Manish Kaushik Singapore

Dr Manish graduated from India. After completing his Residency in Medicine and working in India and overseas, he pursued further training at Singapore General Hospital, Singapore. Following his accreditation in Nephrology, he was awarded the Health Manpower Development Plan Scholarship to do Fellowship in Critical Care Nephrology and Cardiorenal Syndromes at International Renal Research Institute, Vicenza (Italy) under mentorship of Professor Claudio Ronco. He is currently working at Singapore General Hospital where he oversees the Critical Care Nephrology and Extracorporeal Blood Purification and membrane separation based apheresis service. He is actively involved in education at all levels. His research interests are mainly in continuous kidney replacement therapy and apheresis. He served the Nephrology community in his capacity as past Treasurer and Internal Auditor of the Singapore Society of Nephrology and past Chairperson of the Chapter of Renal Physicians, Singapore.

18th September 2026 Friday

Time	Session

08:00 12:30	Physician Track (CRRT Principle / Advanced CRRT Management / CRRT Equipment Demonstration) (Pre-Congress Workshop) Opening Remark Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Yu-Wei FangTaiwan Moderator Yu-Juei HsuTaiwan Moderator Patient Selection, Modality, Dose Manish KaushikSingapore Speaker Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Yu-Juei HsuTaiwan Moderator Yu-Wei FangTaiwan Moderator The ABC of the CRRT Prescription Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Yu-Juei HsuTaiwan Moderator Yu-Wei FangTaiwan Moderator Access, Membrane, Circuit Manish KaushikSingapore Speaker Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Yu-Juei HsuTaiwan Moderator Yu-Wei FangTaiwan Moderator Anticoagulation Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Yu-Juei HsuTaiwan Moderator Yu-Wei FangTaiwan Moderator Q & A Coffee Break Solution and Fluid Balance Nuttha LumlertgulThailand Speaker Solution and Fluid BalanceUtility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRTPersonalized Fluid Management with CRRT Szu-Chun HungTaiwan Moderator Wayne Wei-Cheng ChenTaiwan Moderator Dysnatremia and Acid-Base Disorders Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Szu-Chun HungTaiwan Moderator Wayne Wei-Cheng ChenTaiwan Moderator Connectology with Hybrid Systems: ECMO, Apheresis, ECCO2R Keith Wille Speaker Connectology with Hybrid Systems: ECMO, Apheresis, ECCO2RExtracorporeal life support technologies are increasingly used in critical care settings, with integrating extracorporeal membrane oxygenation (ECMO), apheresis, and extracorporeal carbon dioxide removal (ECCO₂R) to provide multi-organ support. This session explores the principles, clinical applications, and challenges of extracorporeal systems and their integration into CRRT, focusing on the interaction between ECMO and renal replacement therapy (CRRT), the role of ECCO2R in respiratory failure, and the combination of apheresis for immunomodulation. Through discussion, participants will gain an understanding of patient selection, circuit configurations, anticoagulation strategies, and the physiological considerations that impact patient outcomes. Emphasis will be placed on optimizing patient management, recognizing complications, and developing a structured approach to hybrid extracorporeal therapy.AKI in Mechanical Circulatory SupportAcute kidney injury (AKI) is a frequent and important complication of cardiogenic shock and is strongly associated with adverse outcomes. Its pathogenesis is multifactorial, reflecting reduced cardiac output and renal perfusion, venous congestion, neurohormonal activation, systemic inflammation, vasopressor exposure, and hemodynamic instability. Mechanical circulatory support (MCS) may interrupt this cycle by restoring cardiac output, reducing venous congestion, and decreasing vasopressor requirements; however, MCS itself may contribute to kidney injury through hemolysis, embolic events, limb ischemia and rhabdomyolysis, bleeding, contrast exposure, and device-related hemodynamic disturbances. This presentation will review the mechanisms and clinical impact of AKI across commonly used temporary and durable MCS platforms, including intra-aortic balloon pumps, microaxial flow pumps, temporary ventricular assist devices, and durable LVADs. Particular emphasis will be placed on identifying potentially reversible contributors to AKI, understanding the relationship between timing of circulatory support and renal recovery, and managing patients who require concurrent kidney replacement therapy. Practical considerations for CRRT, including vascular access, anticoagulation, ultrafiltration, and interactions between CRRT and MCS, will also be discussed. How do I care for the Patient with ARDS and AKIAcute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) frequently coexist in critically ill patients and together are associated with substantial morbidity and mortality. Their management is closely intertwined: mechanical ventilation, positive end-expiratory pressure, hemodynamic support, and fluid administration may influence renal perfusion and venous congestion, while AKI and fluid accumulation can worsen pulmonary edema, impair gas exchange, and complicate ventilator management. This presentation will provide a practical approach to the patient with concurrent ARDS and AKI, integrating pulmonary and kidney-focused strategies. Key topics will include lung-protective ventilation and its renal consequences, assessment and management of volume status, the role of conservative fluid strategies and de-resuscitation, and the use of diuretics and kidney replacement therapy to achieve fluid-balance goals. Attention will be given to when and how continuous renal replacement therapy can support fluid management in patients with severe respiratory failure, including those with hemodynamic instability. The session will emphasize coordinated decision-making between critical care and nephrology teams to balance lung protection, kidney perfusion, and overall organ support. Szu-Chun HungTaiwan Moderator Wayne Wei-Cheng ChenTaiwan Moderator Hemoadsorption in the ICU Claudio RoncoItaly Speaker Hemoadsorption in the ICUSpecial Lecture: 50 Years of CRRT: A Journey Through InnovationRole of Renal Functional Reserve on AKI Risk and RecoveryHow Do I Use Hemadsorption in My PracticeManaging the Heart Failure Patient With Worsening Renal Function (WRF) Szu-Chun HungTaiwan Moderator Wayne Wei-Cheng ChenTaiwan Moderator System Based Approaches for CRRT Management Ravindra MehtaUnited States Speaker Szu-Chun HungTaiwan Moderator Wayne Wei-Cheng ChenTaiwan Moderator Room 101D
13:30 15:30	Physician Track 3 Interactive Sessions 1/2 1. Prismax Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Manish KaushikSingapore Speaker Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT 2. Multifiltrate Pro Balazs Szamosfalvi Speaker Optimizing Regional Citrate Anticoagulation with MultiFiltrate PRO: Protocol Selection and Management of Challenging PatientsAKI During ECMO: Is It a Consequence, a Complication, or a Modifiable Target? Lui ForniUnited Kingdom Speaker Sepsis Associated AKIBicarbonate in AKI: Use and MisuseAdapting CRRT for Patients with Electrolyte and ACID-Base Disorders Room 101C

