Employment before and after initiation of dialysis or kidney transplantation- a Danish nationwide registry-based cohort study.

Background: Patients treated with chronic dialysis or kidney transplantation have difficulties in maintaining employment. We aimed to estimate employment rates among dialysis and kidney transplant patients from 3 years before to 3 years after initiating dialysis or undergoing transplantation.

Methods: All first-time dialysis and kidney transplantation patients aged 18-65 years in Denmark from 2005 to 2019 were identified using the Danish Nephrological Register and linked with information about social security benefits. Each dialysis or kidney transplant patient was matched with 3 references.

Results: In total, 4,469 patients undergoing dialysis (median age 55 years, 65% males) and 2,294 patients receiving kidney transplants (median age 49 years, 64% males) were included together with 13,262 and 6,790 matched references, respectively. The employment rate was 11% when initiating dialysis compared to 61% for the reference group. Kidney transplantation patients had an employment rate of 20% compared to 67% for the reference group. At all time points (3 years before, 1 year before, at the time of intervention, 1 year after, and 3 years after) both dialysis and kidney transplant patients had lower employment rates compared to references (P < 0.001). There was only a partial return to work after transplantation. Employment rates increased in ESKD patients in the period 2005-2019, however, the increase was not different from corresponding reference groups.

Conclusions: Employment rates in ESKD patients are very low and decline long before initiation of dialysis or kidney transplantation. Of concern, kidney transplantation only leads to a small increase in employment. There has been no improvement in the employment of ESKD patients from the period 2005-2009 to 2015-2019.