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Wong E, Peracha J, Pitcher D, Casula A, Steenkamp R, Medcalf JF, Nitsch D. Seasonal mortality trends for hospitalised patients with acute kidney injury across England. BMC Nephrol 2023; 24:144. [PMID: 37226118 DOI: 10.1186/s12882-023-03094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Incidence of acute kidney injury (AKI) is known to peak in winter months. This is likely influenced by seasonality of commonly associated acute illnesses. We set out to assess seasonal mortality trends for patients who develop AKI across the English National Health Service (NHS) and to better understand associations with patient 'case-mix'. METHODS The study cohort included all hospitalised adult patients in England who triggered a biochemical AKI alert in 2017. We modelled the impact of season on 30-day mortality using multivariable logistic regression; adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), primary diagnosis, comorbidity (RCCI), elective/emergency admission, peak AKI stage and community/hospital acquired AKI. Seasonal odds ratios for AKI mortality were then calculated and compared across individual NHS hospital trusts. RESULTS The crude 30-day mortality for hospitalised AKI patients was 33% higher in winter compared to summer. Case-mix adjustment for a wide range of clinical and demographic factors did not fully explain excess winter mortality. The adjusted odds ratio of patients dying in winter vs. summer was 1.25 (1.22-1.29), this was higher than for Autumn and Spring vs. Summer, 1.09 (1.06-1.12) and 1.07 (1.04-1.11) respectively and varied across different NHS trusts (9 out of 90 centres outliers). CONCLUSION We have demonstrated an excess winter mortality risk for hospitalised patients with AKI across the English NHS, which could not be fully explained by seasonal variation in patient case-mix. Whilst the explanation for worse winter outcomes is not clear, unaccounted differences including 'winter-pressures' merit further investigation.
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Affiliation(s)
- Esther Wong
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Javeria Peracha
- Department of Renal Medicine, Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - David Pitcher
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Renal Medicine, University College London, London, UK
| | - Anna Casula
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - Retha Steenkamp
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - James F Medcalf
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Dorothea Nitsch
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Nephrology, Royal Free London NHS Foundation trust, London, NW3 2QG, UK
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Thomas ME, Abdelaziz TS, Perkins GD, Sitch AJ, Baharani J, Temple RM. The Acute Kidney Outreach to Prevent Deterioration and Death trial: a large pilot study for a cluster-randomized trial. Nephrol Dial Transplant 2021; 36:657-665. [PMID: 31860096 DOI: 10.1093/ndt/gfz246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Acute Kidney Outreach to Reduce Deterioration and Death trial was a large pilot study for a cluster-randomized trial of acute kidney injury (AKI) outreach. METHODS An observational control (before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the intervention (after) phase, a working-hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were at the end of life, unlikely to benefit from outreach, lacking mental capacity or already referred to the renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. A total of 1762 adult patients were recruited; 744 at the intervention site during the after phase. RESULTS A median of 3.0 non-medication recommendations and 0.5 medication-related recommendations per patient were made by the outreach team a median of 15.7 h after the AKI alert. Relatively low rates of the primary outcomes of death within 30 days (11-15%) or requirement for dialysis (0.4-3.7%) were seen across all four groups. In an exploratory analysis, at the intervention hospital during the after phase, there was an odds ratio for the combined primary outcome of 0.73 (95% confidence interval 0.42-1.26; P = 0.26). CONCLUSIONS An AKI outreach service can provide standardized specialist care to those with AKI across a healthcare economy. Trials assessing AKI outreach may benefit from focusing on those patients with 'mid-range' prognosis, where nephrological intervention could have the most impact.
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Affiliation(s)
- Mark E Thomas
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Tarek S Abdelaziz
- Department of Internal Medicine, Nephrology Unit, School of Medicine, Cairo University, Cairo, Egypt
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jyoti Baharani
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - R Mark Temple
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
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Abstract
Objective Improvements in the health care system, resulted in a greater number of geriatric patients diagnosed with acute kidney injury (AKI). We evaluated the incidence and outcome of AKI in octogenarians, as studies in the Middle-East region are few; moreover, treatment approaches, in addition to medical decisions, may require special consideration for advanced age to improve the outcomes. Results At King Abdullah II teaching and referral hospital, we recruited patients aged 80–90 years who were admitted to the medical floor between January 2010 and December 2013. Patients were followed-up for at least 1 year after discharge.850 patients were admitted during the study period. Of these, 135 were excluded from our analysis. The most common admission diagnoses were uncontrolled diabetes mellitus and acute coronary syndrome. AKI occurred in 216 patients (30.2%). Using the acute kidney injury network classification; stage 1, stage 2, and stage 3 disease were present in 59, 17.5, and 23.5% of patients, respectively. Of the 115 patients who died before discharge (16.1%), 87 (75.6%) had developed AKI. Hypertension, the use of angiotensin receptor blockers and non-steroidal anti-inflammatory drugs, heart failure, and exposure to radiologic contrast media were significant risk factors for AKI.
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Affiliation(s)
- Ashraf O Oweis
- Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sameeha A Alshelleh
- Division of Nephrology, Department of Medicine, University of Jordan, Amman, Jordan
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