Renal angina index predicts fluid overload in critically ill children: an observational cohort study

Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc ana...

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Vydáno v:	BMC nephrology Ročník 22; číslo 1; s. 336 - 10
Hlavní autoři:	Gorga, Stephen M., Carlton, Erin F., Kohne, Joseph G., Barbaro, Ryan P., Basu, Rajit K.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 11.10.2021 BioMed Central Ltd Springer Nature B.V BMC
Témata:	Acute kidney injury Acute Kidney Injury - complications Acute Kidney Injury - epidemiology Acute renal failure Adolescent Angina Angina pectoris Body fluid disorders Care and treatment Catheters Child Child, Preschool Children Cohort analysis Cohort Studies Complications and side effects Creatinine Critical Illness Critically ill children Data collection Female Fluid overload Hospitalization Hospitals Humans Identification Infant Intensive care Internal Medicine Kidney disease: improving global outcomes Kidneys Length of stay Male Medicine Medicine & Public Health Methods Mortality Nephrology Observational studies Oliguria Patients Pediatric intensive care Pediatric research Pediatrics Population studies Practice guidelines (Medicine) Predictive Value of Tests Prognosis Prospective Studies Renal angina index Risk Assessment Risk factors Severity of Illness Index Statistical analysis Transplants & implants Urine Ventilators Water-Electrolyte Imbalance - complications United States Renal angina index Kidney disease: improving global outcomes Fluid overload Acute kidney injury
ISSN:	1471-2369, 1471-2369
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Shrnutí:	Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit (PICU). The primary outcome was the performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3. Results 77/139 children (55%) fulfilled renal angina (RA+). After adjusting for covariates, RA+ was associated with increased odds of fluid overload on Day 3 (adjusted odds ratio (aOR) 5.1, 95% CI 1.23–21.2, p = 0.025, versus RA-). RA- resulted in a 90% negative predictive value for fluid overload on Day 3. Median fluid overload was significantly higher in RA+ patients with severe acute kidney injury compared to RA+ patients without severe acute kidney injury (% fluid overload on Day 3: 8.8% vs. 0.73%, p = 0.002). Conclusion Among critically ill children, fulfillment of renal angina was associated with increased odds of fluid overload versus the absence of renal angina and a higher fluid overload among patients who developed acute kidney injury. Renal angina directed risk classification may identify patients at highest risk for fluid accumulation. Expanded study in larger populations is warranted.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3
ISSN:	1471-2369 1471-2369
DOI:	10.1186/s12882-021-02540-6