title: Social functioning and socioeconomic changes after introduction of regular dialysis treatment and impact of dialysis modality: a multi-centre survey of Japanese patients.
abstract: OBJECTIVE
  Patient socialization and preservation of socioeconomic status are important patient-centred outcomes for those who start dialysis, and retention of employment is a key enabler. This study examined the influence of dialysis inception and modality upon these outcomes in a contemporary Japanese cohort.
  
  
  METHODS
  We conducted a survey of prevalent chronic dialysis patients from 5 dialysis centres in Japan. All patients who had been on peritoneal dialysis (PD) since dialysis inception were recruited, and matched with a sample of those on in-centre haemodialysis (ICHD). We assessed patients' current social functioning (Short Form 36 Health Survey), and evaluated changes to patient employment status, annual income, and general health condition from the pre-dialysis period to the current time.
  
  
  RESULTS
  A total of 179 patients were studied (102 PD and 77 ICHD). There were no differences in social functioning by modality. Among them, 113 were employed in the pre-dialysis period with no difference by modality. Of these, 22% became unemployed after dialysis inception, with a corresponding decline in average working hours and annual income. The odds of unemployment after dialysis inception were 5.02 fold higher in those on ICHD compared to those on PD, after adjustment for covariates. There were no changes for those who were already unemployed in the pre-dialysis period.
  
  
  CONCLUSIONS
  Employment status is significantly hampered by dialysis inception, although PD was associated with superior retention of employment and greater income compared to ICHD. This supports a positive role for PD in preservation of socioeconomic status and potentially other patient-centred outcomes.
authors: Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors: Masaaki
authors: M
authors: Nakayama
authors: Nephrology, Kitasaito Hospital, Hokkaido, Japan.
authors: Mari
authors: M
authors: Ishida
authors: Nephrology, Ogihara Hinyouki to Me No Clinic, Fukushima, Japan.
authors: Masahiko
authors: M
authors: Ogihara
authors: Nephrology, Tokyo Jikei University School of Medicine, Tokyo, Japan.
authors: Kazushige
authors: K
authors: Hanaoka
authors: Nephrology, University of Occupational and Environmental Health, Fukuoka, Japan.
authors: Masahito
authors: M
authors: Tamura
authors: Nephrology, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Hidetoshi
authors: H
authors: Kanai
authors: Clinical Development and Medical Afairs, Baxter Limited, Tokyo, Japan.
authors: Yukio
authors: Y
authors: Tonozuka
authors: Medical Affairs, Baxter Healthcare Asia-Pacific, Auckland, New Zealand.
authors: Mark R
authors: MR
authors: Marshall
mesh_terms: D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D007182:Income; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics / Q000523:psychology; D017064:Process Assessment, Health Care / Q000191:economics; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000523:psychology; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D012919:Social Behavior; D012951:Socialization; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014478:Unemployment
keywords: employment; haemodialysis; income; peritoneal dialysis; working hours