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Author Notes:

Correspondence: nkutner@emory.edu; Tel.: +1-404-712-5561

Research idea and study design: N.G.K., R.Z.; data acquisition: N.G.K., R.Z.; data analysis and interpretation: N.G.K., R.Z.; statistical analysis: R.Z.

Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

N.G.K. takes responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

The authors gratefully acknowledge the participation in the AAS of persons on dialysis and the assistance of study coordinators at the Atlanta and San Francisco study sites.

The results presented in this paper have not been published previously in whole or part except in abstract form.

The authors declare no conflict of interest.

The interpretation and reporting of the data presented here are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.


Research Funding:

This research was supported by National Institutes of Health (NIH) contract HHSN267200715004C, ADB No. N01-DK-7-5004 and by NIH grant R01 DK42949 to Kutner (PI).


  • ability to work
  • dialysis
  • employment
  • end-stage kidney disease
  • quality indicators
  • quality of care

Ability to Work among Patients with ESKD: Relevance of Quality Care Metrics.


Journal Title:



Volume 5, Number 3


, Pages 42-42

Type of Work:

Article | Final Publisher PDF


Enabling patient ability to work was a key rationale for enacting the United States (US) Medicare program that provides financial entitlement to renal replacement therapy for persons with end-stage kidney disease (ESKD). However, fewer than half of working-age individuals in the US report the ability to work after starting maintenance hemodialysis (HD). Quality improvement is a well-established objective in oversight of the dialysis program, but a more patient-centered quality assessment approach is increasingly advocated. The ESKD Quality Incentive Program (QIP) initiated in 2012 emphasizes clinical performance indicators, but a newly-added measure requires the monitoring of patient depression-an issue that is important for work ability and employment. We investigated depression scores and four dialysis-specific QIP measures in relation to work ability reported by a multi-clinic cohort of 528 working-age maintenance HD patients. The prevalence of elevated depression scores was substantially higher among patients who said they were not able to work, while only one of the four dialysis-specific clinical measures differed for patients able/not able to work. Ability to work may be among patients' top priorities. As the parameters of quality assessment continue to evolve, increased attention to patient priorities might facilitate work ability and employment outcomes.

Copyright information:

© 2017 by the authors. Licensee MDPI, Basel, Switzerland.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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