Impact of end-stage kidney disease on academic achievement and employment in young adults: a mixed methods study.
OBJECTIVE
Young adult kidney patients are at an important stage of development when end-stage kidney disease (ESKD) may adversely influence progress in education and employment. This study is designed to assess the impact of ESKD on education and employment outcomes in young adults.


METHODS
This cross-sectional study was a mixed methods design. Education and career achievements in young adults with ESKD were recorded quantitatively using a questionnaire survey (n = 57): 14 of 57 representative participants were subsequently selected for semistructured interview.


RESULTS
Questionnaire survey was conducted in 57 young adults (median age 25): 8.8% (n = 5) were predialysis; 14.0% (n = 8) dialysis; and 78.9% (n = 45) were kidney transplant recipients. Median school-leaving age was 16 (interquartile range = 15-19). Of 57 young adults, 10 (17.5%) were still studying, 43 (75.4%) had completed education, 34 (59.7%) were employed (23 full time and 11 part time), and 19 (33.3%) were unemployed. Twenty-seven of 45 transplanted patients were employed (60.0%). Of these 27, 21 were full time (77.8%). Five of eight dialysis patients were employed: only one of eight was full-time employed (12.5%). Themes impacting on education and employment included low energy levels, time missed, loss of self-esteem, and feelings of loneliness and isolation, which may progress to depression and recreational drug use. Lack of understanding from educators and employers resulting in lost work, and career ambitions changed or limited because of dialysis.


CONCLUSIONS
Dialysis has a major negative impact on education and reduced employment rates of young adults. There is a general lack of understanding among educators and employers of the impact of ESKD. Low energy levels, lack of self-esteem, and depression are key factors. There is a need for health care providers to recognize this issue and invest in supporting young adults with ESKD.
Oxford Kidney Unit and Transplant Centre, Churchill Hospital, Oxford, United Kingdom.
Peter D
PD
Murray
Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium.
Fabienne
F
Dobbels
Oxford Kidney Unit and Transplant Centre, Churchill Hospital, Oxford, United Kingdom.
Daniel C
DC
Lonsdale
Oxford Kidney Unit and Transplant Centre, Churchill Hospital, Oxford, United Kingdom. Electronic address: pnharden@hotmail.co.uk.
Paul N
PN
Harden
D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D055815:Young Adult
Depression; ESKD; Education; Employment; End-stage kidney failure; Nonadherence; Pediatrics; Semistructured interviews; Unemployment rates; Young adult clinic; Youth worker