Home Dialysis and Employment

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Studies show that patients on dialysis who work generally have better overall health and more energy than dialysis patients who don't work. This could be because a job helps you feel good about yourself by giving you a new purpose in life, a sense of success, an income and health insurance (a major plus for dialysis patients). While in-center hemodialysis schedules can make it hard to work regular hours, both home hemodialysis (HHD) and peritoneal dialysis (PD) make it easier to maintain your career by providing you with a more flexible treatment schedule and the option of more frequent treatments, which can result in improved energy and endurance.

If you are one of the thousands of patients on PD or home hemodialysis who are interested in working or are currently working, below are some tips on how best to handle issues that may come up regarding employment while on dialysis.

Prepare your employer and coworkers

If your employer and coworkers are like most people, they probably don't know all that much about chronic kidney disease (CKD) or dialysis. In order to help them understand what you are going through and the ways in which your dialysis can affect your work, you may want to take some time to educate them. Educating the people you work with most closely on a daily basis may benefit you greatly. A good way to approach the situation is to speak with your employer and/or human resources department about your health condition to get advice on how best to educate your coworkers.

Some ideas you and your employer can consider include:

  • Leave educational materials in the break room for people to read
  • Take your employer and coworkers out to lunch and explain your situation
  • Host a small, informal question-and-answer session
  • Send out an educational email going over all the basics
  • Ask your doctor to speak with your employer and coworkers

Know your limitations

It is important to know your limits in the workplace. Pay close attention to your body and get a feel for what you can accomplish in a given day. This will help you recognize when a task or a workload requires too much. Beware of working too hard or for too long. While your job may be important to you, your health should be your top priority. There may be certain tasks that you are simply unable to do because of your health conditions. It is essential that you discuss these limitations with your employer to avoid illness or injury.

Many people who are trying to return to work after having been disabled by illness will find that their energy levels have not fully returned to normal. In this situation, it is often better to start off by working part time rather than jumping right into full-time work. Ideally, you could then gradually increase your workload as your endurance and concentration stabilize. You may want to discuss your interest in returning to work with your doctor to understand what your limitations should be.

For persons already working full time, if you find that your current work schedule is pushing you too much, here are some options you can discuss with your supervisor:

  • Part-time work
  • Sick leave
  • Flexible scheduling
  • Company short-term disability
  • Working from home
  • Changing your job responsibilities

These options provide you with some alternatives to full-time, on-site work and may agree better with your health and lifestyle. If you and your boss decide on one of these options, you should continue to work hard to meet the goals that you and your employer have decided are realistic for you and be sure to adhere to any scheduling or work environment flexibility you have been given.

Fight fatigue

If you are anemic, as many people with end stage renal disease (ESRD) are, you may find that you tire easily. As your kidneys fail, they make less erythropoietin, the hormone responsible for signaling your bone marrow to create red blood cells. As a result, you have fewer blood cells to carry oxygen throughout your body. When your body doesn't get enough oxygen, you may experience:

  • Extreme fatigue
  • Muscle weakness
  • Confusion
  • Shortness of breath
  • Dizziness
  • Rapid heartbeat

However, managing your anemia can help free you from these side effects so that they don't affect your ability to work. Anemia management consists of getting injections of medicine such as Aranesp, Procrit or EPOGEN. Managing your anemia can not only make you feel better and improve your quality of life, it can also make it easier to handle your responsibilities at work.

Other possible causes of fatigue include under-dialysis, fluid management problems, excessive use of medications and sleep disorders. You should discuss fatigue with your doctors to ensure that a treatable cause isn't being overlooked.

Know your rights

The Americans with Disabilities Act (ADA), Titles I and V, states that if an employer has 15 or more employees, he or she must accommodate employees with disabilities. It's important to note that you are not required to tell your employer what kind of disability you have. However, you do have to tell him or her that you have a disability so that you can be accommodated. You also have to give sufficient information to allow your employer to understand the nature of the accommodations that you may need.

It's also wise to know what an employer can and cannot ask of you. An employer can ask you to fill out a health form, but only after he or she has offered you a job. An employer can ask you to take a drug test, in which case you can request a hair or blood test if you do not produce urine.

Peritoneal dialysis in the workplace

Some patients on peritoneal dialysis will need to perform an exchange of dialysis fluid during the day. This can be successfully done in an office room, but it's important to take certain precautions. You will need a clean, private room where you can do a safe, hygienic fluid exchange without interruption or interference. You will want permission from your office supervisor and should have all your supplies stored in that office, including the dialysis fluid, mask, gloves and transfer set. It is a good idea to discuss this with your dialysis nurse, who can give you advice about how best to accomplish this.

Some other things to consider

If you choose to work outside the home, you must still remain committed to taking proper care of yourself. You must remember to carry and take your phosphate binders and other medications. You should continue to follow the diet that has been recommended to you and you must not neglect to do your dialysis treatments as they have been prescribed, regardless of how busy you are at work. Work should not prevent you from keeping yourself well.

Summary

If you are capable of maintaining a job and a career adds joy to your life, there's no reason that you shouldn't give it a try. Ultimately, you must believe in yourself and in your ability to succeed in the workplace. If having a job is something you want to do, talk to your doctor or social worker today about how to address the necessary precautions before you start work.

About Dr. Shapiro

Mark Shapiro, M.D., is a nephrologist who practices in Escondido, CA. He is an Assistant Professor of Medicine at University of California, San Diego , and serves as a peritoneal dialysis medical consultant to DaVita.

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