Fired or Told to Leave Because You Are on Peritoneal Dialysis (CAPD): Medical Facts, Thai Worker and Tenant Rights, and Evidence-Based Ways to Cope

A real story from a kidney patient group: two months on peritoneal dialysis, still working, then pushed out with the words “go and die somewhere else”

A member shared that she started peritoneal dialysis two months ago and moved to another province to work, renting an apartment because she could still do her job.
When the people around her learned she had end-stage kidney disease, she was pushed out with the words “go and die somewhere else, don’t die here.” She said she never wanted to be ill — she was only trying to live.

Direct answer: you did nothing wrong, and the speaker’s fear does not match the medical facts — kidney failure is not contagious, and many people on peritoneal dialysis work.
Three things matter at the same time right now: keeping your body safe (doing every exchange on time), using your rights before deadlines pass, and caring for a hurt mind.
This article does not know whether she lost a job, a room, or both, so the advice covers each case.

1. The medical facts: kidney failure is not contagious, and many people on peritoneal dialysis work

Direct answer: chronic kidney failure is not an infectious disease. It comes from kidney damage due to diabetes, high blood pressure, or glomerulonephritis — there is no germ to pass on.
Peritoneal dialysis uses the patient’s own peritoneal membrane as the filter, with fluid moving in and out through a closed system
(NIDDK).

Not contagious, not contaminating, and no health burden on coworkers

The infection to watch for is infection inside the patient’s own abdomen, from germs on hands or surfaces entering the catheter — not the patient infecting others.
Used fluid can be poured into a toilet, and bags are discarded as the dialysis unit instructs.
A study of 75 people on peritoneal dialysis and their relatives found that patients carry a heavy sense of responsibility for cleanliness, want to be “seen as clean,” and feel ashamed when infection occurs, which made some hesitate to seek help
(Baillie 2024).

How long exchanges take, and how to fit them around work

CAPD usually means 3–4 exchanges a day of about 30–40 minutes each; light activity is fine during an exchange, and normal life continues while the fluid dwells for several hours.
Many people schedule them before leaving home, at lunch, after work, and at bedtime. Automated overnight peritoneal dialysis (APD) runs for about 8–10 hours while you sleep and frees the daytime
(NIDDK).
International Society for Peritoneal Dialysis (ISPD) recommendations call for planning dialysis around the person’s life goals, including work, not just lab values
(Corbett 2020).

The data: how many people on dialysis are employed

A meta-analysis of 33 studies found peritoneal dialysis to be one of the factors associated with employment
(Kirkeskov 2021).
Finnish national data on 2,637 patients showed people on APD were 2.14 times as likely to be employed as those on in-center hemodialysis after adjustment
(Helanterä 2012),
and data on 102,104 working-age patients showed that those who chose peritoneal dialysis first were more likely to keep their jobs
(Muehrer 2011).
Thailand itself ran a peritoneal-dialysis-first policy in its Universal Coverage Scheme from 2008 to 2021, growing from 2,760 to over 25,000 patients
(Boongird 2026).

Honestly: what really makes work harder

• Fatigue and reduced concentration — common on dialysis; ask your doctor about anemia, dialysis adequacy, and sleep
• Heavy lifting or strong abdominal straining — raises abdominal pressure; ask your dialysis nurse what you can lift
• Jobs with no clean space or no breaks — reschedule exchanges or consider APD
• Discrimination and stigma — a review of 37 qualitative studies (1,374 people on dialysis from 17 countries) found many were overlooked, pushed out, or fired,
  while understanding managers and adjusted schedules helped people keep working
  (Zhang 2026)

Table: myths about people on peritoneal dialysis vs the facts

Share with an employer, landlord, or anyone who is still afraid — general information, not a medical certificate

2. Words like “go and die somewhere else” really hurt: depression on dialysis is common and treatable

Direct answer: hurt, shame, anger, and hopelessness after stigma are normal reactions. Those words reflect the speaker’s ignorance and fear, not your worth.
But if these feelings last long enough to affect eating, sleeping, or dialysis, they deserve real care — not just “getting over it.”

