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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Bibliographic Details
Published in:BMC nephrology Vol. 22; no. 1; pp. 336 - 10
Main Authors: Gorga, Stephen M., Carlton, Erin F., Kohne, Joseph G., Barbaro, Ryan P., Basu, Rajit K.
Format: Journal Article
Language:English
Published: London BioMed Central 11.10.2021
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:1471-2369
1471-2369
DOI:10.1186/s12882-021-02540-6