American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026
Paid Employment and Ability to Work Among People Receiving Dialysis: A Systematic Review of Qualitative Studies.
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Zhang Ao, Martin Adam, Manera Karine, Guha Chandana, Howell Martin, Natale Patrizia, Scholes-Robertson Nicole, Sabanayagam Dharshana, Levin Adeera, Winkelmayer Wolfgang, Erickson Kevin F, Wong Germaine, Jaure Allison, van Zwieten Anita
Аннотация
RATIONALE & OBJECTIVE: People receiving dialysis have reduced workforce participation, which can affect mental well-being and exacerbate the financial burden of dialysis. This study describes the experiences and perspectives of people receiving dialysis on employment and their ability to work.
STUDY DESIGN: Systematic review and thematic synthesis of qualitative studies.
SETTING & STUDY POPULATIONS: Adults aged 16 years and over receiving dialysis.
SEARCH STRATEGY & SOURCES: MEDLINE, Embase, and PsycINFO were searched to May 2025 for qualitative and mixed-methods studies that reported the perspectives of people receiving dialysis on employment or ability to work.
DATA EXTRACTION: Text from results and conclusions of studies.
ANALYTICAL APPROACH: Thematic synthesis.
RESULTS: The analysis included 37 studies involving 1,374 participants from 17 countries/regions. Six themes were identified: impinging on capacity to work (lacking physical endurance and energy, battling with cognitive symptoms, grueling treatment schedule), narrowed vocational opportunities and financial insecurity (unfulfilled dreams and worry about job prospects, struggling to stay afloat financially), discrimination and stigma (overlooked by potential employers, being pushed out of jobs or fired, delaying or avoiding disclosure of dialysis), conducive workplace environments (empathy and support from managers and colleagues, occupational adjustments), managing dialysis around work (choosing a suitable dialysis type to support work, careful time management and scheduling), and fostering esteem, enjoyment, and social connection.
LIMITATIONS: Only English-language articles were included.
CONCLUSIONS: Among people receiving dialysis, the symptom and treatment burdens, lack of workplace accommodations, and discrimination all compromised sustained employment. Conversely, supportive workplaces that implemented tailored occupational adjustments enabled work participation, thereby boosting psychosocial well-being. Workplace advocacy and flexible work arrangements, symptom management, and aligning dialysis modality choices and timing with work demands may help to improve participation and work ability among people on dialysis.
TRIAL REGISTRATION: Registered at PROSPERO with identification number CRD42023424482.
PLAIN-LANGUAGE SUMMARY: Many people receiving dialysis want to work, but maintaining paid employment can be challenging. Work is important not only for income but also for identity and social connection. We reviewed 37 studies to examine how people on dialysis experience work. People described that fatigue and the time demands of dialysis often limited their ability to work. Many also faced discrimination, job loss, or a lack of understanding from employers. However, supportive workplaces, flexible hours, and choosing dialysis options that accommodate work schedules helped people to remain employed. These findings show that better workplace support, flexible work arrangements, and health care that considers employment needs may help people on dialysis remain employed and support their well-being.
STUDY DESIGN: Systematic review and thematic synthesis of qualitative studies.
SETTING & STUDY POPULATIONS: Adults aged 16 years and over receiving dialysis.
SEARCH STRATEGY & SOURCES: MEDLINE, Embase, and PsycINFO were searched to May 2025 for qualitative and mixed-methods studies that reported the perspectives of people receiving dialysis on employment or ability to work.
DATA EXTRACTION: Text from results and conclusions of studies.
ANALYTICAL APPROACH: Thematic synthesis.
RESULTS: The analysis included 37 studies involving 1,374 participants from 17 countries/regions. Six themes were identified: impinging on capacity to work (lacking physical endurance and energy, battling with cognitive symptoms, grueling treatment schedule), narrowed vocational opportunities and financial insecurity (unfulfilled dreams and worry about job prospects, struggling to stay afloat financially), discrimination and stigma (overlooked by potential employers, being pushed out of jobs or fired, delaying or avoiding disclosure of dialysis), conducive workplace environments (empathy and support from managers and colleagues, occupational adjustments), managing dialysis around work (choosing a suitable dialysis type to support work, careful time management and scheduling), and fostering esteem, enjoyment, and social connection.
LIMITATIONS: Only English-language articles were included.
CONCLUSIONS: Among people receiving dialysis, the symptom and treatment burdens, lack of workplace accommodations, and discrimination all compromised sustained employment. Conversely, supportive workplaces that implemented tailored occupational adjustments enabled work participation, thereby boosting psychosocial well-being. Workplace advocacy and flexible work arrangements, symptom management, and aligning dialysis modality choices and timing with work demands may help to improve participation and work ability among people on dialysis.
TRIAL REGISTRATION: Registered at PROSPERO with identification number CRD42023424482.
PLAIN-LANGUAGE SUMMARY: Many people receiving dialysis want to work, but maintaining paid employment can be challenging. Work is important not only for income but also for identity and social connection. We reviewed 37 studies to examine how people on dialysis experience work. People described that fatigue and the time demands of dialysis often limited their ability to work. Many also faced discrimination, job loss, or a lack of understanding from employers. However, supportive workplaces, flexible hours, and choosing dialysis options that accommodate work schedules helped people to remain employed. These findings show that better workplace support, flexible work arrangements, and health care that considers employment needs may help people on dialysis remain employed and support their well-being.