19th September 2026 Saturday

Time	Session

07:30 08:15	Meet the Expert 3 Severe Hypernatremia and Hyperkalemia in AKI Requiring KRT Yung-Ho HsuTaiwan Moderator Severe Hypernatremia and Hyperkalemia in AKI Requiring KRT Ashita TolwaniUnited States Speaker The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure Manish KaushikSingapore Speaker Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Chingyu WangTaiwan Presenter TING HSUAN CHANGTaiwan Presenter Room 105
14:00 15:30	Workshop 1 - Session A Precision Solute Control and Dynamic Dosing with CRRT Precision Solute Control and Dynamic Dosing with CRRT Manish KaushikSingapore Speaker Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Rolando Claure-Del GranadoBolivia Speaker Practical Steps to Train (and Become) an AI-Era PhysicianArtificial intelligence is rapidly becoming part of everyday medicine, yet many physicians remain uncertain about how to begin using it effectively and responsibly. Becoming an “AI-era physician” does not require advanced technical expertise; it requires curiosity, critical thinking, and practical skills that can be progressively incorporated into clinical, academic, and research activities. In this Meet the Experts session, participants will explore concrete approaches to developing AI literacy, improving prompting skills, critically evaluating AI-generated information, and identifying useful applications in clinical reasoning, education, scientific writing, research, and workflow optimization. Through expert perspectives, real-world examples, and interactive discussion, the session will also address common pitfalls, including hallucinations, bias, privacy concerns, and overreliance on automation. The goal is to provide participants with a practical roadmap for moving from occasional AI use to confident, thoughtful, and responsible integration of AI into professional practice.Precision Solute Control and Dynamic Dosing with CRRTContinuous kidney replacement therapy (CRRT) is often prescribed using fixed effluent targets, yet critically ill patients have rapidly changing metabolic demands, solute loads, and treatment goals. Precision CRRT requires moving beyond a “one-dose-fits-all” approach toward dynamic prescription and real-time adjustment of therapy. In this interactive workshop, participants will learn how to individualize CRRT dose according to clinical objectives, solute kinetics, treatment interruptions, residual kidney function, and evolving metabolic needs. Practical case-based exercises will address clearance of urea and other small solutes, management of severe hyperkalemia and metabolic acidosis, control of sodium and other electrolyte disorders, and strategies for avoiding under- or overdosing. The workshop will also explore how modality, blood flow, dialysate and replacement-fluid rates, predilution, and delivered versus prescribed dose influence solute clearance. Participants will leave with a practical framework for adapting CRRT prescriptions dynamically and safely at the bedside.Social Determinants of Health and Acute Kidney InjuryAcute kidney injury (AKI) is not only a clinical syndrome but also a reflection of social and structural inequities that shape who becomes ill, who receives timely diagnosis, and who survives. Poverty, geography, education, access to clean water and sanitation, healthcare availability, occupational exposures, and delayed referral can all influence the risk, severity, and outcomes of AKI. These determinants are particularly relevant in low- and middle-income settings, where preventable causes of AKI remain common and access to laboratory testing, specialist care, and kidney replacement therapy may be limited. This plenary session will examine how social determinants interact with biological vulnerability and health-system capacity across the AKI continuum—from prevention and early recognition to treatment and recovery. Addressing AKI effectively therefore requires more than advances in diagnostics and therapeutics; it demands equitable health systems, stronger prevention strategies, and policies that reduce barriers to timely kidney care. Jenq-Wen HuangTaiwan Moderator Yung-Chang ChenTaiwan Moderator Room 101
16:00 17:30	AKI CRRT Debate Semifinal Round (WA-WB then WC-WD) Cheng-Chia LeeTaiwan Moderator Chih-Jen WuTaiwan Moderator Manish KaushikSingapore Moderator Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Nattachai SrisawatThailand Moderator Precision Sepsis-AKI — Biomarkers, AI and Phenotyping in the Asia-PacificSepsis-associated AKI in the Asia-Pacific carries a burden that global datasets underrepresent. In the SEA-AKI prospective multicentre ICU study, AKI was very common, with stage 3 reaching 28.9%, and infectious disease among the independent risk factors for AKI development. In the InSEA-RRT registry — 2,315 critically ill patients with stage 3 AKI across 24 hospitals in Southeast Asia and India — 47% died during hospitalization, with major adverse kidney events tracked to two years. These cohorts expose the limits of treating sepsis-AKI as one disease. This lecture examines how damage and stress biomarkers, machine-learning models trained on regional rather than imported data, and sub-phenotyping by trajectory and host response can move us from a single creatinine-based label toward actionable patient groups. Emphasis will be on what is deployable in resource-variable settings, where biomarker access is uneven and registry infrastructure is often the practical starting point for precision medicine.Timing of DialysisWhen to start kidney replacement therapy (KRT) in AKI remains one of the most frequent bedside decisions in critical care, and the trial evidence has settled less than it first appears. ELAIN