non-profit organization for kidney patients, which provides open access to this data for any interested researcher, with the data offered in an anonymized format for legal data protection reasons. Updated data may be requested by contacting [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eInstituto nacional de Estad\u0026iacute;stica. Indicador Multidimensional de Calidad de Vida IMCV. Available in: https://www.ine.es/ss/Satellite?L=es_ES\u0026amp;c=INEPublicacion_C\u0026amp;cid=1259937499084\u0026amp;p=1254735110672\u0026amp;pagename=ProductosYServicios%2F\u003cbr\u003ePYSLayout\u0026amp;param1=PYSDetalleGratuitas\u0026amp;param2=1259944522462\u0026amp;param4=Mostrar Last accessed October 30, 2025.\u003c/li\u003e\n \u003cli\u003eFern\u0026aacute;ndez R. [Unemployment rate in Spain 2000-2023]. Released April 12, 2024. Available in: https://es.statista.com/estadisticas/500987/prevision-tasa-de-paro-en-espana/ Last accessed October 30, 2025.\u003c/li\u003e\n \u003cli\u003eHern\u0026aacute;ndez de Cos P. The Spanish labour market: recent developments and the challenges ahead. Released February 12, 2024. Available in: The Spanish labour market: recent developments and the challenges ahead (bde.es) Last accessed October 30, 2025.\u003c/li\u003e\n \u003cli\u003eLeonardi M, Silvaggi F, Scaratti C, Guastafierro E, Toppo, Eigenmann M, Lindstrom J, Rantala E. Promoting inclusiveness and work ability for people with chronic health conditions. Available in: https://www.epicentro.iss.it/igea/appuntamenti/pdf/WP8-documenti/A%20training%20tool\u003cbr\u003e%20for%20managers.pdf Last accessed October 30, 2025.\u003c/li\u003e\n \u003cli\u003eDeep G. Digital transformation\u0026apos;s impact on organizational culture. International Journal of Science and Research Archive. International Journal of Science and Research Archive, 2023, 10(0), 396\u0026ndash;401. Doi:10.30574/ijsra.2023.10.2.0977.\u003c/li\u003e\n \u003cli\u003evan Manen JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT; NECOSAD Study Group. Netherlands Cooperative Study on Adequacy of Dialysis. Changes in employment status in end-stage renal disease patients during their first year of dialysis. Perit Dial Int. 2001;21(6):595-601.\u003c/li\u003e\n \u003cli\u003eTappe K, Turkelson C, Doggett D, Coates V. Disability under Social Security for patients with ESRD: an evidence-based review. Disabil Rehabil. 2001 Mar 20;23(5):177-85. doi: 10.1080/09638280151080522.\u003c/li\u003e\n \u003cli\u003eD\u0026apos;Egidio V, Mannocci A, Ciaccio D, Sestili C, Cocchiara RA, Del Cimmuto A, et al. Return to work after kidney transplant: a systematic review. Occup Med (Lond). 2019;69(6):412-18. doi: 10.1093/occmed/kqz095.\u003c/li\u003e\n \u003cli\u003evan der Mei SF, Kuiper D, Groothoff JW, van den Heuvel WJ, van Son WJ, Brouwer S. Long-term health and work outcomes of renal transplantation and patterns of work status during the end-stage renal disease trajectory. J Occup Rehabil. 2011;21(3):325-34. doi: 10.1007/s10926-011-9317-1.\u003c/li\u003e\n \u003cli\u003eJulian Mauro JC, Molinuevo Tobalina JA, S\u0026aacute;nchez Gonz\u0026aacute;lez JC. Employment in the patient with chronic kidney disease related to renal replacement therapy. Nefrologia. 2012;32(4):439-45. English, Spanish. doi: 10.3265/Nefrologia.pre2012.Apr.11366.\u003c/li\u003e\n \u003cli\u003eKirkeskov L, Carlsen RK, Lund T, Buus NH. Employment of patients with kidney failure treated with dialysis or kidney transplantation-a systematic review and meta-analysis. BMC Nephrol. 2021;22(1):348. doi: 10.1186/s12882-021-02552-2..\u003c/li\u003e\n \u003cli\u003ede Jong RW, Boezeman EJ, Chesnaye NC, Bemelman FJ, Massy ZA, Jager KJ, et al. Work status and work ability of patients receiving kidney. replacement therapy: results from a European survey. Nephrol Dial Transplant. 