Pre-dialysis patients' perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study

Patients (N = 109) completed questionnaires at home. Data were analysed using bivariate and multivariate analyses.The results showed that the average autonomy levels were not very high, but the average level of self-esteem was rather high, and that drop out of the labor market already occurs during the pre-dialysis phase. Positive illness and treatment beliefs were associated with higher autonomy and self-esteem levels, but not with employment. Multiple regression analyses revealed that illness and treatment perceptions explained a substantial amount of variance in autonomy (17%) and self-esteem (26%). The perception of less treatment disruption was an important predictor.Patient education on possibilities to combine CKD and its treatment with activities, including paid work, might stimulate positive (realistic) beliefs and prevent or challenge negative beliefs. Interventions focusing on these aspects may assist patients to adjust to CKD, and ultimately prevent unnecessary drop out of the labor market.Chronic renal failure, also referred to as end-stage renal disease (ESRD; chronic kidney disease (CKD) stage V), is a permanent condition which requires renal replacement therapy (peritoneal dialysis, haemodialysis or transplantation) to maintain life. At the end of 2005, approximately 1,9 million people were receiving renal replacement therapy worldwide [1]. In January 2006, 12,038 people in the Netherlands received renal replacement therapy (737 people per million Dutch residents) [2]. ESRD is associated with specific disease and treatment aspects. Patients with ESRD often experience physical symptoms such as fatigue, pain, cramps and itching [3]. Furthermore, patients are extremely dependent on treatment and the treatment itself - dialysis in particular - places substantial behavioral and psychosocial demands on the patient. Neto et al. [4] showed that the quality of life of ESRD patients is already lowered at the initiation of dialysis treatment, which was clearly