Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark.
Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, OUS, Rikshospitalet, 0372, Oslo, Norway.
BMC Nephrol. 2021 Oct 22;22(1):348. doi: 10.1186/s12882-021-02552-2.
Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and kidney transplantation and to identify predictors of employment during dialysis and posttransplant.
This systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross-sectional or cohort studies published in English between January 1966 and August 2020 in the PubMed, Embase, and Cochrane Library databases. Data on employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment, with odds ratios and confidence intervals, and tests for heterogeneity, using chi-square and I statistics, were calculated. PROSPERO registration number: CRD42020188853.
Thirty-three studies included 162,059 participants receiving dialysis, and 31 studies included 137,742 participants who received kidney transplantation. Dialysis patients were on average 52.6 years old (range: 16-79; 60.3% male), and kidney transplant patients were 46.7 years old (range: 18-78; 59.8% male). The employment rate (weighted mean) for dialysis patients was 26.3% (range: 10.5-59.7%); the employment rate was 36.9% pretransplant (range: 25-86%) and 38.2% posttransplant (range: 14.2-85%). Predictors for employment during dialysis and posttransplant were male, gender, age, being without diabetes, peritoneal dialysis, and higher educational level, and predictors of posttransplant: pretransplant employment included transplantation with a living donor kidney, and being without depression.
Patients with kidney failure had a low employment rate during dialysis and pre- and posttransplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure that they remain working.
接受透析或肾移植治疗的肾衰竭患者由于疾病本身和治疗而难以维持就业。我们旨在确定透析和肾移植前后开始时的就业率，并确定透析期间和移植后就业的预测因素。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行，该指南纳入了接受透析或肾移植的成年人的就业率研究。文献检索包括 1966 年 1 月至 2020 年 8 月期间在 PubMed、Embase 和 Cochrane Library 数据库中发表的横断面或队列研究。提取就业率、研究人群、年龄、性别、教育水平、透析时间、肾供体、种族、透析方式、移植等待时间、糖尿病和抑郁的数据。使用纽卡斯尔-渥太华量表进行质量评估。使用优势比和置信区间计算就业预测因素的荟萃分析，并使用卡方和 I 统计量进行异质性检验。PROSPERO 注册号：CRD42020188853。
33 项研究纳入了 162059 名接受透析的参与者，31 项研究纳入了 137742 名接受肾移植的参与者。透析患者的平均年龄为 52.6 岁（范围：16-79；60.3%为男性），肾移植患者的平均年龄为 46.7 岁（范围：18-78；59.8%为男性）。透析患者的就业率（加权平均值）为 26.3%（范围：10.5-59.7%）；移植前的就业率为 36.9%（范围：25-86%），移植后的就业率为 38.2%（范围：14.2-85%）。透析和移植后就业的预测因素包括男性、性别、年龄、无糖尿病、腹膜透析和较高的教育水平，移植后的预测因素包括：移植前的就业包括活体供肾移植，以及无抑郁。
肾衰竭患者在透析和移植前、移植后就业率较低。肾衰竭患者应通过临床和社会措施相结合来提供支持，以确保他们继续工作。
