Employment and life participation in patients with kidney disease: a narrative review

People living with kidney disease consistently rank employment and the ability to participate in life activities among their most important outcomes, yet employment among working-aged U.S. patients at dialysis initiation has remained at 20-24% for more than two decades. This review synthesizes recent evidence on why patients with kidney disease stop working and what may help them remain employed.

Job loss begins well before dialysis: only about one-third of working-aged U.S. patients are employed 6 months before starting dialysis, and employment is lowest among patients receiving in-center hemodialysis, recovering only partially after transplantation. Employment is associated with better survival, greater access to transplantation, improved mental health, social connectedness, and protection from illness-related financial insecurity. Patients stop working for multiple reasons, including symptoms, treatment time and travel, employer inflexibility, and benefit structures that penalize work. Flexible dialysis options (home dialysis, evening shifts), psychosocial support, exercise, and vocational rehabilitation may help patients remain employed.

Employment is a modifiable, patient-prioritized outcome. Restoring patient-level employment reporting in national registries and directly testing employment-focused interventions in kidney disease are priorities for research and quality improvement.