Depression on dialysis: about 1 in 4 to 1 in 3

Data from a meta-analysis of 16 studies (26,301 people) using screening tools (Zaragoza-Fernández 2025)

When diagnosed by clinical interview, depression affects 22.8% of people on dialysis; screening questionnaires find depressive symptoms in 39.3%
(Palmer 2013).
Depression is associated with a 1.59-fold higher risk of death in chronic kidney disease
(Palmer 2013),
partly because people without emotional energy tend to dialyze irregularly, eat less, and sleep poorly — so mental health care is part of kidney care.

Why it matters to ask directly about self-harm

US data on people on dialysis showed a suicide rate 1.84 times that of the general population, although it is rare overall
(Kurella 2005).
If you or someone close says “I’m just a burden” or “I don’t want dialysis anymore,” treat it as a signal to talk and call a crisis line (1323 in Thailand), not just venting.

The first 72 hours after being pushed out: what to do first

3. Worker and tenant rights in Thailand: what to know before rights lapse

Direct answer: illness is not a reason an employer can withhold severance, and it is not a breach of a lease. How much you can claim depends on length of service, contract type, and evidence.
The points below are a general overview, not legal advice — call a hotline or consult a lawyer about your actual case.

The core principle: no discrimination on health grounds

Section 27 of Thailand’s 2017 Constitution prohibits unjust discrimination against a person on grounds of physical or health condition — a principle that supports complaints, although specific laws are needed in practice.

If you are dismissed

• Severance (Labour Protection Act, Section 118): employees with at least 120 days of service dismissed without serious misconduct under Section 119 are entitled to severance by length of service, starting at 30 days’ wages — illness is not an exemption
• Pay in lieu of notice (Section 17): for open-ended contracts, the employer must give at least one pay period of notice or pay wages instead
• Ask for a written termination letter with the reason: if serious misconduct is not stated in the letter, it is hard for the employer to raise it later to avoid severance
• Unfair dismissal: dismissal only because of illness, with no harm to the work, may be challenged in the Labour Court under Section 49 of the Labour Court Act, which can order reinstatement or compensation
• File for free: submit a complaint to a labour inspector (form KR.7) or call 1546 — no lawyer needed first

Never sign a resignation under pressure

If you are told to “write a resignation so it won’t be on your record” — do not sign yet. Resigning usually means losing severance and some unemployment benefits. Ask for time, photograph the document, and call 1546 first.

Sick leave for kidney care

Employees may take sick leave for as long as they are actually ill and receive wages for up to 30 working days a year (Sections 32 and 57). For 3 or more days, the employer may ask for a medical certificate — so dialysis-unit appointments are not absences.

Social Security unemployment benefits

If you are insured under Section 33 and meet the contribution requirements, register as unemployed within 30 days of dismissal. Ask about benefits and continued medical coverage at 1506; for the Universal Coverage Scheme, call 1330.

If you are told to leave a dormitory or apartment

• Being ill is not a breach of the lease — check what your contract says about termination
• Landlords renting 5 or more units must use contracts that follow the 2018 Contract Committee notification: in general, termination only for a material breach, with at least 30 days of written notice, and the deposit returned within 7 days after the lease ends
• Locking you out, cutting water or power, or removing your belongings may be unlawful — complain to the Consumer Protection Board at 1166
• Staff housing tied to the job may depend on employment status — raise it together with the dismissal at 1546
• Nowhere to stay right now: call the social assistance hotline 1300 and tell your dialysis unit so they can help find a temporary place to do exchanges

Insults made to your face

Words like “go and die somewhere else” said in front of others may amount to the offense of insulting a person to their face under Section 393 of the Thai Criminal Code. Whether to act is your choice — the Lawyers Council at 1167 offers free advice.

