Kyungho Lee South Korea

Kyungho Lee
Kyungho Lee is currently an Associate Professor in the Division of Nephrology, Department of Medicine, at Samsung Medical Center, Seoul, Korea. He earned his PhD degree in 2020 from Sungkyunkwan University School of Medicine. After completing his internal medicine residency and nephrology fellowship at Samsung Medical Center, he worked as a postdoctoral research fellow at the Johns Hopkins University School of Medicine, mentored by Dr. Hamid Rabb. His basic research focuses on the role of lymphocytes in acute kidney injury, with particular interest in the immunological mechanisms underlying kidney injury and repair. His clinical research encompasses critical care nephrology, continuous kidney replacement therapy, and kidney transplantation. He has also contributed to international collaborations in extracorporeal blood purification, including co-authorship of the Asia-Pacific oXiris Expert Meeting 2024 consensus statement.

18th September 2026 Friday

Time Session
18:00
19:00
Mini‑Oral Presentation 1 - Group A
Jui-Yi ChenTaiwan Moderator
Kyungho LeeSouth Korea Moderator Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs))
Room 101D

19th September 2026 Saturday

Time Session
16:00
17:30
Regional Symposium (AKD/EBM)
AKD in Asia-Pacific: Post-AKI Recovery, Critical Illness, and Regional Phenotypes
Tai-Shuan LaiTaiwan Moderator
WEIHUNG LinTaiwan Moderator 重症腎臟醫學的能力架構：里程碑與 EPAs 重症腎臟醫學的能力架構：里程碑與可信賴專業活動（EPAs） 林威宏醫師 醫學系副系主任｜教學中心主任｜內科部副部長｜一般內科主任 成功大學醫學院附設醫院 重症腎臟醫學要求臨床醫師在高度不確定、時間敏感且跨專業的情境中，整合急性腎損傷、腎替代治療、電解質與酸鹼異常、液體與血流動力學，以及倫理與溝通等多重能力。傳統以訓練年資、授課主題或病例數為主的課程，往往無法回答最關鍵的問題：受訓醫師究竟能在何種督導程度下，安全且一致地完成真實臨床任務？ 本演講將介紹一套適用於重症醫學專科訓練的「重症腎臟醫學核心能力框架」草案。此框架以能力導向醫學教育為基礎，將 ACGME 六大核心能力整合至六個臨床領域，建構18項可信賴專業活動（entrustable professional activities, EPAs）及五階段里程碑。L4定義為完訓時可被信賴執行的目標層級；在臺灣ICU主治醫師覆核文化下，對應於間接督導及次日覆核，L5則代表完訓後的進階專家發展。七項涉及病人安全的核心任務被列為must-pass EPAs，包括腎臟替代療法的適應症與時機、CRRT處方、CRRT劑量調整與治療藥物監測、危急電解質異常、以床邊超音波及VExUS評估液體反應性與靜脈充血、敗血症相關AKI，以及腎臟替代療法撤除與緩和醫療。 評量採多工具、縱向及多來源的整合式評量，結合病例討論、mini-CEX、DOPS、模擬式OSCE、360度回饋與學習歷程；罕見但高風險的臨床情境，可由模擬、病歷回顧或結構式病例討論補足。建議的完訓門檻為七項must-pass EPAs全數達L4、18項中至少15項達L4，其餘至少達L3，並完成跨團隊品質改善成果。 此框架將訓練焦點由「教過多少、做過幾例」轉向「能否在適當督導下可靠完成臨床工作」，並透過可觀察表現、持續回饋與縱向進展，支持可辯護的信賴決策，同時為後續AI輔助學習與可信賴教育系統提供由臨床專業所界定的能力基礎。 關鍵詞：能力導向醫學教育、重症腎臟醫學、可信賴專業活動、里程碑、整合式評量 Competency Frameworks in Critical Care Nephrology: Milestones and Entrustable Professional Activities (EPAs) Wei-Hung Lin, MD, PhD Vice Chair, Department of Medicine, College of Medicine, National Cheng Kung University Director, Education Center Deputy Director, Department of Internal Medicine Chief, Division of General Internal Medicine National Cheng Kung University Hospital (NCKUH), College of Medicine, National Cheng Kung University Critical care nephrology requires clinicians to integrate acute kidney injury, renal replacement therapy, electrolyte and acid–base disorders, fluid and hemodynamic management, and ethically complex communication in time-sensitive, uncertain, and interprofessional settings. Traditional curricula based on training duration, covered topics, or case numbers do not adequately answer a fundamental question: What clinical work can a trainee be trusted to perform, and at what level of supervision? This lecture introduces a proposed competency-based framework for postgraduate training in critical care nephrology. The framework maps the six Accreditation Council for Graduate Medical Education core competencies across six clinical domains and organizes authentic workplace practice into 18 entrustable professional activities (EPAs) with five developmental milestone levels. Level 4 (L4) represents the graduation target—interpreted in the Taiwanese ICU context as indirect supervision with next-day attending review—whereas L5 denotes aspirational post-training expertise. Seven safety-critical EPAs require achievement of L4: determining the indications and timing of renal replacement therapy; prescribing continuous renal replacement therapy (CRRT); adjusting CRRT dose and therapeutic drug monitoring; managing life-threatening electrolyte disorders; assessing fluid responsiveness and venous congestion using point-of-care ultrasound (POCUS) and venous excess ultrasound (VExUS); managing sepsis-associated AKI; and leading decisions on withdrawal of renal replacement therapy and palliative care. Assessment is programmatic, longitudinal, and multisource, combining case-based discussion, mini-CEX, direct observation of procedural skills, simulation-based OSCEs, multisource feedback, and a longitudinal portfolio. Simulation, chart review, and structured case conferences can address low-frequency, high-risk clinical exposures. Proposed graduation standards require all seven must-pass EPAs and at least 15 of 18 EPAs to reach L4, with the remainder at L3 or above, plus documented interprofessional quality-improvement work. By shifting the focus from content coverage and case counting to observable performance, feedback, progression, and defensible entrustment decisions, the framework provides a clinically defined foundation for subsequent AI-enabled learning and trustworthy education systems. Keywords: competency-based medical education; critical care nephrology; entrustable professional activities; milestones; programmatic assessment
