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. 2023 Jan 24;15(1):e34139.
doi: 10.7759/cureus.34139. eCollection 2023 Jan.

Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample

Fidelis E Uwumiro  1 , Victory O Okpujie  2 , Aminnah Oyesomi  3 , Festa C Madu  4 , Ayodeji Ilelaboye  5 , Muhammed L Shielu  6 , Ruth C Otu  7 , Grace D Ogunkoya  8 , Loveth S Ezennaya  4 , Michael M Bojerenu  9
Affiliations

Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample

Fidelis E Uwumiro et al. Cureus. .

Abstract

Background: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions.

Objectives: To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays.

Design and setting: A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample. Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements included in-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges.

Results: The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRT over the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p = 0.07).

Limitations: The limitations of the study include the use of retrospective data and an administrative database.

Conclusion: Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions.

Keywords: dialysis; end-stage renal disease; esrd; nationwide inpatient sample; nationwide inpatient sample (nis); renal replacement therapy; weekend effect.

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Conflict of interest statement

The authors of this study are members of a large community of medical researchers actively pursuing a medical residency in the United States. This physician community is, as one would expect, diverse, with doctors from hospitals all over the world. The authors listed, however, are a small group within this community who have a special interest in renal medicine and have prior experience in the use of statistical software such as STATA and administrative databases, such as the Nationwide Inpatient Sample and the National Emergency Department Sample, to conduct research. All the listed authors significantly contributed to the conceptualization, design, data collection and coding, formal analysis, and writing of the manuscript. Apart from the aforementioned, no additional ties, conditions, or circumstances present a potential conflict of interest.

Figures

Figure 1
Figure 1. Proportion of patients receiving renal replacement therapy in the study population
HD: hemodialysis; PD: peritoneal dialysis; TP: kidney transplantation; CRRT: continuous renal replacement therapy; None: not receiving any of the renal replacement therapies.
Figure 2
Figure 2. Number of patients who received renal replacement therapy on weekends versus weekdays
HD: hemodialysis; PD: peritoneal dialysis; TP: kidney transplantation; CRRT: continuous renal replacement therapy.
See this image and copyright information in PMC

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