favoured early initiation, AKIKI and IDEAL-ICU did not, STARRT-AKI showed no survival benefit from an accelerated strategy with more dialysis dependence at 90 days, and AKIKI-2 found that delaying further offered no advantage and may cause harm. This session works through illustrative cases rather than trial summaries: the patient with rising creatinine but no urgent indication, refractory hyperkalaemia or acidosis demanding immediate treatment, the fluid-overloaded patient with worsening oxygenation, and the diuretic-responsive patient in whom watchful waiting proves correct. Each case is used to separate absolute indications from the discretionary zone where trials apply. Emphasis will be on practical decision aids — urine output trajectory, furosemide stress testing, fluid balance, and organ-support burden — and on when not starting is the better decision.Acute PD vs Acute HD: Which Is the Right Choice?For AKI requiring kidney replacement therapy outside well-resourced ICUs, the practical question is which modality can be started safely tonight. Acute peritoneal dialysis (PD) needs no vascular access, anticoagulation, water treatment, or machine, but concerns persist about clearance and ultrafiltration control. Our multicentre randomized trial assigned 157 patients with AKI to lower-dosage acute PD (18–24 L/day) or intermittent hemodialysis three times weekly. Sepsis caused 68% of AKI. Twenty-eight-day mortality was 50% versus 49% (risk difference 0.6%), meeting the prespecified noninferiority margin, with comparable dialysis-free survival and seven-day fluid balance. Complications diverged rather than favoured one modality: intradialytic hypotension was more frequent with hemodialysis, hypokalemia with PD. This lecture translates these findings into practice — where lower-dosage PD is a legitimate first choice, where it is not, how to prescribe and monitor it, and how modality availability shapes AKI preparedness in resource-limited settings. Serum cystatin C should replace serum creatinine as the primary functional biomarker for diagnosing AKI and assessing recovery. Chih-Jen WuTaiwan Moderator Nattachai SrisawatThailand Moderator Precision Sepsis-AKI — Biomarkers, AI and Phenotyping in the Asia-PacificSepsis-associated AKI in the Asia-Pacific carries a burden that global datasets underrepresent. In the SEA-AKI prospective multicentre ICU study, AKI was very common, with stage 3 reaching 28.9%, and infectious disease among the independent risk factors for AKI development. In the InSEA-RRT registry — 2,315 critically ill patients with stage 3 AKI across 24 hospitals in Southeast Asia and India — 47% died during hospitalization, with major adverse kidney events tracked to two years. These cohorts expose the limits of treating sepsis-AKI as one disease. This lecture examines how damage and stress biomarkers, machine-learning models trained on regional rather than imported data, and sub-phenotyping by trajectory and host response can move us from a single creatinine-based label toward actionable patient groups. Emphasis will be on what is deployable in resource-variable settings, where biomarker access is uneven and registry infrastructure is often the practical starting point for precision medicine.Timing of DialysisWhen to start kidney replacement therapy (KRT) in AKI remains one of the most frequent bedside decisions in critical care, and the trial evidence has settled less than it first appears. ELAIN favoured early initiation, AKIKI and IDEAL-ICU did not, STARRT-AKI showed no survival benefit from an accelerated strategy with more dialysis dependence at 90 days, and AKIKI-2 found that delaying further offered no advantage and may cause harm. This session works through illustrative cases rather than trial summaries: the patient with rising creatinine but no urgent indication, refractory hyperkalaemia or acidosis demanding immediate treatment, the fluid-overloaded patient with worsening oxygenation, and the diuretic-responsive patient in whom watchful waiting proves correct. Each case is used to separate absolute indications from the discretionary zone where trials apply. Emphasis will be on practical decision aids — urine output trajectory, furosemide stress testing, fluid balance, and organ-support burden — and on when not starting is the better decision.Acute PD vs Acute HD: Which Is the Right Choice?For AKI requiring kidney replacement therapy outside well-resourced ICUs, the practical question is which modality can be started safely tonight. Acute peritoneal dialysis (PD) needs no vascular access, anticoagulation, water treatment, or machine, but concerns persist about clearance and ultrafiltration control. Our multicentre randomized trial assigned 157 patients with AKI to lower-dosage acute PD (18–24 L/day) or intermittent hemodialysis three times weekly. Sepsis caused 68% of AKI. Twenty-eight-day mortality was 50% versus 49% (risk difference 0.6%), meeting the prespecified noninferiority margin, with comparable dialysis-free survival and seven-day fluid balance. Complications diverged rather than favoured one modality: intradialytic hypotension was more frequent with hemodialysis, hypokalemia with PD. This lecture translates these findings into practice — where lower-dosage PD is a legitimate first choice, where it is not, how to prescribe and monitor it, and how modality availability shapes AKI preparedness in resource-limited settings. Ying-Ying Chen Judge For critically ill patients with AKI and severe metabolic acidosis, bicarbonate therapy should be administered routinely. Cheng-Chia LeeTaiwan Moderator Manish KaushikSingapore Moderator Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Jui-Yi ChenTaiwan Judge Room 103

