By Jennifer Casey, MSW

As someone with chronic kidney disease (CKD), you can continue to work and spend time doing the things you enjoyed before your CKD diagnosis. There will be adjustments made to your lifestyle, but with the help of your healthcare team and a healthcare plan, you don’t need to let CKD stop you from working.

This article hopes to provide you with tips that will allow you to continue to enjoy your job, as well as prepare you for obstacles that may lay ahead including physical, emotional and financial stress.
Lack of planning and stress can cause:
• Decline in work performance
• Un-planned hospitalization
• Starting dialysis without a plan
• Un-planned time off work
• Utilizing all of your vacation time and sick leave
• Difficulty completing Family and Medical Leave Act (FMLA) paperwork
• Loss of income

This stress may be avoided by having clear expectations of what you need to plan for when you have CKD. Your CKD health regimen is prescribed by your nephrologist who assesses your general well-being by evaluating your lab work and symptoms. Your nephrologists will prescribe treatments to help you live with CKD.

CKD is separated into five stages based on your glomerular filtration rate (GFR). Knowing the stage of CKD you are in will help you plan ahead and coordinate your work schedule with your CKD health regimen.

Integrating the CKD health regimen into your work schedule

CKD Stages 2-5

• Look at your work schedule to see what day of the month works best to schedule your doctor appointments.
• Ask for that time off or change your schedule ahead of time. Giving advanced notice for medical appointments helps you and your employer.
• Telling your superior at work about your CKD is a personal decision. You will have to evaluate your working relationship and how you think this information will affect your job before you decide to share this information.
• Have your blood drawn a week before you see your nephrologist. Your current lab results show your doctor the status of your CKD.
• The frequency of your doctor visits depends on your doctor, your symptoms, lab work and standard guidelines from the National Kidney Foundation.
• Your doctor may inform you that your lab work indicates you are anemic and you need intravenous iron or erythropoiesis stimulating agent (ESA) replacement. IV iron is given by a nurse in an out-patient setting typically lasting about 20 minutes. ESA replacement is a subcutaneous injection given by schedule either in an out-patient setting by a medical assistant or at home by you. These medicines are important to your health and well-being, and can aid in your job performance. Untreated anemia makes doing your job difficult because it can make you feel tired, have low energy, shortness of breath, sadness, intolerance of cold and have a poor appetite.
• Your doctor may refer you to a registered dietitian (RD) to assist you with learning and integrating a CKD diet into your life. A dietitian will help you learn what kind of lunch/snack to pack for work.
• Confirm and maintain your medical insurance; Check to see if your employer offers short and long term disability coverage.
• Check with your employer’s human resources office to see if you qualify for employee benefits such as Short Term Disability, Long Term Disability or a Flex Spending Account. These benefits will come in handy later on if you need to take extended time off work to dedicate to your health. These benefits will also help ensure you get partial or full financial compensation during this time off from work.
• Check with your employer’s human resources office to see if you qualify for FMLA. This federal law for qualified employees states that an employee can take 12 weeks of unpaid leave due to a medical condition which can be taken intermittently or all at one time. The FMLA paperwork requires medical certification and medical records so it can take some time to have it on file. Start this process and complete the paperwork each year so it is already in your employee file if and when you need to use it. For more information about this law and other laws that protect you, please read Employment: A Kidney Patient’s Guide to Working and Paying for Treatment available on www.lifeoptions.org.

CKD Stages 4-5

During Stages 4-5 there are more specific appointments to plan ahead for associated with preparing for dialysis and or a transplant.
• Options education appointment. Your doctor will refer you to an options educator who will help you understand your dialysis and transplantation treatment options.
• Visit a dialysis facility to see what it looks like.
• Transplant education and evaluation appointments. If you qualify, your doctor will refer you to a transplant program covered by your insurance. You will have several medical evaluations to determine if you are a transplant candidate.
• Surgeon appointment. Once you have decided on a therapy, you will have appointments preparing for your dialysis access (fistula, graft or a peritoneal dialysis (PD) catheter) to be placed. After your access is placed you may need to take a couple days off work to recuperate.

CKD Stage 5

When your doctor tells you it is time to start dialysis or you are matched for a kidney transplant you will need to plan on taking time off to recover from surgery or become acquainted with dialysis and complete your training.

Complete human resource paperwork immediately after your nephrologist has informed you it is time for treatment.
• Apply for FMLA if you qualify.
• Use vacation days if you have them.
• If you have and decide to take Short Term Disability, complete the paperwork.
• If you are getting a transplant, plan on taking 4-6 weeks off of work after the surgery to recover and to go to laboratory and doctor appointments to monitor “your new kidney’s function.”
• If you are training for home hemodialysis, plan on taking four hours off a day for 3-4 weeks to train on the machine. After you have completed the training you can do your dialysis at home before or after work on your own time.
• If you are training for PD, plan on taking 4 hours a day for 1-2 weeks to train. After you have completed the training you will most likely have to do at least one 30 minute exchange during your work day. Plan on additional time if you need to train on the cycler.
• If you chose in-center hemodialysis, plan on taking the first 1-2 weeks off to get used to the process. Ask the dialysis center for a dialysis schedule that works with your work schedule.

Maintaining employment is one way to take control of your kidney disease. Planning ahead and integrating your health regimen into your work schedule may help you avoid a health crisis and decrease your stress.

Jennifer Casey, MSW, works with CKD patients at The Southwest Kidney Institute in Tempe, Ariz. For more information about The Southwest Kidney Institute visit www.swkidney.com.

This article appeared in the September 2008 issue of aakpRENALIFE.

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