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Kidney Week

Abstract: TH-PO022

AKI Mortality and Weekend Nephrologist Consultation

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Tome, Ana carolina Nakamura, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
  • Ramalho, Rodrigo J., Hospital de Base/FAMERP, Sao Jose Rio Preto, SÃO PAULO, Brazil
  • Lima, Emerson Quintino, FAMERP, São José do Rio Preto, Brazil

Group or Team Name

  • Hospital de Base / FAMERP - São José do Rio Preto - Brazil
Background

Admission to the hospital on weekends (WKD) is associated with increased mortality for acute illnesses than weekdays (WDAY). Previous analysis showed that this phenomenom also occurs in patients with acute kidney injury (AKI). However, there is still no data about this association and nephrologist consultation. Aim: analyse the impact of the day of the week of nephrologist consultation on the mortality in patients with AKI.

Methods

Database of patients over 18 years with AKI between 1srt January 2012 and 28st February 2018. Patients were analyzed according to the day of the week of first nephrologist consultation.

Results

During the period 6177 patients diagnosed with AKI were attended. The mean age was 64.1±15.7 years. They were classified in KDIGO I (46.3%), KDIGO II (26.5%) e KDIGO III (27.2%) at the nephrologist’s called. The mean SOFA was 7.3 ± 4.7, 34.1% dialyzed and global mortality was 37.1%. WDAY called group has 4761 (77.1%) and WKD, 1416 (22.9%) patients. SOFA (7.8±4.7 vs 7.1±4.6, p<0.001) and mortality (41.5% vs 35.8%, p <0,001) were higher on WKD group. The following mortality risk factors were identified: age (OR 1.02; IC 1.02-1.03; p<0.001), obstructive AKI (OR 0.39; IC 0.26-0.58; p<0.001), sepsis (OR 1.26; IC 1.10-1.45; p=0.001), liver disease (OR 1.40; IC 1.11-1.77; p=0.004), cancer (OR 1.17; IC 1.19-2.62; p=0.005), dialysis (OR 1.54; IC 1.31-1.80; p<0.001), SOFA at the moment of the call (OR 1.18; IC 1.16-1.20; p<0.001) and at the first dialysis (OR 1.07; IC 1.05-1.08, p<0.001). In the model with only patients hospitalized in intensive care unit (ICU) (3283 patients; 53.14%), nephrologist consultation at WKD (OR 1.22; IC 1.02-1.46; p=0.028), age (OR 1.01; IC 1.01-1.02; p<0.001), obstructive AKI (OR 0.51; IC 0.27-0.96; p=0.037), cancer (OR 2.30; IC 1.34-3.94; p=0.002), dialysis (OR 1.57; IC 1.31-1.88; p<0.001), SOFA at the moment of the call (OR 1.11; IC 1.09-1.13; p<0.001) and at the first dialysis (OR 1.08; IC 1.07-1.10; p<0.001) were identified as risk factors of mortality.

Conclusion

First nephrologist consultation at WKD was associated a higher mortality, particularly those hospitalized in ICU. This association can be due to the highest severity of this population.