2022;37(10):2022-33. doi: 10.1093/ndt/gfab300\u003c/li\u003e\n \u003cli\u003eOrganizaci\u0026oacute;n Nacional de Trasplantes. REGISTRO ESPA\u0026Ntilde;OL DE ENFERMOS RENALES. Available in: https://www.ont.es/informacion-a-los-profesionales-4/registros-de-donacion-de-trasplantes-4-9/registro-espanol-de-enfermos-renales-4-9-4/ Last accessed October 30, 2025.\u003c/li\u003e\n \u003cli\u003eMuehrer RJ, Schatell D, Witten B, Gangnon R, Becker BN, Hofmann RM. Factors affecting employment at initiation of dialysis. Clin J Am Soc Nephrol. 2011;6(3):489-96. doi: 10.2215/CJN.02550310.\u003c/li\u003e\n \u003cli\u003eErickson KF, Zhao B, Ho V, Winkelmayer WC. Employment among Patients Starting Dialysis in the United States. Clin J Am Soc Nephrol. 2018;13(2):265-73. doi: 10.2215/CJN.06470617.\u003c/li\u003e\n \u003cli\u003eLakshmi BS, Kumar ACV, Reddy HK, Gopal J, Chaitanya V, Chandra VS, et al. Employment Status of Patients Receiving Maintenance Dialysis - Peritoneal and Hemodialysis: A Cross-sectional Study. Indian J Nephrol. 2017;27(5):384-88. doi: 10.4103/ijn.IJN_151_16.\u003c/li\u003e\n \u003cli\u003eLang KM, Little TD (2018). Principled Missing Data Treatments. Prev Sci 19:284-94. doi: 10.1007/s11121-016-0644-5.\u003c/li\u003e\n \u003cli\u003eRajkumar R, Baumgart A, Martin A, Tong A, Evangelidis N, Manera KE, et al; SONG-HD and SONG-PD initiativesfor the SONG-HD and SONG-PD initiatives. Perspectives on ability to work from patients\u0026apos; receiving dialysis and caregivers: analysis of data from the global SONG initiative. J Nephrol. 2022;35(1):255-66. doi: 10.1007/s40620-021-01105-y.\u003c/li\u003e\n \u003cli\u003eCarter SA, Gutman T, Logeman C, Cattran D, Lightstone L, Bagga A, et al; SONG-GD Investigators. Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers. Clin J Am Soc Nephrol. 2020;15(5):673-84. doi: 10.2215/CJN.13101019.\u003c/li\u003e\n \u003cli\u003eAwan AA, Zhao B, Anumudu SJ, Winkelmayer WC, Ho V, Erickson KF. Pre-ESKD Nephrology Care and Employment at the Start of Dialysis. Kidney Int Rep. 2020;5(6):821-30. doi: 10.1016/j.ekir.2020.03.004.\u003c/li\u003e\n \u003cli\u003eFeder J, Nadel MV, Krishnan M. A Matter of Choice: Opportunities and Obstacles Facing People with ESRD. Clin J Am Soc Nephrol. 2016 Mar 7;11(3):536-8. doi: 10.2215/CJN.04470415.\u003c/li\u003e\n \u003cli\u003eBurnes D, Sheppard C, Henderson CR Jr, Wassel M, Cope R, Barber C, et al. Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis. Am J Public Health. 2019;109(8):e1-e9. doi: 10.2105/AJPH.2019.305123.\u003c/li\u003e\n \u003cli\u003eAlma MA, van der Mei SF, Brouwer S, Hilbrands LB, van der Boog PJM, Uiterwijk H, et al. Sustained employment, work disability and work functioning in CKD patients: a cross-sectional survey study. J Nephrol. 2023;36(3):731-743. doi: 10.1007/s40620-022-01476-w.\u003c/li\u003e\n \u003cli\u003eBay SS, Kamaruzaman L, Mohd R, Azhar Shah S. Work disability and employment status among advanced chronic kidney disease patients. PLoS One. 2024;19(3):e0297378. doi: 10.1371/journal.pone.0297378.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Mean demographic and clinical features of the study cohort at diagnosis of the chronic kidney disease (CKD).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall (n=402)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed (n=307)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed (n=95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003cp\u003eMedian (IqR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49.3\u0026plusmn;9.8\u003c/p\u003e\n \u003cp\u003e50.0 (43.0 to 57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49.2\u0026plusmn;8.9\u003c/p\u003e\n \u003cp\u003e50.0 (43.3 to 56.