#5743 ALTERNATIVES TO DAYTIME IN-CENTER HEMODIALYSIS AND EMPLOYMENT AMONG PATIENTS WITH KIDNEY FAILURE

Background and Aims Maintaining employment is a priority for many patients with kidney failure. In addition to its economic benefits, employment is associated with physical and psychological wellbeing. Yet, only 30-35% of working aged patients with advanced chronic kidney disease in the United States (US) report employment prior to starting dialysis and many patients stop working at the onset of kidney failure. While access to a dialysis treatment schedule outside of working hours may help patients to remain employed, the effects of alternative dialysis options on employment after starting dialysis are not well understood. Method We analyzed data from the US National Dialysis Registry to determine whether access to nearby facilities offering evening dialysis shifts and home dialysis increases the likelihood that patients are able to continue working after they start dialysis. Our cross-sectional analysis included working-aged patients (ages 18-54) receiving dialysis in US facilities in 2016. We combined information reported at the levels of individual patients and dialysis facilities. In a negative binomial regression model, we examined the associations among exposures of interest (the presence of facilities offering home dialysis and/or evening dialysis shifts in a patient's locality) and the number of employed working-aged adults at each dialysis facility. The multivariable regression model adjusted for observed patient, dialysis facility, and geographic characteristics, including patient health and demographic characteristics, information about individual patient employment at the onset of dialysis, local unemployment rates, and the number of working-aged patients at a given dialysis facility. Results We identified 4,860 US dialysis facilities with information about patient employment in 2016. Median employment among working-aged adults at these facilities was 17.9% (interquartile range 8.8% to 28.6%). In multivariable, fully adjusted, regression models, the presence of at least one facility offering an evening dialysis shift in a county was associated with a 5% increase in the relative rate of maintaining employment among all working-aged patients receiving dialysis in the county (risk ratio (rr) 1.05; 95% Confidence Interval (CI) 1.01 to 1.09; p = 0.02). The presence of at least one facility offering home dialysis in a county was associated with a 26% increase in the relative rate of maintaining employment (RR 1.26; 95% CI 1.18 to 1.34; p<0.001). The likelihood of employment did not increase with additional facilities in a county offering home dialysis. Conclusion Access to dialysis schedules outside of regular working hours – evening dialysis shifts and home dialysis – is associated with increased employment among patients with kidney failure. Efforts to increase access to these alternative dialysis treatments could help patients to continue working.