Patients with end-stage kidney disease (ESKD) are more likely to die in a hospital if they are admitted on a weekend rather than a weekday, investigators conclude.

In addition, patients admitted on the weekend vs a weekday were less likely to receive dialysis, but more likely to undergo kidney transplantation.

In a retrospective study, Fidelis E. Uwumiro, MD, MSc, of Our Lady of Apostles Hospital in Akwanga, Nigeria, and colleagues analyzed data from 1,144,385 patients captured in the US 2018 Nationwide Inpatient Sample. In adjusted analyses, patients with ESKD admitted on weekends had significant 8% increased odds of in-hospital death and 9% decreased odds of any kidney replacement therapy over the weekend vs on weekdays, the investigators reported in Cureus. Those admitted on weekends had significant 32% higher odds of kidney transplantation.

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The study included adult patients with a principal or secondary diagnosis of ESKD or hospital admission with a diagnosis related to initiation, maintenance, or complications of kidney replacement therapy. The investigators classified patients admitted from midnight Friday to midnight Sunday as weekend admissions.

The higher death risk among patients admitted on weekends could be a consequence of being admitted as emergency cases, the authors explained, “and the observed weekend mortality effect is mostly due to this imbalance.” In addition, they cited previous reports that have identified “inadequate staffing on weekends, delay in the commencement of procedural care and interventions, and a high burnout rate as important determinants of care and in-hospital mortality in ESKD.”

The authors also offered explanations for the greater likelihood of kidney transplantation among patients admitted on a weekend. “One possibility is that there are fewer elective surgeries scheduled on weekends, so there may be more availability for transplant surgeries,” Dr Uwumiro and colleagues wrote. “Another reason could be that transplant surgeons and other medical staff may have more time to devote to transplant surgeries on weekends, since they may have fewer other commitments.”


Uwumiro FD, Okpujie VO, Oyesoma A, et al. 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. Cureus. Published online January 26, 2022. doi:10.7759/cureus.34139