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Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts
1Welsh Renal Clinical Network, Cwm Taf University Health Board, Cardiff, UK.
Background:
Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate.
Aim:
We compared mortality following detection of acute kidney injury (AKI) on week and weekend days across community and hospital settings.
Design:
A prospective national cohort study, with AKI identified using the Welsh National electronic AKI reporting system.
Methods:
Data were collected on outcome for all cases of adult AKI in Wales between 1 November 2013 and 31 January 2017.
Results:
There were a total of 107 298 episodes. Weekday detection of AKI was associated with 28.8% (26 439); 90-day mortality compared to 90-day mortality of 31.9% (4551) for AKI detected on weekdays (RR: 1.11, 95% CI: 1.08-1.14, P < 0.001, HR: 1.16 95% CI: 1.12-1.20, P < 0.001). There was no 'weekend effect' for mortality associated with hospital-acquired AKI. Weekday detection of community-acquired AKI (CA-AKI) was associated with a 22.6% (10 356) mortality compared with weekend detection of CA-AKI, which was associated with a 28.6% (1619) mortality (RR: 1.26, 95% CI: 1.21-1.32, P < 0.001, HR: 1.34, 95%CI: 1.28-1.42, P < 0.001). The excess mortality in weekend CA-AKI was driven by CA-AKI detected at the weekend that was not admitted to hospital compared with CA-AKI detected on weekdays which was admitted to hospital (34.5% vs. 19.1%, RR: 1.8, 95% CI: 1.69-1.91, P < 0.001, HR: 2.03, 95% CI: 1.88-2.19, P < 0.001).
Conclusion:
'Weekend effect' in AKI relates to access to in-patient care for patients presenting predominantly to hospital emergency departments with AKI at the weekend.
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