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

• Published in: BMC nephrology 2021-10, Vol.22 (1), p.336-336, Article 336
• Main Authors: Gorga, Stephen M, Carlton, Erin F, Kohne, Joseph G, Barbaro, Ryan P, Basu, Rajit K
• Format: Article
• Language: English
• 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; Kidney disease: improving global outcomes; Kidneys; Length of stay; Male; 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
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-021-02540-6

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. 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. 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). 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.