Factors associated with employment in end-stage kidney disease patients at the initiation of chronic dialysis or kidney transplantation—a national register-based cohort study

End-stage kidney disease (ESKD), requiring chronic dialysis or kidney transplantation, significantly affects work ability. This study aimed to identify factors associated with employment in ESKD patients at the initiation of dialysis and at the time of kidney transplantation, and to determine if these factors differ from those in a matched reference group from the general population. ESKD patients aged 18–65 years who initiated dialysis or underwent kidney transplantation for the first time between 2005 and 2019 were identified via the Danish Nephrological Registry. These patients were matched with three individuals from the general population based on age, sex, and municipality. Socioeconomic data and information on government benefits were also linked. Multiple logistic regression analyses were conducted to identify employment-associated factors. The study included 4,469 dialysis patients (median age 55 years, 65% males) matched with 13,262 individuals and 2,294 kidney transplantation patients (median age 49 years, 64% males) matched with 6,790 individuals. Employment rates were significantly lower in ESKD patients compared to their matched reference groups: 11.2% versus 61.2% at dialysis initiation, and 19.8% versus 67.4% at transplantation. Male sex and higher education were associated with employment in both patient and reference groups. However, age, ethnicity, education, and the absence of diabetes (in dialysis patients) and ischemic heart disease (in transplant patients) had a stronger association with employment in the reference group. For ESKD patients, peritoneal dialysis, shorter dialysis duration, preemptive transplantation, and absence of comorbidities were positively associated with employment. Ethnic Danish patients were more likely to be employed than immigrants, particularly among transplant recipients. While male sex, higher education, ethnicity, and the absence of comorbidities were positively associated with employment in both ESKD and reference groups, these factors were less impactful in ESKD patients. ESKD remains a primary driver of unemployment, underscoring the need for early intervention and tailored support to maintain work ability.