Table: action plan when facing discrimination — mind, rights, and who can help

Pick the row that fits — work on the “mind” and “rights” columns at the same time

4. Evidence-based ways to cope, and fitting dialysis around work

Direct answer: cognitive behavioral therapy (CBT) has the best evidence in people on dialysis. Antidepressants help some people but need doctor-chosen doses for kidney failure,
and practical help with work and housing directly reduces the root stress.

• CBT: in a randomized trial of 59 people on hemodialysis, 89% of those with depression no longer met depression criteria after 3 months of CBT, compared with 38% on the wait list, and quality of life improved
  (Cukor 2014)
• ACT and mindfulness: a randomized trial of 52 people on peritoneal dialysis found 4 weeks of ACT reduced anxiety and depression
  (Zhang 2025),
  and 30-minute mindfulness sessions 3 times a week for 8 weeks in 61 people on hemodialysis reduced stress and depression
  (Alhawatmeh 2024) — trials are still small
• Antidepressants: the ASCEND trial in 120 people on hemodialysis found sertraline lowered depression scores slightly more than CBT at 12 weeks, with more side effects
  (Mehrotra 2019).
  A Cochrane review of 4 studies (170 people) rated the evidence low-certainty and found more nausea
  (Palmer 2016) — a doctor must choose the drug and dose; do not self-medicate
• Social workers and peer groups: help with housing, jobs, rights, and loneliness — ask through your dialysis unit or treating hospital
• Fit dialysis to work: ask your unit about an exchange schedule that suits your shifts, or overnight APD if your coverage and housing allow

Table: comparing support options for people on dialysis facing discrimination

Figures come from the cited studies — not individual predictions. All medicines need a doctor’s prescription and kidney-adjusted dosing.

5. Going back to work or job hunting: whether to disclose, and what to say

Direct answer: whether to say you are on dialysis is your right. Many people on dialysis delay disclosure for fear of discrimination,
but if you need to do exchanges at work, telling a manager at least part of it helps you get a clean room and break time.

A short script you can use

“I have a non-contagious kidney condition treated with peritoneal dialysis. I need a clean room for about 30–40 minutes once or twice a day, and I have a medical certificate confirming I am fit to work. Everything else in the job I can do as usual.”

Jobs to discuss with your dialysis unit first

• Heavy lifting or frequent abdominal straining
• Hot, dirty, very dusty, or water-based work, which needs extra exit-site care
• Long shifts with no breaks or nowhere to wash your hands

If you do exchanges at work

Choose a room with a door that closes, switch off fans or air conditioning blowing directly at you, wash your hands every time, wear a mask as your unit taught you, and carry backup supplies — the same as at home.

Frequently asked questions (FAQ)

Can people on peritoneal dialysis (CAPD) work?

Many can, but not everyone and not in every job. A meta-analysis of 162,059 people on dialysis found an average employment rate of 26.3%, and peritoneal dialysis was one of the factors associated with being employed. National data from Finland showed 31% employment on peritoneal dialysis versus 19% on in-center hemodialysis, and 44% on automated overnight peritoneal dialysis. What needs planning is a clean place to do 3 to 4 exchanges a day of about 30 to 40 minutes each, fatigue, and heavy lifting, which you should discuss with your dialysis nurse first.

Is kidney disease or peritoneal dialysis contagious or dangerous to coworkers?

No. Chronic kidney failure comes from kidney damage, such as diabetes, high blood pressure, or glomerulonephritis, not from a germ that spreads to others. Peritoneal dialysis is a closed system: fluid flows in and out only through the catheter in the patient’s own abdomen. The infection risk is to the patient’s own abdomen, not to the people around them. Used fluid can be poured into a toilet, and bags are discarded as the dialysis unit instructs.

What can I do if I am dismissed because of kidney disease?

Ask for a written termination letter that states the reason, and keep evidence such as chats, voice messages, pay slips, and witnesses. Under Thailand’s Labour Protection Act, employees with at least 120 days of service who are dismissed without serious misconduct are entitled to severance pay, and the employer must give advance notice or pay in lieu of notice. Illness is not an exemption from severance. If your work was not affected, the dismissal may be unfair, and the Labour Court can order reinstatement or compensation. In Thailand, call the labour protection hotline 1546 or the Lawyers Council 1167 as soon as possible.

