Work ability and health status in dialysis patients

End stage renal disease (ESRD) is a highly disabling state, conditioning not only patients' quality of life but also the maintenance of their job and social status. The access to work of ESRD patients is a problem which involves hundreds of thousand people in the industrial world and their number will increase in the next years. One of the prominent goals of medicine is to help patients to maintain their ability to participate in social life and to recover their efficiency. The beginning of dialysis seems to be a critical moment for the onset of working disability. Indeed, a fall from 42% to 6% in patients' occupational rates has been recorded, respectively 6 months before and one year after the beginning of dialysis. The variables which may affect the employability of ESRD patients can be grouped into four main categories: demographic, psychological, medical and occupational. Patients' occupational status correlates only partially to their demographic data and to the parameters normally used for the clinical-functional assessment. On the other hand, the subjective dimension plays a significant role in determining the degree of patients' working activity. Unfortunately, few data are available about work type and organization influence. We believe that this area of clinical research is crucial, despite the fact that it has received very little attention. A comprehensive understanding of those factors determining employability, and of the effects of unemployment on health status and life styles, will provide knowledge for a multidisciplinary patient-centered approach to treat and to rehabilitate patients on dialysis