Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference

David T. Selewski, Matthew F. Barhight, Erica C. Bjornstad, Zaccaria Ricci*, Marcelo de Sousa Tavares, Ayse Akcan-Arikan, Stuart L. Goldstein, Rajit Basu, Sean M. Bagshaw

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)955-979
Number of pages25
JournalPediatric Nephrology
Volume39
Issue number3
DOIs
StatePublished - Mar 2024

Keywords

  • Acute kidney injury
  • Continuous kidney replacement therapy
  • Fluid balance
  • Fluid overload
  • Neonatal
  • Pediatric

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

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