Publication Date
3-1-2024
Journal
Pediatric Nephrology
DOI
10.1007/s00467-023-06156-w
PMID
37934274
PMCID
PMC10817849
PubMedCentral® Posted Date
11-7-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Infant, Newborn, Humans, Child, Acute Disease, Water-Electrolyte Imbalance, Water-Electrolyte Balance, Acute Kidney Injury, Heart Failure, Critical Illness, Acute kidney injury, Fluid balance, Fluid overload, Pediatric, Neonatal, Continuous kidney replacement therapy
Abstract
BACKGROUND: The impact of disorders of fluid balance, including the pathologic state of fluid overload in sick children has become increasingly apparent. With this understanding, there has been a shift from application of absolute thresholds of fluid accumulation to an appreciation of the intricacies of fluid balance, including the impact of timing, trajectory, and disease pathophysiology.
METHODS: The 26th Acute Disease Quality Initiative was the first to be exclusively dedicated to pediatric and neonatal acute kidney injury (pADQI). As part of the consensus panel, a multidisciplinary working group dedicated to fluid balance, fluid accumulation, and fluid overload was created. Through a search, review, and appraisal of the literature, summative consensus statements, along with identification of knowledge gaps and recommendations for clinical practice and research were developed.
CONCLUSIONS: The 26th pADQI conference proposed harmonized terminology for fluid balance and for describing a pathologic state of fluid overload for clinical practice and research. Recommendations include that the terms daily fluid balance, cumulative fluid balance, and percent cumulative fluid balance be utilized to describe the fluid status of sick children. The term fluid overload is to be preserved for describing a pathologic state of positive fluid balance associated with adverse events. Several recommendations for research were proposed including focused validation of the definition of fluid balance, fluid overload, and proposed methodologic approaches and endpoints for clinical trials.