Fluid Overload and Kidney Injury Score: A Multidimensional Real-Time Assessment of Renal Disease Burden in the Critically Ill Patient*

Akcan-Arikan, Ayse; Gebhard, Daniel; Arnold, Megan; Loftis, Laura; Kennedy, Curtis

doi:10.1097/pcc.0000000000001123

Cited by 28 publications

(14 citation statements)

References 35 publications

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“…The FOKIS study by Akcan-Arikan et al (14) demonstrated that higher FOKIS was associated with morbidity and mortality in PICU. Our study is the first in pediatrics to use a decision-support tool for identifying patients at risk of VAC and/or IVAC.…”

Section: Discussionmentioning

confidence: 99%

“…The FOKIS comprises three variables; (1) AKI severity according to pRIFLE, (2) FO severity, and (3) nephrotoxic medication exposure (Supplementary Material Table 1). This scoring system serves as a decision support tool for identification of patients with renal disease burde (14) at our institution.…”

Section: Definitionsmentioning

confidence: 99%

“…Fluid Overload Kidney Injury Score (FOKIS) is a scoring system that incorporates FO severity and nephrotoxic medication exposure to AKI assessment by pRIFLE. FOKIS has been shown to be independently associated with ICU mortality and length of stay, and had better correlation with mortality than FO or AKI definition alone (14).…”

Section: Introductionmentioning

confidence: 99%

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Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

et al. 2019

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Objective: The Pediatric and Neonatal Working group developed new ventilator associated events (VAE) definitions for children and neonates. VAE includes ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and ventilator-associated pneumonia (VAP). Acute kidney injury (AKI) and fluid overload (FO) have been associated with worse clinical outcomes of ventilated children. Fluid Overload and Kidney Injury Score (FOKIS) is an automatically calculated score that combines AKI and FO in one numeric quantifiable metric. This study analyzed the association between FOKIS and VAE. Design: Retrospective matched case control study. Setting: A freestanding children's hospital. Patients: A total of 168 who were ventilated > 2 days. Interventions: None. Measurements and Main Results: We identified 42 VAC cases (18 IVAC and 24 non-infection-related VAC cases). Controls were matched to cases for age, immunocompromised status and ventilator days prior to VAC. VAC cases had longer ICU days, median (IQR), 28.5 (15, 47) vs. controls 11 (6, 16), p < 0.001; longer ventilation days, 19.5 (13, 32) vs. 9 (4,13), p < 0.001; and higher hospital mortality, 45.2 vs. 18%, p < 0.001. VACs had a higher incidence of AKI, 85.7 vs. 47.3%, p < 0.001; higher peak daily FO% within 3 days preceding VAC, mean (SD), 8.1(7.8) vs. 4.1 (3.4), p < 0.005; and higher peak FOKIS, 6.4(3.8) vs. 3.7(2.8), ( p < 0.001). Multivariate regression model adjusted for severity of illness identified peak FOKIS (odds ratio [OR] 1.29, 95%CI: 1.14–1.48, p < 0.001) and peak inspiratory pressure (OR 1.08, 95%CI: 1.02–1.15, p = 0.007) as risk factors for VAC. Conclusions: The FOKIS and its clinical variables were associated risk factors for ventilator-associated events. Further studies will determine the utility of FOKIS as a predictor for VAEs.

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Section: Discussionmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

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Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

et al. 2019

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“…All subjects were normalized to 0% FO after RAI calculation and FO was calculated thereafter. Cumulative FO was then calculated every 12 h through 96 h according to previously published definitions [ 14 ]: …”

Section: Methodsmentioning

confidence: 99%

“…Despite this, evidence suggests that in daily practice, clinicians fail to recognize nearly one-third of patients who have significant FO and patients continue to receive unrecognized levels of fluid administration [ 19 , 22 , 23 ]. This delayed recognition likely contributes to worse outcomes [ 14 , 19 ]. Currently, there are no instruments to assist clinicians’ identification of patients at risk for the development of significant FO.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

et al. 2022

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ImportanceIncreasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.ObjectiveTo develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.Evidence ReviewAt the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.FindingsThe meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.Conclusions and RelevanceExisting evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.

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Fluid Overload and Kidney Injury Score: A Multidimensional Real-Time Assessment of Renal Disease Burden in the Critically Ill Patient*

Abstract: A multidimensional score of renal disease burden was significantly associated with adverse PICU outcomes. Further studies will evaluate Fluid Overload Kidney Injury Score as a warning and decision support tool to impact patient-centered outcomes.

Cited by 28 publications

References 35 publications

Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events

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

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

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