20th September 2026 Sunday

Time	Session

16:00 17:30	Plenary 6: Emerging Strategies in AKI Care, Kidney Safety, and Extracorporeal Support Manish KaushikSingapore Moderator Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT Yu-Chang YEHTaiwan Moderator Clinical Support Information with Generative AI: Content Generation and Evaluation Generative artificial intelligence is shifting from single-question answering toward structured clinical decision support at the bedside. This lecture presents a practical approach to generating and evaluating AI-derived clinical support information in critical care. On the generation side, we describe a multi-turn conversation and multi-task workflow in which structured patient data, a machine learning mortality prediction model, and SHAP-based explanations are passed sequentially to a large language model through five linked task prompts covering risk interpretation, syndrome identification, current status and diagnoses, recommended examinations, and management suggestions. Each turn inherits the context of the previous one, so the output accumulates into a coherent clinical narrative rather than a set of isolated answers. On the evaluation side, we introduce the IMPACT Framework, a six-domain, 21-item instrument developed through a multinational Delphi consensus involving 58 panelists from 12 countries. Its domains, Integration, Mastery, Precision, Applicability, Comprehensiveness, and Timeliness, allow both clinicians and automated judges to score generated content reproducibly. We share validation results, examples from an intensive care cohort, and lessons learned from iterative prompt refinement. Attendees will leave with a transferable method for building and auditing generative AI support tools in their own units. AKD Care Redefined: Diabetes, Hypertension, and Strategies for Long-Term Health VinCent WuTaiwan Speaker AKD Care Redefined: Diabetes, Hypertension, and Strategies for Long-Term Health Traditional acute kidney injury (AKI) classifications, centered around semi-anatomical lines, no longer suffice in capturing the complexity of AKI. Subphenotyping, enriched with AKI biomarkers, holds insights into distinct risk profiles and tailored treatment strategies, redefining AKI and contributing to improved clinical management (Critical Care). Incorporating kidney biomarkers into strategies for early AKI detection and the initiation of AKI care bundles has shown greater effectiveness than using care bundles without these novel biomarkers. Our investigations have made notable advancements in identifying water-soluble regulatory iron hepcidin as a promising early biomarker for predicting postoperative acute kidney injury. Beyond hepcidin, our research extended into the exploration of predictive biomarkers, such as HJV, NGAL, and cFGF-23, uncovering their potential in prognosticating the occurrence and severity of AKI (Cell Death Dis, Antioxidants & redox signaling). The amalgamation of these biomarkers with existing clinical AKI scores holds immense promise in revolutionizing critical care and ushering in a new era of personalized patient management. Moreover, our endeavors have transcended theoretical advancements, with successful patent acquisition for AKI biomarkers attesting to our commitment. We were the inaugural contributors to the discourse on the effects of indoxyl sulfate on the tubulogenesis capability of endothelial progenitor cells and cell aging in acute kidney injury(Angiogenesis). A comprehensive review of the long-term prognosis of acute kidney injury, encompassing impacts on the heart, brain, bone lesions, gastrointestinal, and tissue carcinogenesis, was presented. (JASN, KI, cJASN, JAHA, ICM, CC). Our team posited that transferring post-AKI patients to nephrologists for care could reduce overall mortality and cardiovascular events (Value in Health). Through integrated analysis, we demonstrated that standard dialysis would increase the number of patients avoiding dialysis (CC), stimulating fervent discussions among AKI physicians at international conferences. Notably, we were global trailblazers in proposing that acute kidney disease, regardless of AKI presence, leads to mortality and end-stage kidney disease(eClinicalMedicine ). Although the evidence for patients with acute kidney disease (AKD) is still lacking, several potential pharmacological agents may improve outcomes, including but not limited to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists (JAMA NO). In conclusion, accurate prognosis prediction and effective treatment for AKD are critical yet unmet clinical needs. Future studies are urgently needed to improve patient care in this complex and rapidly evolving field. Drug Exposures: Concerns in Kidney Safety (PPI vs Potassium-Competitive ACID Blockers (P-CABs)) Kyungho LeeSouth Korea Speaker Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs)) Acute PD vs Acute HD: Which Is the Right Choice? Nattachai SrisawatThailand Speaker Precision Sepsis-AKI — Biomarkers, AI and Phenotyping in the Asia-PacificSepsis-associated AKI in the Asia-Pacific carries a burden that global datasets underrepresent. In the SEA-AKI prospective multicentre ICU study, AKI was very common, with stage 3 reaching 28.9%, and infectious disease among the independent risk factors for AKI development. In the InSEA-RRT registry — 2,315 critically ill patients with stage 3 AKI across 24 hospitals in Southeast Asia and India — 47% died during hospitalization, with major adverse kidney events tracked to two years. These cohorts expose the limits of treating sepsis-AKI as one disease. This lecture examines how damage and stress biomarkers, machine-learning models trained on regional rather than imported data, and sub-phenotyping by trajectory and host response can move us from a single creatinine-based label toward actionable patient groups. Emphasis will be on what is deployable in resource-variable settings, where biomarker access is uneven and registry infrastructure is often the practical starting point for precision medicine.Timing of DialysisWhen to start kidney replacement therapy (KRT) in AKI remains one of the most frequent bedside decisions in critical care, and the trial evidence has settled less than it first appears. ELAIN favoured early initiation, AKIKI and IDEAL-ICU did not, STARRT-AKI showed no survival benefit from an accelerated strategy with more dialysis dependence at 90 days, and AKIKI-2 found that delaying further offered no advantage and may cause harm. This session works through illustrative cases rather than trial summaries: the patient with rising creatinine but no urgent indication, refractory hyperkalaemia or acidosis demanding immediate treatment, the fluid-overloaded patient with worsening oxygenation, and the diuretic-responsive patient in whom watchful waiting proves correct. Each case is used to separate absolute indications from the discretionary zone where trials apply. Emphasis will be on practical decision aids — urine output trajectory, furosemide stress testing, fluid balance, and organ-support burden — and on when not starting is the better decision.Acute PD vs Acute HD: Which Is the Right Choice?For AKI requiring kidney replacement therapy outside well-resourced ICUs, the practical question is which modality can be started safely tonight. Acute peritoneal dialysis (PD) needs no vascular access, anticoagulation, water treatment, or machine, but concerns persist about clearance and ultrafiltration control. Our multicentre randomized trial assigned 157 patients with AKI to lower-dosage acute PD (18–24 L/day) or intermittent hemodialysis three times weekly. Sepsis caused 68% of AKI. Twenty-eight-day mortality was 50% versus 49% (risk difference 0.6%), meeting the prespecified noninferiority margin, with comparable dialysis-free survival and seven-day fluid balance. Complications diverged rather than favoured one