What should I do if I am pressured to write a resignation letter?

Do not sign a resignation letter or waiver under pressure, because resigning usually means losing statutory severance and some unemployment benefits. Ask for time to read the document, photograph it, and call 1546 in Thailand before deciding. If the employer wants you to leave, it should be a dismissal with a written reason, which keeps your rights intact.

Can a landlord make me leave my apartment because I am ill?

Being ill is not, by itself, a breach of a lease. In Thailand, landlords renting 5 or more residential units must use contracts that follow the 2018 Contract Committee notification: in general, they may end the lease only for a material breach by the tenant, with at least 30 days of written notice, and they must return the deposit within 7 days after the lease ends, deducting only actual damage. Locking you out or removing your belongings yourself may be unlawful. Staff housing tied to a job may follow different rules. Contact the Office of the Consumer Protection Board at 1166, and tell your dialysis unit your new address so fluid deliveries follow you.

Someone told me to go and die somewhere else. How do I cope with the hurt?

Anger, shame, and grief are normal reactions to stigma. Those words reflect the speaker’s ignorance and fear, not your worth. First protect your body by doing every exchange on time and sleeping enough, and tell someone you trust or your dialysis nurse and social worker. If sadness, hopelessness, or poor sleep lasts more than 2 weeks, ask to be assessed, because depression affects about 1 in 4 to 1 in 3 people on dialysis and it is treatable. In one trial, 89% of depressed patients who received CBT no longer met depression criteria, compared with 38% on the wait list. If you think about harming yourself or stopping dialysis, call the mental health hotline 1323 in Thailand, available 24 hours a day.

Do I have to tell a new employer that I am on peritoneal dialysis?

That is your decision. A review of 37 studies from 17 countries found that many people on dialysis delay or avoid disclosure because they fear discrimination, while those with understanding managers and adjusted schedules were more likely to keep working. If you need to do exchanges at work, telling your manager helps you get a clean room and break time. A short script works: it is a non-contagious kidney condition, you need a clean room for about 30 to 40 minutes once or twice a day, and you have a medical certificate confirming you are fit to work. You can also ask your unit about switching to automated overnight dialysis.

Which symptoms on peritoneal dialysis need hospital care right away?

Cloudy drained fluid, abdominal pain, or fever may mean peritonitis: contact your dialysis unit or go to hospital the same day and bring the bag with you. Also seek care for a red, swollen, or pus-draining exit site; breathlessness, being unable to lie flat, heavy swelling, or rapid weight gain; chest pain, irregular heartbeat, or marked weakness; several missed exchanges because you have no room or no supplies; and any thoughts of self-harm. In Thailand, call 1669 for emergencies or 1323 for a mental health crisis.

Scientific mechanism

How peritoneal dialysis works: the peritoneum, the lining of the abdomen, is rich in tiny blood vessels. When dextrose-containing fluid is placed in the abdomen,
wastes such as urea and creatinine move from the blood into the fluid by diffusion, and excess water is drawn out by osmosis; the fluid is then drained.
All of this happens inside the patient’s body — there is no mechanism by which germs or “illness” pass to the people nearby.

Why stigma affects both mind and kidneys: social rejection triggers the same stress response as a physical threat, leading to poor sleep, rumination, and loss of motivation.
Shame leads some people to hide exchanges, rush them in unclean places, or hesitate to report cloudy fluid
(Baillie 2024),
raising the risk of peritonitis, while job loss reduces income and food. This cycle helps explain why depression is associated with a higher risk of death
(Palmer 2013).

Why support must work on several fronts: CBT breaks the cycle of self-blaming thoughts, rights support fixes the root problems of income and housing,
and fitting dialysis around life — such as overnight APD — eases pressure at work. Stable work itself restores identity and social connection
(Zhang 2026).

Compiled and reviewed by Asst. Prof. Dr. Norawit Raatpiboon

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