Workforce Detachment in Persons with CKD

KEY POINTS: In this study, we identified individuals in the workforce with estimated kidney function based on sequential serum creatinine measurements. Individuals with CKD were more likely to experience workforce detachment. The risk of workforce detachment was graded according to CKD severity. These findings were persistent irrespective of age, sex, diabetes status, and level of education. BACKGROUND: Impaired kidney function is associated with mortality, cardiovascular events, and hospitalization as well as diminished functional capacity and health-related quality of life. We hypothesized that kidney function would be linked to employment status, which itself is closely linked to financial stability, physical and mental health, and personal identity. METHODS: By the use of weekly updated information of patients' occupational status, combined with laboratory data and nationwide registries on hospitalizations and deaths, we estimated kidney function in a working age population (18-60 years) to examine the absolute risk of workforce detachment by CKD status and CKD stage using the Aalen-Johansen estimator accounting for competing risks of retirement, and death. RESULTS: We identified 12,704 individuals with CKD and 68,938 matched individuals without CKD in the workforce at index date. Persons with CKD had a higher absolute risk of workforce detachment (1-year absolute risk: 9% versus 5%, P < 0.001); the absolute risk was higher with more advanced CKD: (1-year absolute risk: eGFR >60 ml/min per 1.73 m 2 =5%; CKD stages G3a=8%, G3b=12%, G4=14%, and G5=20%). Older age, female sex, diabetes, and lower level of education were associated with higher likelihood of workforce detachment. Findings related to kidney function were persistent across all subgroups examined. CONCLUSIONS: Persons with CKD were significantly more likely to experience workforce detachment than persons with normal or near normal kidney function. These data highlight another, less well-documented burden of CKD, highlighting the urgency to develop and disseminate early detection and treatment interventions.