modality: intradialytic hypotension was more frequent with hemodialysis, hypokalemia with PD. This lecture translates these findings into practice — where lower-dosage PD is a legitimate first choice, where it is not, how to prescribe and monitor it, and how modality availability shapes AKI preparedness in resource-limited settings. Defining What matters in AKI trials: Heterogeneity and Future Direction of Major Adverse Kidney Events Kent DoiJapan Speaker Organ Crosstalk in AKIAcute kidney injury (AKI) is frequently complicated by distant organ dysfunction, significantly increasing patient morbidity and mortality. Recent clinical and experimental evidence highlights complex inter-organ crosstalk mechanisms, such as systemic cytokine release, oxidative stress, immune dysregulation, and damage-associated molecular patterns (DAMPs), that mediate extrarenal tissue injury. Experimental studies demonstrate distinct pathophysiological axes connecting the injured kidney with the heart and lungs. Specifically, mitochondrial dysfunction plays a critical role in acute cardiorenal syndrome. Furthermore, in AKI-induced acute lung injury, in addition to activation of the HMGB1–Toll-like receptor 4 (TLR4) pathway and formation of neutrophil extracellular traps (NETs), recent studies have reported a novel pathophysiological mechanism of impaired gas exchange mediated by neutrophil retention. This presentation provides an updated overview of the molecular pathways driving AKI-induced distant organ crosstalk, emphasizing key pathophysiology involving the heart and lungs, and discusses targeted therapeutic strategies to improve clinical outcomes in multi-organ failure.Heterogeneity and Future Direction of Major Adverse Kidney EventsThe "AKI/AKD/CKD axis" represents a critical continuum in nephrology, highlighting that acute kidney injury (AKI) is not merely a self-limiting episode but a potent driver of chronic kidney disease (CKD). Numerous clinical studies have reported the epidemiology of the AKI-to-CKD transition, demonstrating how recurrent or severe AKI accelerates renal decline. Crucially, methodological heterogeneity in defining Major Adverse Kidney Events (MAKE), as highlighted by our recent scoping review (Maeda et al., Intensive Care Med 2024), complicates the interpretation of clinical trial outcomes. To ensure the success of future clinical trials targeting AKI and the AKI-to-CKD transition, we must not only identify optimal therapeutic targets, but also establish standardized outcomes that directly align with improved patient care.Targeted Polymyxin B Hemadsorption in Sepsis: Lessons from Japanese Experience and Patient SelectionPolymyxin B haemadsorption (PMX-HA) has a long clinical history in Japan in the treatment of endotoxemia and septic shock. However, recent international randomized controlled trials and clinical guidelines have caused controversy regarding its routine use, citing inconsistent survival benefits in unselected populations. This presentation reviews the evolution of PMX-HA, from its origins in extensive Japanese clinical experience to modern precision medicine approaches in intensive care. Recent secondary analyses and real-world studies have highlighted significant heterogeneity in treatment effects, underscoring the necessity of appropriate patient selection. Subgroup analyses from the EUPHRATES trial demonstrated the potential efficacy of PMX-HA in patients with moderate-to-high endotoxin activity levels (EAA 0.6–0.9) and high severity of organ failure. Furthermore, machine learning applications such as causal forest modelling on large observational and trial cohorts have successfully identified specific biomarker profiles and clinical characteristics that define true responders. Extracorporeal Therapies in Trauma, Burns and Cerebral Edema John ProwleUnited Kingdom Speaker Trajectories of Critical Illness – Defining Endotypes from Routine DataCritical illness is a heterogeneous syndrome characterized by diverse clinical trajectories and variable responses to treatment. Defining biologically and clinically meaningful endotypes using routinely collected healthcare data offers an opportunity to improve risk stratification, prognostication, and personalized therapeutic strategies, enabling earlier intervention, enhanced clinical decision-making, and precision medicine in critical care. In particular the transition from acute to persistent critical illness represents a pivotal phase in intensive care, marked by a shift from the initial disease insult to prolonged organ dysfunction driven by complex host responses. Early identification of patients at risk of this transition remains a major clinical challenge and opportunity.Dynamic Prescription of CRRT Ready for Prime TimeContinuous renal replacement therapy (CRRT) has evolved from a standardized supportive therapy to a platform for precision critical care. Increasing evidence suggests that fixed prescriptions fail to accommodate the dynamic physiological changes encountered during critical illness, resulting in suboptimal solute clearance, fluid management, and metabolic control. Dynamic prescription integrates evolving haemodynamic status, fluid balance, acid–base homeostasis, electrolyte disturbances, and recovery trajectories to optimize therapy delivery while minimizing complications and treatment interruptions. This paradigm supports individualized kidney support rather than protocol-driven care. Emerging decision-support systems and data-driven algorithms have the potential to transform CRRT into a responsive, patient-centred intervention, improving kidney recovery, organ support, and outcomes in critically ill patients. Adapting CRRT for patients with Electrolyte and acid-base disordersContinuous renal replacement therapy (CRRT) is uniquely positioned to provide precise correction of complex electrolyte and acid–base disturbances in critically ill patients. Beyond kidney support, modern CRRT prescriptions can be individualized to account for the severity and evolution of dysnatremia, dyskalemia, calcium disorders, and metabolic acidosis or alkalosis. Customization of dialysate and replacement fluid composition, treatment dose, buffer delivery, and regional citrate anticoagulation enables controlled correction while minimizing the risks of metabolic complications. Dynamic prescription based on serial biochemical monitoring and changing clinical physiology can be embedded into treatment protocols, facilitating safe correction of sodium, potassium, calcium, and bicarbonate abnormalities while optimizing organ support and improving outcomes in critically ill patients. Extracorporeal Therapies in Trauma, Burns and Cerebral OedemaExtracorporeal therapies (ECTs) are an important adjunct in the management of critically ill patients with severe trauma, major burns, and brain injuries. Acute kidney injury, systemic inflammation, rhabdomyolysis, and profound fluid and electrolyte disturbances frequently complicate these conditions, necessitating timely organ support. Continuous kidney replacement therapy (CKRT) provides effective management of metabolic derangements while enabling precise fluid balance in hemodynamically unstable patients. In trauma and burns, ECTs may facilitate the clearance of myoglobin in severe rhabdomyolysis, support fluid management during resuscitation, and could enable removal of damage or pathogen associated molecular patterns mediating multiorgan failure. In patients with cerebral edema, CKRT offers gradual osmotic control and minimizes intracranial pressure fluctuations compared with intermittent dialysis, making it the preferred modality when kidney replacement therapy is required. We will review current evidence, practical considerations, and emerging extracorporeal strategies, highlighting their role in improving physiological stability and supporting recovery in critically ill patients. Q & A Room 101AB

