The Effect of Peritoneal Dialysis on Labor Market Outcomes Compared with Institutional Hemodialysis

Perit Dial Int. 2019 Jan-Feb;39(1):59-65. doi: 10.3747/pdi.2017.00236. Epub 2018 Sep 25.


Background: The aim of this study is to compare the impact of peritoneal dialysis (PD) and institutional hemodialysis (IHD), the 2 most common dialysis modalities, on employment, work income, and disability pension in Sweden.

Methods: Included in this study were 4,734 patients in IHD and PD, aged 20 - 60 years, starting treatment in Sweden during 1995 - 2012, and surviving the first year of dialysis therapy. Both "intention to treat" and "on treatment" analyses were performed by including transplant patients into the former and censoring them at the date of transplant in the latter analysis. A reduced bias treatment effect of PD vs IHD on labor market outcomes was estimated while accounting for non-random selection into treatment.

Results: Peritoneal dialysis was found to be associated with a 4-percentage-point increased probability of employment compared with IHD in the "on treatment" analysis. Also, PD was associated with a reduced disability pension by 6 percentage points, as well as increased work income (EUR 3,477 for employed) compared with IHD during the first year of treatment. The "intention to treat" analysis tended to give higher effect sizes compared with "on treatment."

Conclusions: The results indicate that PD is associated with a treatment advantage over IHD in terms of increased employment, work income, and reduced disability pension in the Swedish population after controlling for non-random selection into treatment.

Keywords: Renal dialysis; disability pension; employment rate; propensity score matching; renal replacement therapy; treatment effect; work income.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cost of Illness*
  • Employment / economics*
  • Female
  • Humans
  • Income / statistics & numerical data*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Propensity Score
  • Renal Dialysis / economics*
  • Sweden
  • Young Adult