Employment and Economic Activity Among Patients with End-stage Renal Disease on Maintenance Dialysis: A Cross-sectional Study from North India
Vishal Pooniya, Abhilash Chandra, S Namrata Rao, Amit Kumar Singh, Nisha PandeyIntroduction:
Initiating maintenance dialysis for end-stage renal disease (ESRD) is widely recognised as a critical barrier to sustained employment. Job loss in this setting carries consequences well beyond income — it affects self-esteem, psychological wellbeing, and day-to-day quality of life. Indian data on vocational outcomes in dialysis patients, particularly from resource-limited public-sector settings, are sparse. This study aimed to estimate the proportion of patients on maintenance dialysis who remain employed and to identify factors associated with retaining employment.
Methods:
This cross-sectional observational study was conducted between January 2020 and September 2021 at a 1,250-bed public tertiary care hospital in North India. Consecutive patients aged 18-65 years with ESRD who had been on maintenance dialysis for at least three months were enrolled. Clinical, demographic, and socioeconomic data were recorded. Employment status was assessed both at the time of dialysis initiation and at study enrolment, and factors associated with retention were examined using multiple logistic regression. The study was reported in accordance with STROBE guidelines.
Results:
Of the 225 patients enrolled, 155 (68.9%) had been in some form of employment before starting dialysis; only 35 (15.6%) remained employed at the time of study inclusion — a job-loss rate of 78.1% among those who had previously worked. Loss of employment was universal among unskilled workers and reached 91.2% in the skilled category. On multivariate logistic regression, factors independently associated with higher odds of retaining employment were peritoneal dialysis as the treatment modality (OR 17.26; 95% CI 3.54-84.15), self-financing of treatment (OR 6.03; 95% CI 1.93-18.81), professional occupational category before dialysis (OR 6.02; 95% CI 1.77-20.41), and nuclear family residence (OR 3.76; 95% CI 1.33-10.61). Greater distance from the dialysis centre was independently associated with job loss.
Discussion:
The degree of occupational disruption recorded here is more pronounced than that typically reported from high-income countries, which likely reflects the absence of welfare safety nets, restricted workplace flexibility, and the logistical demands of in-centre haemodialysis in this setting. The strong association between peritoneal dialysis and employment retention points to the occupational advantages of home-based modalities. Reliance on government-funded treatment in the context of job loss raises concern about a welfare trap effect. The protective role of nuclear family structure is a contextually specific finding that has not featured prominently in published literature from other regions.
Conclusion:
In this North Indian public-sector cohort, the majority of ESRD patients on dialysis lost their jobs after treatment began, and only one in six remained employed at the time of assessment. Peritoneal dialysis, nuclear family structure, self-financed treatment, and professional occupational status were each associated with higher odds of remaining in work. Pre-dialysis vocational counselling and greater availability of home-based dialysis modalities may help protect the economic productivity of this patient group.