Time

Session

16:00

17:30

Plenary 6: Emerging Strategies in AKI Care, Kidney Safety, and Extracorporeal Support

Manish KaushikSingapore Moderator Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT

Yu-Chang YEHTaiwan Moderator Clinical Support Information with Generative AI: Content Generation and Evaluation Generative artificial intelligence is shifting from single-question answering toward structured clinical decision support at the bedside. This lecture presents a practical approach to generating and evaluating AI-derived clinical support information in critical care. On the generation side, we describe a multi-turn conversation and multi-task workflow in which structured patient data, a machine learning mortality prediction model, and SHAP-based explanations are passed sequentially to a large language model through five linked task prompts covering risk interpretation, syndrome identification, current status and diagnoses, recommended examinations, and management suggestions. Each turn inherits the context of the previous one, so the output accumulates into a coherent clinical narrative rather than a set of isolated answers. On the evaluation side, we introduce the IMPACT Framework, a six-domain, 21-item instrument developed through a multinational Delphi consensus involving 58 panelists from 12 countries. Its domains, Integration, Mastery, Precision, Applicability, Comprehensiveness, and Timeliness, allow both clinicians and automated judges to score generated content reproducibly. We share validation results, examples from an intensive care cohort, and lessons learned from iterative prompt refinement. Attendees will leave with a transferable method for building and auditing generative AI support tools in their own units.

