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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>daily fluid balance<\/jats:italic>\n                      ,\n                      <jats:italic>cumulative fluid balance<\/jats:italic>\n                      , and\n                      <jats:italic>percent cumulative fluid balance<\/jats:italic>\n                      be utilized to describe the fluid status of sick children. The term\n                      <jats:italic>fluid overload<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-023-06156-w","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T09:01:58Z","timestamp":1699347718000},"page":"955-979","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference"],"prefix":"10.1007","volume":"39","author":[{"given":"David T.","family":"Selewski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Barhight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica C.","family":"Bjornstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8916-0569","authenticated-orcid":false,"given":"Zaccaria","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"de Sousa Tavares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Akcan-Arikan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart L.","family":"Goldstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajit","family":"Basu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M.","family":"Bagshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Pediatric the Acute Disease Quality Initiative (ADQI) Consensus Committee Members","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Alobaidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Askenazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Barreto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benan","family":"Bayrakci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"O. 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Dr. Akcan-Arikan reported receiving financial support for research from BioPorto research funds paid to her institution outside the submitted work. Dr. Askenazi reported receiving personal fees from Baxter, Nuwellis Inc., Medtronic, SeaStar, and BioPorto, and financial support for research from Zorro-Flow outside the submitted work; in addition, Dr. Askenazi reported having a patent for Zorro-Flow, an external urine collection device pending, and a patent for continuous renal replacement therapy (CRRT) advancements pending. Dr. Bagshaw reported receiving personal fees from Baxter and BioPorto during the conduct of the study. Dr. Barreto reported receiving financial support for research from FAST Biomedical Consultant and Wolters-Kluwer Consultant outside the submitted work. Dr. Brophy reported receiving personal fees from UpToDate, during the conduct of the study, and American Board of Medical Specialities finance board. Dr. Charlton reported receiving personal fees from Medtronics Carpediem Clinical Events Committee outside the submitted work. Dr. Devarajan reported receiving grants from National Institutes of Health\/National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study; holding a patent as co-inventor on patents licensed to Abbott Diagnostics and BioPorto Inc., on use of neutrophil gelatinase-associated lipocalin as a biomarker of kidney injury. Dr. Gist reported receiving financial support for research from Medtronic Speaker Honorarium and financial support for research from BioPorto Diagnostics consulting fees outside the submitted work. Dr. Menon reported receiving personal fees from Nuwellis Inc. outside the submitted work. Dr. J. Morgan reported receiving personal fees from Medtronic Consultant outside the submitted work. Dr. Mottes reported receiving financial support for research from Medtronic outside the submitted work. Dr. Stanski reported receiving grants from National Center for Advancing Translational Sciences of the National Institutes of Health Institutional CT2 grant, 2UL1TR001425-05A1 and travel reimbursement from pADQI Travel funds to travel to consensus meeting (flight and hotel) during the conduct of the study; in addition, Dr. Stanski reported holding a patent for PERSEVERE-II AKI Prediction Model pending. Dr. Zappitelli reported receiving financial support for research from BioPorto Inc. adjudicator\/consultant for a study on neutrophil gelatinase-associated lipocalin and financial support for research from Baxter Inc. Honorarium for a national talk on CRRT (not viewed by company ahead of time) outside the submitted work. Dr. Kellum reported receiving personal fees from Dialco; being an employee of Spectral Medical and its wholly owned subsidiary Dialco outside the submitted work; and paid consultant for Astute Medical. Dr. Ostermann reported receiving grants from Fresenius Research funding, grants from Baxter Research funding, and grants from bioMerieux Research funding during the conduct of the study. Dr. Basu reported receiving personal fees from BioPorto Diagnostics outside of the submitted work and personal fees from bioMerieux outside of the submitted work. During the conduct of the study, in addition, Dr. Basu reported having a patent for Renal Angina Index pending outside of the submitted work, and a patent for olfactomedin-4 pending outside of the submitted work. No other disclosures were reported.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}