Sundays and mortality in patients with AKI

F. Perry Wilson*, Wei Yang, Sarah Schrauben, Carlos Machado, Jennie J. Lin, Harold I. Feldman

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background and objectives Initiation of dialysis on Sunday is limited by constraints that do not exist on other days of the week, which may lead to triaging of dialysis therapy. The study hypothesis was that patients with AKI on a Sunday would sustain higher mortality rates. Design, setting, participants, & measurements Study participants (n=4970) were part of the retrospective University of Pennsylvania Health AKI cohort, which is composed of patients with severe inpatient AKI (characterized by a doubling of admission creatinine) who were hospitalized from January 1, 2004, to August 31, 2010. Patient-days (n=15,995) were included if the patient had AKI severity of Acute Kidney Injury Network (AKIN) stage 2 or greater and had not yet begun receiving dialysis. The association of day of the week and inpatient mortality was assessed with logistic regression of data updated daily, using robust variance estimators. Results The rate (95% confidence interval [CI]) of initiation of dialysis on Sunday was 2.5 (1.8 to 3.1) per 100 patient-days, compared with 3.8 (3.5 to 4.1) per 100 patient-days on other days of the week (P=0.001). Inpatient mortality (95% CI) among patients with severe AKI present on a Sunday was 30% (28% to 32%), compared with 31% (31% to 32%) on other days of the week (P=0.08). Inpatient mortality among patients who initiated dialysis on Sunday was 65% (52% to 79%), compared with 65% (61% to 70%) among those who initiated dialysis from Tuesday through Saturday (P=0.79). Patients who initiated dialysis on Monday had a lower mortality than those who initiated it on another day of the week (52% [40% to 64%] versus 65% [61% to 70%]; P=0.03). Conclusions Despite a lower frequency of dialysis, patients with severe AKI on Sunday have mortality similar to that of patients with severe AKI on other days of the week.

Original languageEnglish (US)
Pages (from-to)1863-1869
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number11
DOIs
StatePublished - Nov 7 2013

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Perry Wilson, F., Yang, W., Schrauben, S., Machado, C., Lin, J. J., & Feldman, H. I. (2013). Sundays and mortality in patients with AKI. Clinical Journal of the American Society of Nephrology, 8(11), 1863-1869. https://doi.org/10.2215/CJN.03540413