1. Introduction

In the Republic of Uzbekistan, the prevalence of end-stage chronic kidney disease (CKD) requiring renal replacement therapy is 149 cases per 1 million population. With a need for kidney transplantation of 30 cases per 1 million population per year (according to referral, taking into account the possibility of only related transplantation), an average of 8-9 transplants per 1 million population per year are performed in the republic.

In recent years, various researchers and international working groups have noted that the study of health-related quality of life (QOL) is an important tool for assessing the effectiveness and quality of care provided by patient-centered RTR [1,2,3]. In the vast majority of international studies of QOL in RTR, the universal health-related quality of life questionnaire SF-36 was used. In studies that studied the impact of socio-demographic parameters on the QOL of the RTR, significantly high rates of both mental and physical components of QOL were found in the RTR who continued their labor activity, compared with the unemployed, a higher degree of positive correlation of QOL indicators with the predominantly mental nature of work and the presence of higher professional education [4]. An important task of RTR rehabilitation is the ability to return the patient to the previous social interaction. Factors such as education and employment are significant here.

Lilly Kirkeskov et al conducted a systematic review and meta-analysis of 31 studies including 137,742 participants who underwent kidney transplantation between 1966 and 2020 (mean age 46.7 years, 59.8% men). For kidney transplant recipients, the pre-transplant occupancy rate (weighted average) was 36.9% (range: 25-86%) and 38.2% post-transplant (range: 14.2-85%). Employment predictors for RTR were male gender, age, absence of diabetes, and higher educational attainment, as well as pre-transplant employment, living-donor kidney transplantation, and absence of depression [5]. The authors concluded that patients with renal insufficiency receiving renal replacement therapy, including those after kidney transplantation, had low employment and this category of patients, in addition to clinical and medical measures, needs social support to help maintain or continue their employment.

The presence of education implies the opportunity to fully realize oneself in any type of activity, employment, respectively, to provide oneself with the necessary material level. This is especially true for young recipients, because chronic kidney disease, RTR, disability delay the opportunity to get an education and find a job. Some countries, such as Norway, provide economic and practical assistance to young people with chronic diseases, including efforts to integrate RTR into social, cultural and family life. W. Aasebo et al. [6] report that 42% of young RTR s in Norway had higher education. This indicator was 1.5 times higher than the general population indicator of the country, however, 25% of the RTP were still not employed. S. F. Niu et al. [7] note that the level of education and employment among RTR is significantly higher than among patients on other types of RTR.

Thus, the aspect of the influence of demographic and social factors, in particular the level of education and employment of patients, on the quality of life of RTR requires further study, and it is impossible to draw an unambiguous conclusion about this effect.

Purpose of the study: To study and evaluate the influence of some socio-demographic factors, in particular the level of education and employment of the RTR on the indicators of their QOL.

2. Material and Methods

In 78 RPTs who gave informed consent to the study, QOL indicators were studied using a modified SF-36 questionnaire, taking into account the socio-demographic and clinical and laboratory characteristics of patients.

Health-related quality of life was assessed using the SF-36 questionnaire, where 36 items of the questionnaire were grouped into 8 scales:

- Physical functioning, i.e. ability to withstand physical activity (PF);

- Role physical functioning, reflecting the impact of physical condition on daily activities (RP);

- Intensity of pain and impact of pain on daily activities (BP);

- General health (GH);

- General activity, vitality (VT);

- Social functioning (SF);

- Role emotional functioning, which characterizes the influence of the emotional state on daily activities (RE);

- Mental health (MH).

The absence of restrictions corresponds to 50% of the results on these scales, and the maximum values (up to 100 points) indicate the predominance of positive statements and a favorable assessment of one's health. Two integral indicators of QoL were also calculated: the physical component of health (PHgen), consisting of the first 4 scales, and the mental component of health (MHgen), integrating the assessments of mental health scales.

The questionnaire was modified - the survey was conducted online through Google forms in Uzbek and Russian.

3. Results and Discussion

According to the results of studies, in the RTR group with higher education (30.7%), indicators of QOL on most scales of physical (PF, p=0.002, RP, p=0.026) and mental (RE p=0.028, MH p=0.026), as well as health status (p=0.063) and general mental health (p=0.044) significantly exceeded the indicators of RTR with secondary or secondary specialized education.

Table 1. Indicators of QOL in RTR depending on the level of education

Evaluation of the impact of employment on the QOL of the RTR showed that the parameters of QOL on 5 out of 8 scales (PF (p = 0.092), RP (p = 0.009), GH (p = 0.098), RE (p = 0.001), MH (p = 0.031), as well as MHgen (p=0.013) is significantly higher in the group of RTRs who continue working.

Table 2. Indicators of QOL in RTR depending on the level of employment

These data are in good agreement with the results of the majority of foreign studies, which found a higher subjective assessment of QOL in RTRs who continued to work [5,7,8]. So, Pikalova N.N. notes that employment causes a higher assessment of the QOL of the RTP on the scales of physical and mental health (PF, BP, MH), according to M. Neipp [9] the QOL indicators of working RTR on three scales of the physical component of health (PF, BP, GH) and on three scales of the mental component of health (VT, SF, MH) exceeds the QOL indicators of unemployed RTRs. Employability is a factor influencing not only the survival of recipients and graft [10], but also the quality of life. The predominantly mental nature of labor allows you to save physical resources, which indirectly affects a higher subjective assessment of physical health. Employment, being a vital necessity for every person, makes it possible to more fully realize their abilities, to assert themselves, feeling their usefulness in the family and society.

4. Conclusions

The results of the study show that in the group of RTRs with higher education and employment, the indicators of QOL, on most scales of physical and mental components of health, as well as on the integral indicator of mental health, significantly exceed similar indicators of QOL of RTRs with secondary education and unemployed.

Thus, such socio-demographic factors as the presence of higher education, employment, as well as the predominantly mental nature of work act as independent factors that have a positive effect on QOL and the functioning (survival) of the graft, providing better medical and social rehabilitation of RTR.