AKD Care Redefined: Diabetes, Hypertension, and Strategies for Long-Term Health

VinCent WuTaiwan Speaker AKD Care Redefined: Diabetes, Hypertension, and Strategies for Long-Term Health Traditional acute kidney injury (AKI) classifications, centered around semi-anatomical lines, no longer suffice in capturing the complexity of AKI. Subphenotyping, enriched with AKI biomarkers, holds insights into distinct risk profiles and tailored treatment strategies, redefining AKI and contributing to improved clinical management (Critical Care). Incorporating kidney biomarkers into strategies for early AKI detection and the initiation of AKI care bundles has shown greater effectiveness than using care bundles without these novel biomarkers. Our investigations have made notable advancements in identifying water-soluble regulatory iron hepcidin as a promising early biomarker for predicting postoperative acute kidney injury. Beyond hepcidin, our research extended into the exploration of predictive biomarkers, such as HJV, NGAL, and cFGF-23, uncovering their potential in prognosticating the occurrence and severity of AKI (Cell Death Dis, Antioxidants & redox signaling). The amalgamation of these biomarkers with existing clinical AKI scores holds immense promise in revolutionizing critical care and ushering in a new era of personalized patient management. Moreover, our endeavors have transcended theoretical advancements, with successful patent acquisition for AKI biomarkers attesting to our commitment. We were the inaugural contributors to the discourse on the effects of indoxyl sulfate on the tubulogenesis capability of endothelial progenitor cells and cell aging in acute kidney injury(Angiogenesis). A comprehensive review of the long-term prognosis of acute kidney injury, encompassing impacts on the heart, brain, bone lesions, gastrointestinal, and tissue carcinogenesis, was presented. (JASN, KI, cJASN, JAHA, ICM, CC). Our team posited that transferring post-AKI patients to nephrologists for care could reduce overall mortality and cardiovascular events (Value in Health). Through integrated analysis, we demonstrated that standard dialysis would increase the number of patients avoiding dialysis (CC), stimulating fervent discussions among AKI physicians at international conferences. Notably, we were global trailblazers in proposing that acute kidney disease, regardless of AKI presence, leads to mortality and end-stage kidney disease(eClinicalMedicine ). Although the evidence for patients with acute kidney disease (AKD) is still lacking, several potential pharmacological agents may improve outcomes, including but not limited to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists (JAMA NO). In conclusion, accurate prognosis prediction and effective treatment for AKD are critical yet unmet clinical needs. Future studies are urgently needed to improve patient care in this complex and rapidly evolving field.
Drug Exposures: Concerns in Kidney Safety (PPI vs Potassium-Competitive ACID Blockers (P-CABs))

Kyungho LeeSouth Korea Speaker Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs))
Acute PD vs Acute HD: Which Is the Right Choice?

Nattachai SrisawatThailand Speaker Precision Sepsis-AKI — Biomarkers, AI and Phenotyping in the Asia-PacificSepsis-associated AKI in the Asia-Pacific carries a burden that global datasets underrepresent. In the SEA-AKI prospective multicentre ICU study, AKI was very common, with stage 3 reaching 28.9%, and infectious disease among the independent risk factors for AKI development. In the InSEA-RRT registry — 2,315 critically ill patients with stage 3 AKI across 24 hospitals in Southeast Asia and India — 47% died during hospitalization, with major adverse kidney events tracked to two years. These cohorts expose the limits of treating sepsis-AKI as one disease. This lecture examines how damage and stress biomarkers, machine-learning models trained on regional rather than imported data, and sub-phenotyping by trajectory and host response can move us from a single creatinine-based label toward actionable patient groups. Emphasis will be on what is deployable in resource-variable settings, where biomarker access is uneven and registry infrastructure is often the practical starting point for precision medicine.Timing of DialysisWhen to start kidney replacement therapy (KRT) in AKI remains one of the most frequent bedside decisions in critical care, and the trial evidence has settled less than it first appears. ELAIN favoured early initiation, AKIKI and IDEAL-ICU did not, STARRT-AKI showed no survival benefit from an accelerated strategy with more dialysis dependence at 90 days, and AKIKI-2 found that delaying further offered no advantage and may cause harm. This session works through illustrative cases rather than trial summaries: the patient with rising creatinine but no urgent indication, refractory hyperkalaemia or acidosis demanding immediate treatment, the fluid-overloaded patient with worsening oxygenation, and the diuretic-responsive patient in whom watchful waiting proves correct. Each case is used to separate absolute indications from the discretionary zone where trials apply. Emphasis will be on practical decision aids — urine output trajectory, furosemide stress testing, fluid balance, and organ-support burden — and on when not starting is the better decision.Acute PD vs Acute HD: Which Is the Right Choice?For AKI requiring kidney replacement therapy outside well-resourced ICUs, the practical question is which modality can be started safely tonight. Acute peritoneal dialysis (PD) needs no vascular access, anticoagulation, water treatment, or machine, but concerns persist about clearance and ultrafiltration control. Our multicentre randomized trial assigned 157 patients with AKI to lower-dosage acute PD (18–24 L/day) or intermittent hemodialysis three times weekly. Sepsis caused 68% of AKI. Twenty-eight-day mortality was 50% versus 49% (risk difference 0.6%), meeting the prespecified noninferiority margin, with comparable dialysis-free survival and seven-day fluid balance. Complications diverged rather than favoured one modality: intradialytic hypotension was more frequent with hemodialysis, hypokalemia with PD. This lecture translates these findings into practice — where lower-dosage PD is a legitimate first choice, where it is not, how to prescribe and monitor it, and how modality availability shapes AKI preparedness in resource-limited settings.
Defining What matters in AKI trials: Heterogeneity and Future Direction of Major Adverse Kidney Events