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49.4\u0026plusmn;12.1\u003c/p\u003e\n \u003cp\u003e52.0 (39.3 to 59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.8848\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e171 (42.5)\u003c/p\u003e\n \u003cp\u003e231 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e131 (42.7)\u003c/p\u003e\n \u003cp\u003e176 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (42.1)\u003c/p\u003e\n \u003cp\u003e55 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation level, n (%)\u003c/p\u003e\n \u003cp\u003eWithout studies\u003c/p\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003cp\u003eMiddle/High school\u003c/p\u003e\n \u003cp\u003eProfessional training\u003c/p\u003e\n \u003cp\u003eAssociated/bachelor degree\u003c/p\u003e\n \u003cp\u003eMaster/Doctorate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (2.5)\u003c/p\u003e\n \u003cp\u003e95 (23.6)\u003c/p\u003e\n \u003cp\u003e106 (26.4)\u003c/p\u003e\n \u003cp\u003e94 (23.4)\u003c/p\u003e\n \u003cp\u003e61 (15.2)\u003c/p\u003e\n \u003cp\u003e36 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (1.6)\u003c/p\u003e\n \u003cp\u003e65 (21.2)\u003c/p\u003e\n \u003cp\u003e92 (30.0)\u003c/p\u003e\n \u003cp\u003e73 (23.8)\u003c/p\u003e\n \u003cp\u003e45 (14.7)\u003c/p\u003e\n \u003cp\u003e27 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (5.3)\u003c/p\u003e\n \u003cp\u003e30 (31.6)\u003c/p\u003e\n \u003cp\u003e14 (14.7)\u003c/p\u003e\n \u003cp\u003e21 (22.1)\u003c/p\u003e\n \u003cp\u003e16 (16.8)\u003c/p\u003e\n \u003cp\u003e9 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of job, n (%)\u003c/p\u003e\n \u003cp\u003eSalaried employment in the private sector\u003c/p\u003e\n \u003cp\u003eSalaried employment in the public sector\u003c/p\u003e\n \u003cp\u003eSelf-employment/Entrepreneurship with employed staff\u003c/p\u003e\n \u003cp\u003eSelf-employment/Entrepreneurship without employees\u003c/p\u003e\n \u003cp\u003eAssistance in family-owned or company business\u003c/p\u003e\n \u003cp\u003eSick leave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e254 (63.2)\u003c/p\u003e\n \u003cp\u003e81 (20.1)\u003c/p\u003e\n \u003cp\u003e21 (5.2)\u003c/p\u003e\n \u003cp\u003e41 (10.2)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e192 (62.5)\u003c/p\u003e\n \u003cp\u003e58 (19.9)\u003c/p\u003e\n \u003cp\u003e17 (5.5)\u003c/p\u003e\n \u003cp\u003e35 (11.4)\u003c/p\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (65.3)\u003c/p\u003e\n \u003cp\u003e23 (24.2)\u003c/p\u003e\n \u003cp\u003e4 (4.2)\u003c/p\u003e\n \u003cp\u003e6 (6.3)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIncome level, n (%)*\u003c/p\u003e\n \u003cp\u003e\u0026le; 500\u003c/p\u003e\n \u003cp\u003e\u0026gt; 500 \u0026le; 700\u003c/p\u003e\n \u003cp\u003e\u0026gt; 700 \u0026le; 900\u003c/p\u003e\n \u003cp\u003e\u0026gt; 900 \u0026le; 1200\u003c/p\u003e\n \u003cp\u003e\u0026gt; 1200 \u0026le; 1500\u003c/p\u003e\n \u003cp\u003e\u0026gt; 1500 \u0026le; 2000\u003c/p\u003e\n \u003cp\u003e\u0026gt; 2000 \u0026le; 2500\u003c/p\u003e\n \u003cp\u003e\u0026gt; 2500 \u0026le; 3000\u003c/p\u003e\n \u003cp\u003e\u0026gt; 3000\u003c/p\u003e\n \u003cp\u003eDK/NA/REF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (10.4)\u003c/p\u003e\n \u003cp\u003e35 (8.7)\u003c/p\u003e\n \u003cp\u003e54 (13.4)\u003c/p\u003e\n \u003cp\u003e90 (22.4)\u003c/p\u003e\n \u003cp\u003e52 (12.9)\u003c/p\u003e\n \u003cp\u003e33 (8.2)\u003c/p\u003e\n \u003cp\u003e25 (6.2)\u003c/p\u003e\n \u003cp\u003e9 (2.2)\u003c/p\u003e\n \u003cp\u003e18 (4.5)\u003c/p\u003e\n \u003cp\u003e44 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (9.8)\u003c/p\u003e\n \u003cp\u003e24 (7.8)\u003c/p\u003e\n \u003cp\u003e41 (13.4)\u003c/p\u003e\n \u003cp\u003e74 (24.1)\u003c/p\u003e\n \u003cp\u003e43 (14.0)\u003c/p\u003e\n \u003cp\u003e26 (8.5)\u003c/p\u003e\n \u003cp\u003e21 (6.8)\u003c/p\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003cp\u003e14 (4.6)\u003c/p\u003e\n \u003cp\u003e31 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (12.6)\u003c/p\u003e\n \u003cp\u003e11 (11.6)\u003c/p\u003e\n \u003cp\u003e13 (13.7)\u003c/p\u003e\n \u003cp\u003e16 (16.8)\u003c/p\u003e\n \u003cp\u003e9 (9.5)\u003c/p\u003e\n \u003cp\u003e7 (7.4)\u003c/p\u003e\n \u003cp\u003e4 (4.2)\u003c/p\u003e\n \u003cp\u003e6 (6.3)\u003c/p\u003e\n \u003cp\u003e4 (4.2)\u003c/p\u003e\n \u003cp\u003e13 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInitial KRT, n (%)\u003c/p\u003e\n \u003cp\u003eAPD\u003c/p\u003e\n \u003cp\u003eCAPD\u003c/p\u003e\n \u003cp\u003eICHD\u003c/p\u003e\n \u003cp\u003eHHD\u003c/p\u003e\n \u003cp\u003eCKT\u003c/p\u003e\n \u003cp\u003eLDKT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43 (10.7)\u003c/p\u003e\n \u003cp\u003e63 (15.7)\u003c/p\u003e\n \u003cp\u003e244 (60.7)\u003c/p\u003e\n \u003cp\u003e14 (3.5)\u003c/p\u003e\n \u003cp\u003e24 (6.0)\u003c/p\u003e\n \u003cp\u003e14 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (10.4)\u003c/p\u003e\n \u003cp\u003e51 (16.6)\u003c/p\u003e\n \u003cp\u003e188 (61.2)\u003c/p\u003e\n \u003cp\u003e9 (2.9)\u003c/p\u003e\n \u003cp\u003e16 (5.2)\u003c/p\u003e\n \u003cp\u003e11 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (11.6)\u003c/p\u003e\n \u003cp\u003e12 (12.6)\u003c/p\u003e\n \u003cp\u003e56 (58.9)\u003c/p\u003e\n \u003cp\u003e5 (5.3)\u003c/p\u003e\n \u003cp\u003e8 (8.4)\u003c/p\u003e\n \u003cp\u003e3 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInitial KRT, n (%)\u003c/p\u003e\n \u003cp\u003eKTX\u003c/p\u003e\n \u003cp\u003eICHD\u003c/p\u003e\n \u003cp\u003eHBD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (9.5)\u003c/p\u003e\n \u003cp\u003e244 (60.7)\u003c/p\u003e\n \u003cp\u003e120 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (8.8)\u003c/p\u003e\n \u003cp\u003e188 (61.2)\u003c/p\u003e\n \u003cp\u003e92 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (11.6)\u003c/p\u003e\n \u003cp\u003e56 (58.9)\u003c/p\u003e\n \u003cp\u003e28 (29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eChi-squared test.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003eIndependent sample Student t test.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003eFisher exact test.\u003c/p\u003e\n\u003cp\u003e*Euros per month before taxes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation; IqR: Interquartile range; DK/NA/REF: Do not know/Not applicable/Refuse; APD: Automated peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis; ICHD: In-center Hemodialysis; HHD: Home hemodialysis; CKT: Cadaveric kidney transplant; LDKT: Living-donor kidney transplant; KTX: CKT+LDKT; HBD: Home-based dialysis (APD+CAPD+HHD).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Overview of the second renal replacement therapy administered based on the initial kidney replacement therapy (KRT) undergone. Significant changes were observed between the first and second RKRT (p\u0026lt;0.0001, Chi-squared test).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"66%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial KRT, n (%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond KRT, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eKTX\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eICHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eHBD\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eKTX\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e30 (78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e38 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eICHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e114 