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

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Intensive Care

Background:

• Fluid overload and acute kidney injury (AKI) are prevalent in critically ill children, leading to adverse outcomes.
• The renal angina prodrome aids in stratifying AKI risk, but its predictive value for fluid overload remains unestablished.

Purpose of the Study:

• To investigate the predictive performance of renal angina fulfillment on ICU admission for identifying fluid overload in critically ill children.
• To assess the association between renal angina and the risk and severity of fluid overload.

Main Methods:

• A post-hoc analysis was conducted on patients admitted to a tertiary care pediatric intensive care unit (PICU).
• Renal angina fulfillment on Day 1 of ICU admission was evaluated as a predictor for developing ≥15% fluid overload by Day 3.

Main Results:

• 55% of children (77/139) fulfilled renal angina criteria (RA+).
• RA+ was significantly associated with increased odds of fluid overload on Day 3 (aOR 5.1, p=0.025).
• Absence of renal angina (RA-) demonstrated a 90% negative predictive value for fluid overload. RA+ patients with severe AKI had higher fluid overload (8.8%) compared to RA+ patients without AKI (0.73%, p=0.002).

Conclusions:

• Renal angina fulfillment in critically ill children is linked to a higher likelihood of fluid overload.
• This finding suggests renal angina can aid in classifying patients at high risk for fluid accumulation.
• Further research in larger cohorts is recommended to validate these findings.