Acute Kidney Injury Clinical Trial
Official title:
Effect of Weekend Admission on Mortality Associated With Severe Acute Kidney Injury in England: a Propensity Score Matched, Population-based Study
Increased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated "weekend effect" for acute kidney injury requiring dialysis (AKI-D). In this study, the investigators compared mortality in AKI-D patients admitted on weekday versus weekend and assessed factors associated with increased mortality.
Several studies have reported an unwanted adverse effect of weekend admission on mortality
in certain acute medical conditions. Though the reason for this variation could be illness
severity, some studies have hypothesized that this could be due to variation in care
provided over weekends when services are a minimum. The increased mortality over weekends
for certain conditions in the National Health Service (NHS) in England has led to an intense
debate on reconfiguring the health service. Little is known about the impact of the weekend
effect on severe acute kidney requiring dialysis (AKI-D) in England, the incidence of which
has increased more than 12-foldover the past 15 years. Most nephrology departments in
England provide continuous consultant cover over weekends and have the capacity to perform
emergency dialysis as needed over weekends suggesting that a weekend effect is less likely
to occur. Patients admitted over the weekend may present in three ways - with severe AKI
requiring dialysis over the weekend, with AKI and requiring dialysis on a subsequent weekday
or with no AKI, but develop AKI-D during the in-patient stay over next few days. Some
studies have reported that patients starting dialysis on Sunday or a diagnosis of severe AKI
over weekend, does not affect mortality, while others have reported increased mortality for
AKI in all sizes of hospital over weekend. One explanation for this observation is that
necessary dialysis therapy may not be initiated on a weekend as a result of limitations in
physician or nurse staffing or device availability. However, bias can be created by single
center studies as it is well recognized that the epidemiology of AKI-D shows considerable
regional variation and this may be true for all days of the week. It can also be speculated
that patients admitted on weekends may not receive optimal care resulting in development of
new AKI or progression of AKI to AKI-D resulting in excess mortality.
With this background, the investigators wanted to investigate whether a weekend effect on
mortality exists for AKI-D patients in England. The investigators hypothesized that patients
admitted over weekend would have increased mortality irrespective of demographic features
and clinical characteristics. They also hypothesized that the effect on mortality would be
more pronounced in centers with no on-site nephrology services.
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Observational Model: Case Control, Time Perspective: Retrospective
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