Association of Employment Status with Quality of Life in Patients across Chronic Kidney Disease G3-G5 Non-Dialysis and Kidney Replacement Therapies

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INTRODUCTION: Treatment conditions and progression of chronic kidney disease (CKD) are factors for work incapacity, related with physical limitations and social and emotional distress, affecting quality of life (QOL). METHODS: In a cross-sectional study, 343 patients with CKD were included: chronic kidney disease non-dialysis (CKD G3-G5ND) (n = 98), hemodialysis (HD) (n = 95), peritoneal dialysis (PD) (n = 96), and kidney transplant (KT) (n = 54). A clinical and nutritional assessment was carried out using the Subjective Global Assessment instrument. QOL was assessed using the Kidney Disease Quality of Life Short Form instrument. RESULTS: Employed patients (44%) were younger (40 ± 14 vs. 51 ± 16 years, p < 0.0001), had >9 years of schooling (49 vs. 29%, p < 0.0001), lower diabetes frequency (21 vs. 47%, p < 0.0001), hypertension (71 vs. 87%, p < 0.0001), cardiovascular disease (5 vs. 16%, p = 0.002), and better nutritional status score (6 ± 1 vs. 5 ± 1, p < 0.0001) than unemployed. Employed patients with KT had better QOL than employed patients on CKD G3-G5ND, HD, and PD (76 ± 6, 68 ± 13, 68 ± 12, and 67 ± 7, respectively, p < 0.05). In multivariate analysis, employment predicted QOL in all kidney replacement therapies (KRTs): HD (B = 10.1, 95% CI: 5.5-14.6), PD (B = 4.5, 95% CI: 0.08-8.9) and KT (B = 13.3, 95% CI: 6.1-20.5). Nutritional status predicted QOL in all groups: CKD G3-G5ND (B = 3.6, 95% CI: 1.24-5.97), HD (B = 2.44, 95% CI: 0.4-4.4), PD (B = 3.73, 95% CI: 2.1-5.3), and KT (B = 4.4, 95% CI: 0.05-8.8). CONCLUSION: Only 44% of patients had employment. Employed patients had better QOL, were younger, more educated, had fewer comorbidities and better nutritional status than unemployed patients. Employment predicted QOL in all three KRTs but not in CKD G3-G5ND patients, and nutritional status was a predictor QOL in all groups.

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