Kent DoiJapan Speaker Organ Crosstalk in AKIAcute kidney injury (AKI) is frequently complicated by distant organ dysfunction, significantly increasing patient morbidity and mortality. Recent clinical and experimental evidence highlights complex inter-organ crosstalk mechanisms, such as systemic cytokine release, oxidative stress, immune dysregulation, and damage-associated molecular patterns (DAMPs), that mediate extrarenal tissue injury. Experimental studies demonstrate distinct pathophysiological axes connecting the injured kidney with the heart and lungs. Specifically, mitochondrial dysfunction plays a critical role in acute cardiorenal syndrome. Furthermore, in AKI-induced acute lung injury, in addition to activation of the HMGB1–Toll-like receptor 4 (TLR4) pathway and formation of neutrophil extracellular traps (NETs), recent studies have reported a novel pathophysiological mechanism of impaired gas exchange mediated by neutrophil retention. This presentation provides an updated overview of the molecular pathways driving AKI-induced distant organ crosstalk, emphasizing key pathophysiology involving the heart and lungs, and discusses targeted therapeutic strategies to improve clinical outcomes in multi-organ failure.Heterogeneity and Future Direction of Major Adverse Kidney EventsThe "AKI/AKD/CKD axis" represents a critical continuum in nephrology, highlighting that acute kidney injury (AKI) is not merely a self-limiting episode but a potent driver of chronic kidney disease (CKD). Numerous clinical studies have reported the epidemiology of the AKI-to-CKD transition, demonstrating how recurrent or severe AKI accelerates renal decline. Crucially, methodological heterogeneity in defining Major Adverse Kidney Events (MAKE), as highlighted by our recent scoping review (Maeda et al., Intensive Care Med 2024), complicates the interpretation of clinical trial outcomes. To ensure the success of future clinical trials targeting AKI and the AKI-to-CKD transition, we must not only identify optimal therapeutic targets, but also establish standardized outcomes that directly align with improved patient care.Targeted Polymyxin B Hemadsorption in Sepsis: Lessons from Japanese Experience and Patient SelectionPolymyxin B haemadsorption (PMX-HA) has a long clinical history in Japan in the treatment of endotoxemia and septic shock. However, recent international randomized controlled trials and clinical guidelines have caused controversy regarding its routine use, citing inconsistent survival benefits in unselected populations. This presentation reviews the evolution of PMX-HA, from its origins in extensive Japanese clinical experience to modern precision medicine approaches in intensive care. Recent secondary analyses and real-world studies have highlighted significant heterogeneity in treatment effects, underscoring the necessity of appropriate patient selection. Subgroup analyses from the EUPHRATES trial demonstrated the potential efficacy of PMX-HA in patients with moderate-to-high endotoxin activity levels (EAA 0.6–0.9) and high severity of organ failure. Furthermore, machine learning applications such as causal forest modelling on large observational and trial cohorts have successfully identified specific biomarker profiles and clinical characteristics that define true responders.
Extracorporeal Therapies in Trauma, Burns and Cerebral Edema

John ProwleUnited Kingdom Speaker Trajectories of Critical Illness – Defining Endotypes from Routine DataCritical illness is a heterogeneous syndrome characterized by diverse clinical trajectories and variable responses to treatment. Defining biologically and clinically meaningful endotypes using routinely collected healthcare data offers an opportunity to improve risk stratification, prognostication, and personalized therapeutic strategies, enabling earlier intervention, enhanced clinical decision-making, and precision medicine in critical care. In particular the transition from acute to persistent critical illness represents a pivotal phase in intensive care, marked by a shift from the initial disease insult to prolonged organ dysfunction driven by complex host responses. Early identification of patients at risk of this transition remains a major clinical challenge and opportunity.Dynamic Prescription of CRRT Ready for Prime TimeContinuous renal replacement therapy (CRRT) has evolved from a standardized supportive therapy to a platform for precision critical care. Increasing evidence suggests that fixed prescriptions fail to accommodate the dynamic physiological changes encountered during critical illness, resulting in suboptimal solute clearance, fluid management, and metabolic control. Dynamic prescription integrates evolving haemodynamic status, fluid balance, acid–base homeostasis, electrolyte disturbances, and recovery trajectories to optimize therapy delivery while minimizing complications and treatment interruptions. This paradigm supports individualized kidney support rather than protocol-driven care. Emerging decision-support systems and data-driven algorithms have the potential to transform CRRT into a responsive, patient-centred intervention, improving kidney recovery, organ support, and outcomes in critically ill patients. Adapting CRRT for patients with Electrolyte and acid-base disordersContinuous renal replacement therapy (CRRT) is uniquely positioned to provide precise correction of complex electrolyte and acid–base disturbances in critically ill patients. Beyond kidney support, modern CRRT prescriptions can be individualized to account for the severity and evolution of dysnatremia, dyskalemia, calcium disorders, and metabolic acidosis or alkalosis. Customization of dialysate and replacement fluid composition, treatment dose, buffer delivery, and regional citrate anticoagulation enables controlled correction while minimizing the risks of metabolic complications. Dynamic prescription based on serial biochemical monitoring and changing clinical physiology can be embedded into treatment protocols, facilitating safe correction of sodium, potassium, calcium, and bicarbonate abnormalities while optimizing organ support and improving outcomes in critically ill patients. Extracorporeal Therapies in Trauma, Burns and Cerebral OedemaExtracorporeal therapies (ECTs) are an important adjunct in the management of critically ill patients with severe trauma, major burns, and brain injuries. Acute kidney injury, systemic inflammation, rhabdomyolysis, and profound fluid and electrolyte disturbances frequently complicate these conditions, necessitating timely organ support. Continuous kidney replacement therapy (CKRT) provides effective management of metabolic derangements while enabling precise fluid balance in hemodynamically unstable patients. In trauma and burns, ECTs may facilitate the clearance of myoglobin in severe rhabdomyolysis, support fluid management during resuscitation, and could enable removal of damage or pathogen associated molecular patterns mediating multiorgan failure. In patients with cerebral edema, CKRT offers gradual osmotic control and minimizes intracranial pressure fluctuations compared with intermittent dialysis, making it the preferred modality when kidney replacement therapy is required. We will review current evidence, practical considerations, and emerging extracorporeal strategies, highlighting their role in improving physiological stability and supporting recovery in critically ill patients.
Q & A

Room 101AB