Day of the week plays no role in mortality risk for patients with acute kidney injury, study finds

(Medical Xpress)—Disproving commonly held beliefs, a new study by researchers at the Perelman School of Medicine at the University of Pennsylvania showed that despite a lower frequency of dialysis on Sunday, patients with acute kidney injury (AKI) have mortality rates similar to that of patients who receive the therapy on any other day of the week. The study appears online in the Clinical Journal of the American Society of Nephrology.

AKI, previously referred to as , is most often caused by reduced or blocked blood flow to the kidney and can be caused by conditions such as shock, trauma, sepsis, and heart attack. It can also occur during surgical procedures. Initiation of is necessary to help remove toxins and excess fluids from the body while the kidneys heal.

"Initiation of dialysis on Sunday is limited by constraints that do not exist on other days of the week, such as staffing differences, drug availability and patient load, which may lead to triaging of dialysis therapy," said F. Perry Wilson, MD, MSCE, an instructor of Medicine in the Renal, Electrolyte and Hypertension Division at Penn. "Until now, many in the believed that these potential constraints may lead to negative outcomes, but our research suggests that patients with the most severe AKI are receiving the appropriate intervention regardless of day of the week. The patients in whom dialysis happens to be deferred because the day is a Sunday appear to be able to be deferred safely."

In the study, Wilson and colleagues reviewed the data of over 4,900 patients from the University of Pennsylvania Acute Kidney Injury (UPHS-AKI) cohort between January 2004 and August 2010. The UPHS-AKI cohort is a retrospective cohort study composed of patients with severe inpatient AKI during admissions to one of the three UPHS hospitals in Philadelphia.

Despite prior research that suggested weekend admission with AKI is associated with higher , the current study found no difference in inpatient mortality among patients with severe AKI present on a Sunday (30 percent) compared with those with severe AKI for the rest of the week (31 percent).

The rate of initiation of dialysis for AKI was much lower on Sunday than other days of the week, with 2.5 initiations per 100 patient-days on Sunday versus 3.3 on Monday and 3.9 on Tuesday through Saturday. Despite these differences, the research team found inpatient mortality among those who initiated dialysis on a Sunday was the same (65 percent) as for those initiated Tuesday through Saturday. However, patients who initiated dialysis on Monday had a lower mortality than those who initiated it on another day of the week (52 percent).

"The finding of a lower mortality among patients who initiated dialysis on Monday prompted an exploration of characteristics of these patients compared with those who were initiated on other days of the week," said Wilson. "Interestingly, there were no statistically significant differences between patients initiated on Monday versus other days of the week across a range of laboratory, demographic, and clinical variables."

The authors write that given the severity of renal injury among dialyzed patients was higher on Sunday than other days of the week, it may be that clinicians are delaying or not pursuing dialysis in a population of patients who would be expected to derive less benefit from the therapy.

"If this is the case, the "Sunday model" can be entertained as one that could be realistically transferred to other days of the week, reducing resource consumption without compromising patient care," said Wilson.

Dr. Wilson and his colleagues are actively pursuing research to characterize which patients benefit most from the initiation of dialysis, and in whom a policy of "watchful waiting" might be superior. In the future, randomized trials of dialysis initiation will help to guide clinicians and facing this very difficult treatment decision.

More information: cjasn.asnjournals.org/content/… JN.03540413.abstract

add to favorites email to friend print save as pdf

Related Stories

Serious acute kidney injury: More common than ever

Dec 06, 2012

Acute kidney injury (AKI), an abrupt or rapid decline in kidney function, is a serious and increasingly prevalent condition that can occur after major infections, major surgery, or exposure to certain medications. The incidence ...

Kidney injury in hospital increases long-term risk of death

Dec 17, 2009

Patients with sudden loss of kidney function, called acute kidney injury (AKI), are more likely to die prematurely after leaving the hospital—even if their kidney function has apparently recovered, according to an upcoming ...

Recommended for you

Mediterranean diet may help protect kidney health

8 hours ago

Adhering to a Mediterranean-style diet may significantly reduce the risk of developing chronic kidney disease, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (C ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.