[Dialysis and the risk of poverty].

Introduction: For patients with severe kidney failure, the only alternative to transplantation today is an enduring dialysis treatment. But dialysis is associated with manifold physical and social restrictions. The study analyses the psychosocial consequences of the chronic disease of renal insufficiency: Does chronic kidney failure increase the patients' risk to sink into poverty? SAMPLE/METHODS: In the year 2006 625 dialysis patients participated in an enquiry in 77 dialysis centres in Germany. The newly developed questionnaire included 19 items about social situation, treatment conditions, and quality of life. The response rate was 54.3%. The analyses were calculated using descriptive statistics and discriminatory analyses.

Results: 51.8% of the patients lived in the new German federal states (the former GDR), 44.9% are female. The mean age of the sample was 62.2 years. 57.5% of the participants were married or cohabited. There was at least one person aged younger than 18 years in 12% of the households. 54.8% of the respondents had a German CSE, 25.3% had a German Remedial School Certificate of Completion, and 12.4% had a German Abitur (German university entrance qualification). At the time of the enquiry, 60.2% of the patients were below the poverty level (60% of the mean income in Germany). Important impact factors for an existence above the poverty level were the number of persons per household and the age of the participants. The more persons per household, the greater was the risk to be below the poverty level. Households with more than two persons had a significantly higher risk to be below the poverty level (OR=63.3). Persons aged younger than 50 years had a significantly higher risk to be below the poverty level than those aged 50 years or older (OR=2.0).

Conclusions: Chronic renal insufficiency is associated with a higher poverty risk if the patients feature specific attributes. Although living alone is often regarded as a poverty risk because larger households usually have more opportunities to save costs, due to our findings patients living together with several persons in a household are at higher risk to sink into poverty. They are younger or middle-aged and have responsibility to support children or partners. A higher poverty risk results from the fact that they are at a younger age when their dialysis starts and usually receive a lower employment disability pension. The results correspond with data of the German Federal Statistical Office, which show that the number of paupers is greater within younger age groups. Relevant for prevention seems to be the impact of the physician on a possible further occupation of dialysis patients.