The socioeconomic impact of rehabilitation.

Rehabilitation of patients with end-stage renal disease (ESRD) should encompass all aspects of the patient's well-being and include vocational, physical, and medical therapies. This would be best achieved by careful management of the patient before the start of dialysis, as well as by provision of adequate dialysis in the most appropriate setting for the individual patient's needs. Before starting dialysis, blood pressure should be well controlled, nutrition maintained, and human recombinant erythropoetin (epoetin) used as necessary to prevent the development of anemia. In patients who are employed, efforts should be made to maintain employment, and vocational counseling should be provided to unemployed patients who are capable of work. Physical well-being should be maintained by encouraging participation in an exercise program. Social, financial, and other counseling should be provided as necessary, together with patient education regarding treatment, including modalities and other aspects of care. The social impact of these efforts primarily will be on the patient's quality of life, and secondarily, on family members and friends. Quality of life depends on many factors, including modality of treatment and adequacy of dialysis. Economic impact also depends on many factors. Providing optimal care before starting dialysis, including the use of epoetin where appropriate, will increase the cost both for drugs and staff. For patients who are able to continue working or can be successfully retrained, these costs will be offset to some degree in the future by taxes paid by the patient and by the patient not participating in the Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI) programs.(ABSTRACT TRUNCATED AT 250 WORDS)