Disability under Social Security for patients with ESRD: an evidence-based review

In the United States, all individuals with end-stage renal (ESRD) disease are automatically eligible for disability benefits under the Social Security Act. Recently, there have been questions about whether the diagnosis of ESRD alone is an appropriate criterion for determining disability under Social Security.

We conducted a systematic review of the published literature and de novo analysis of data from the United States Renal Data System (USRDS) in an attempt to identify the best predictors of inability to work that might be useful during the disability determination process.

The published literature yielded little relevant evidence. The USRDS provided a prospectively-collected set of data on 4,026 incident dialysis patients over their first year on dialysis, a time period particularly applicable to the key questions. However. data from over half of the patients were missing for the most important variables to this project, and only 42% of patients completed the one-year follow-up questionnaire. These limitations rendered de novo analyses unreliable. However, summary statistics did reveal a decreasing number of working individuals over time, from 41.9% before the initiation of dialysis. to 21.1% at initiation, and 6.6% a year later.