Gorga SM, Carlton EF, Kohne JG, et al. - In children who were critically ill, fulfillment of renal angina was related to elevated odds of fluid overload vs the absence of renal angina and a higher fluid overload in those who developed acute kidney injury. Identification of patients carrying the highest risk for fluid accumulation may be achieved through renal angina directed risk classification.

• This is a post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit.

• Performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3 was the primary outcome; 55% children fulfilled renal angina (RA+).

• Increased odds of fluid overload on Day 3 were observed in relation to RA+, post-adjustment for covariates (adjusted odds ratio 5.1, 95% CI 1.23–21.2, p = 0.025, vs RA-).

• RA- led to a 90% negative predictive value for fluid overload on Day 3.

• Among RA+ patients, presence of severe acute kidney injury, vs its absence, was associated with significantly higher median fluid overload (% fluid overload on Day 3: 8.8% vs 0.73%, p = 0.002).