Abstract
BackgroundFluid 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.MethodsPost-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.Results77/139 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).ConclusionAmong 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.
Highlights
Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children
Compared to the absence of renal angina (RA) (RA-), a higher proportion of RA+ had Fluid overload (FO) on Day 3 (27% vs. 10%, p = 0.009). This finding remained significant after correcting for severity of illness, age, mechanical ventilator status, transplant status, CRRT receipt, and presence of severe acute kidney injury (AKI) (adjusted odds ratio 5.1, 95% CI 1.23–21.2, p = 0.025)
RAI- Renal Angina Index negative, RAI+ Renal angina index positive, PRISM III Pediatric risk of mortality 3, CRRTContinuous renal replacement therapy, AKI Acute kidney injury, stages defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, intensive care unit (ICU) Intensive care unit
Summary
Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. Fluid overload (FO) and acute kidney injury (AKI) are common and both are associated with poor outcomes among critically ill children [1,2,3,4,5]. In the absence of proven restorative therapy, prevention of AKI has been identified as a priority for management of at risk critically ill patients [7]. Identification of these patients appears to be possible using the renal angina (RA) prodrome for AKI risk stratification [8, 9]. The Renal Angina Index (RAI) is a validated measurement of RA that combines patient-specific risk factors as well as early signs of renal dysfunction [9, 10]
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