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e117 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e13 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e244 (60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eHBD\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e38 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e25 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e57 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e120 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e182 (45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e148 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e72 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e402 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*The percentages have been computed based on the data from the initial treatment.\u003c/p\u003e\n\u003cp\u003eKTX: Kidney transplant\u003csup\u003e1\u003c/sup\u003e; ICHD: In-center Hemodialysis; HBD: Home-based dialysis.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eIt included Cadaveric kidney transplant (CKT) and Living-donor kidney transplant (LDKT).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eIt included Automated peritoneal dialysis (APD) and Continuous ambulatory peritoneal dialysis (CAPD) and Home hemodialysis (HHD).\u003c/p\u003e\n\u003cp\u003eTable 3. \u0026nbsp;Overview of the employment rates over time of the study cohort based on their initial renal replacement therapy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eKRT assigned\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed following first RRT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently employed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003cp\u003eAPD\u003c/p\u003e\n \u003cp\u003eCAPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83 (78.3)\u003c/p\u003e\n \u003cp\u003e32 (74.4)\u003c/p\u003e\n \u003cp\u003e51 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (21.7)\u003c/p\u003e\n \u003cp\u003e11 (25.6)\u003c/p\u003e\n \u003cp\u003e12 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (53.8)\u003c/p\u003e\n \u003cp\u003e26 (60.5)\u003c/p\u003e\n \u003cp\u003e31 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (46.2)\u003c/p\u003e\n \u003cp\u003e17 839.5)\u003c/p\u003e\n \u003cp\u003e32 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (38.7)\u003c/p\u003e\n \u003cp\u003e18 (41.9)\u003c/p\u003e\n \u003cp\u003e23 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65 (61.3)\u003c/p\u003e\n \u003cp\u003e25 (58.9)\u003c/p\u003e\n \u003cp\u003e40 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHD\u003c/p\u003e\n \u003cp\u003eICHD\u003c/p\u003e\n \u003cp\u003eHHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e197 (76.4)\u003c/p\u003e\n \u003cp\u003e188 (77.0)\u003c/p\u003e\n \u003cp\u003e9 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61 (23.6)\u003c/p\u003e\n \u003cp\u003e56 (23.0)\u003c/p\u003e\n \u003cp\u003e5 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117 (45.3)\u003c/p\u003e\n \u003cp\u003e110 (45.1)\u003c/p\u003e\n \u003cp\u003e7 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e141 (54.7)\u003c/p\u003e\n \u003cp\u003e134 (54.9)\u003c/p\u003e\n \u003cp\u003e7 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70 (27.1)\u003c/p\u003e\n \u003cp\u003e64 (26.2)\u003c/p\u003e\n \u003cp\u003e6 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188 (72.9)\u003c/p\u003e\n \u003cp\u003e180 (73.8)\u003c/p\u003e\n \u003cp\u003e8 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHBD*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73 (60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKTX\u003c/p\u003e\n \u003cp\u003eCKT\u003c/p\u003e\n \u003cp\u003eLDKT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (71.1)\u003c/p\u003e\n \u003cp\u003e16 (66.7)\u003c/p\u003e\n \u003cp\u003e11 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (28.9)\u003c/p\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (60.5)\u003c/p\u003e\n \u003cp\u003e15 (62.5)\u003c/p\u003e\n \u003cp\u003e8 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (39.5)\u003c/p\u003e\n \u003cp\u003e9 (37.5)\u003c/p\u003e\n \u003cp\u003e6 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (55.3)\u003c/p\u003e\n \u003cp\u003e13 (54.2)\u003c/p\u003e\n \u003cp\u003e8 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (44.7)\u003c/p\u003e\n \u003cp\u003e11 (45.8)\u003c/p\u003e\n \u003cp\u003e6 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*\u0026nbsp;HBD: (APD + CAPD + HHD)\u003c/p\u003e\n\u003cp\u003eAPD: Automated peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis; ICHD: In-center Hemodialysis; HHD: Home hemodialysis; HBD: Home-based dialysis; CKT: Cadaveric kidney transplant; LDKT: Living-donor kidney transplant.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic Kidney Disease, Home Dialysis, Employment, Kidney Replacement Therapy, Work performance","lastPublishedDoi":"10.21203/rs.3.rs-8007798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8007798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: To assess the impact of kidney replacement therapy (KRT) on employment status among patients with chronic kidney disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Retrospective analysis of a prospective registry database of the Federation of Associations of Renal Patients (ALCER). Study participants completed a structured questionnaire gathering information on their employment status before being diagnosed before and throughout the study follow-up. For statistical purposes, patients were grouped according to their initial KRT in: Kidney-transplant (KTX) Group; In-center hemodialysis (ICHD); and home-based dialysis (HBD) Group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Among the 402 patients surveyed, 307 (76.4%) were employed at diagnosed (before starting KRT), while 95 (23.6%) were unemployed. Following the initial KRT, 197 (49.0%) subjects were employed and 205 (51.0%) were unemployed. Whereas, at the conclusion of data collection, 132 (32.8%) had a job, while 270 (67.2%) were unemployed. Patients who initiated KRT with KTX (21/38, 55.3%) or with HBD (47/120, 39.2%) had significantly higher employment rates than those who started on ICHD (64/244, 26.2%) (p=0.0024 and p=0.0356, respectively). Among patients who were employed at diagnosis, patients who underwent KTX as initial KRT or were on HBD showed significantly higher current employment rates than those who started on ICHD (P=0.0070 and p=0.0174, respectively).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: According to the results of this study, CKD had a negative impact on patients' employment status. Despite a decline in employment rates over time, patients starting KRT on HBD or KTX exhibited higher employment rates compared to those starting on ICHD.\u003c/p\u003e","manuscriptTitle":"Maintenance of employment based on kidney replacement therapy and previous employment situation: an observational cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 11:59:40","doi":"10.21203/rs.3.rs-8007798/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f21f54f6-0692-4030-90ed-efaf2be0ce89","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T10:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 11:59:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8007798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8007798","identity":"rs-8007798","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}