What happens when one of your employees tells you that he or she will be needing time off two or three times a week for dialysis? Or that because of dialysis, he or she will require extra rest breaks?

Answer: You must accommodate their requests.

Kidney Disease

Kidney disease is one of the most common — and dangerous — health conditions, affecting over 26 million Americans. And most don’t even know they have it. The two main causes of kidney disease are diabetes and high blood pressure. With one out of three people at risk for developing it, chances are that most businesses have employees with some stage of the disease, which may ultimately lead to kidney failure.

What the Kidneys Do

Kidneys serve many crucial functions in the human body. According to the National Kidney Foundation, kidneys are constantly working to:

• Monitor the fluid volume in the body
• Filter and purify the blood every 30 minutes
• Produce a hormone that regulates blood pressure
• Help direct and regulate the production of red blood cells
• Balance important electrolytes such as sodium, potassium, and phosphorus
• Maintain healthy bones by activating Vitamin D

Symptoms of Trouble

Because the progression from early kidney disease to kidney failure is usually gradual, most people aren’t aware that they need medical evaluation and treatment. Initially, there are no signs or symptoms; the only way to find out if the kidneys are damaged is by a urine test or blood test. If detected in the early stages, changes in diet, regular exercise, as well as monitoring blood pressure and glucose levels, can prevent the condition from getting worse.

Eventually, employees — and their supervisors — may notice fatigue, weakness, decreased concentration or a change in job performance. Employees may also experience nausea, vomiting, weight loss, changes in urine output, and sleep problems. At this point, the kidney disease may be advanced, with only 10-15% of kidney function remaining. Dialysis is likely a medical necessity.

Hemodialysis

By the time an employee receives dialysis, their kidneys have failed. The process that cleanses the blood of wastes and toxins is not working. Easily done by healthy kidneys, it now has to be performed by a machine. Dialysis (short for hemodialysis) is the medical way of performing normal kidney functions, only outside of the body, with the assistance of a machine.

Hemodialysis is done at a dialysis center, a specialized outpatient facility. Patients are connected to a hemodialyzer machine which has a membrane that filters the blood, just as the kidneys would. The process is done three times a week for about four hours each time. At first, patients feel tired after their dialysis sessions, but should soon feel better than before they began dialysis. Still, extra rest breaks may be ordered by the patient’s doctor.

Aside from the time required to attend dialysis, employees will also be on special diets that control how much sodium, potassium, and fluid they have in their bodies. If they are also diabetic, there will be other food restrictions. As the employer, you will want to provide appropriate food storage and preparation facilities.

Work During Hemodialysis

Can employees continue to work while undergoing dialysis? Yes, especially after they adjust to their treatment regime. The Job Accommodation Network (JAN) of the U.S. Department of Labor notes that each person with kidney failure may require a specific plan, but offers the following general accommodation suggestions in order for employers who employ more than 15 people to comply with the Americans with Disabilities Act (ADA):

1. Allow for flexible work hours, leave time, and rest periods.

2. If physical job requirements (Learn more in Physical Demands Analysis 101) are too much, a less demanding job may be necessary.

3. For dietary restrictions, give enough time for proper breaks and food preparation.

4. Employees with late-stage kidney disease or on dialysis may need more time to commute, more breaks, and a job transfer closer to their home.

Legal Rights and Benefits for Employees

Employees have rights under ADA when they choose to stay at their jobs during dialysis. They may be eligible for the Family and Medical Leave Act (FMLA) which allows for up to twelve weeks of unpaid leave during a twelve-month year. They can request reasonable accommodation to help them perform essential job functions. And, if they are denied, they can file for discrimination with the Equal Employment Opportunity Commission (EEOC).

End Stage Renal Disease, which requires dialysis, can be covered by Medicare, regardless of the patient’s age. Once an employee is on a dialysis regime, he or she can apply for Medicare benefits. The wait for Medicare coverage can be as short as 90 days from the first dialysis treatment. If the employee has healthcare insurance through the employer and decides to use Medicare as a supplemental plan, there is a 33-month Coordination of Benefits (COB) period, when the employer insurance plan is the primary payer. Medicare then covers costs not included in the primary plan. Benefits between the employer and Medicare are best handled by an expert or the social worker at the dialysis center.

Working is Important for Hemodialysis Patients

For employees who choose to continue to work while on dialysis treatments, their jobs are important to them in several ways:

• Jobs help keep lives structured.
• Employees can maintain their sense of identity and self-worth.
• They can have an income, even if working part-time.
• Benefits remain intact for the employee and dependents.

With the rate of diabetes and high blood pressure rising, along with the aging of the American work force, employers should be aware of the probability of kidney disease among employees and be ready to implement a protocol for those who may require dialysis.