  • Chair's Opening: Framing Post-AKI Recovery, Critical Illness, and Regional AKD Phenotypes
    Tai-Shuan LaiTaiwan Speaker
    WEIHUNG LinTaiwan Speaker 重症腎臟醫學的能力架構：里程碑與 EPAs 重症腎臟醫學的能力架構：里程碑與可信賴專業活動（EPAs） 林威宏醫師 醫學系副系主任｜教學中心主任｜內科部副部長｜一般內科主任 成功大學醫學院附設醫院 重症腎臟醫學要求臨床醫師在高度不確定、時間敏感且跨專業的情境中，整合急性腎損傷、腎替代治療、電解質與酸鹼異常、液體與血流動力學，以及倫理與溝通等多重能力。傳統以訓練年資、授課主題或病例數為主的課程，往往無法回答最關鍵的問題：受訓醫師究竟能在何種督導程度下，安全且一致地完成真實臨床任務？ 本演講將介紹一套適用於重症醫學專科訓練的「重症腎臟醫學核心能力框架」草案。此框架以能力導向醫學教育為基礎，將 ACGME 六大核心能力整合至六個臨床領域，建構18項可信賴專業活動（entrustable professional activities, EPAs）及五階段里程碑。L4定義為完訓時可被信賴執行的目標層級；在臺灣ICU主治醫師覆核文化下，對應於間接督導及次日覆核，L5則代表完訓後的進階專家發展。七項涉及病人安全的核心任務被列為must-pass EPAs，包括腎臟替代療法的適應症與時機、CRRT處方、CRRT劑量調整與治療藥物監測、危急電解質異常、以床邊超音波及VExUS評估液體反應性與靜脈充血、敗血症相關AKI，以及腎臟替代療法撤除與緩和醫療。 評量採多工具、縱向及多來源的整合式評量，結合病例討論、mini-CEX、DOPS、模擬式OSCE、360度回饋與學習歷程；罕見但高風險的臨床情境，可由模擬、病歷回顧或結構式病例討論補足。建議的完訓門檻為七項must-pass EPAs全數達L4、18項中至少15項達L4，其餘至少達L3，並完成跨團隊品質改善成果。 此框架將訓練焦點由「教過多少、做過幾例」轉向「能否在適當督導下可靠完成臨床工作」，並透過可觀察表現、持續回饋與縱向進展，支持可辯護的信賴決策，同時為後續AI輔助學習與可信賴教育系統提供由臨床專業所界定的能力基礎。 關鍵詞：能力導向醫學教育、重症腎臟醫學、可信賴專業活動、里程碑、整合式評量 Competency Frameworks in Critical Care Nephrology: Milestones and Entrustable Professional Activities (EPAs) Wei-Hung Lin, MD, PhD Vice Chair, Department of Medicine, College of Medicine, National Cheng Kung University Director, Education Center Deputy Director, Department of Internal Medicine Chief, Division of General Internal Medicine National Cheng Kung University Hospital (NCKUH), College of Medicine, National Cheng Kung University Critical care nephrology requires clinicians to integrate acute kidney injury, renal replacement therapy, electrolyte and acid–base disorders, fluid and hemodynamic management, and ethically complex communication in time-sensitive, uncertain, and interprofessional settings. Traditional curricula based on training duration, covered topics, or case numbers do not adequately answer a fundamental question: What clinical work can a trainee be trusted to perform, and at what level of supervision? This lecture introduces a proposed competency-based framework for postgraduate training in critical care nephrology. The framework maps the six Accreditation Council for Graduate Medical Education core competencies across six clinical domains and organizes authentic workplace practice into 18 entrustable professional activities (EPAs) with five developmental milestone levels. Level 4 (L4) represents the graduation target—interpreted in the Taiwanese ICU context as indirect supervision with next-day attending review—whereas L5 denotes aspirational post-training expertise. Seven safety-critical EPAs require achievement of L4: determining the indications and timing of renal replacement therapy; prescribing continuous renal replacement therapy (CRRT); adjusting CRRT dose and therapeutic drug monitoring; managing life-threatening electrolyte disorders; assessing fluid responsiveness and venous congestion using point-of-care ultrasound (POCUS) and venous excess ultrasound (VExUS); managing sepsis-associated AKI; and leading decisions on withdrawal of renal replacement therapy and palliative care. Assessment is programmatic, longitudinal, and multisource, combining case-based discussion, mini-CEX, direct observation of procedural skills, simulation-based OSCEs, multisource feedback, and a longitudinal portfolio. Simulation, chart review, and structured case conferences can address low-frequency, high-risk clinical exposures. Proposed graduation standards require all seven must-pass EPAs and at least 15 of 18 EPAs to reach L4, with the remainder at L3 or above, plus documented interprofessional quality-improvement work. By shifting the focus from content coverage and case counting to observable performance, feedback, progression, and defensible entrustment decisions, the framework provides a clinically defined foundation for subsequent AI-enabled learning and trustworthy education systems. Keywords: competency-based medical education; critical care nephrology; entrustable professional activities; milestones; programmatic assessment
  • Talk 1: From AKI to AKD: Recovery Pathways and High-Risk Phenotypes
    Jia-Jin ChenTaiwan Speaker From AKI to AKD: Recovery Pathways and High-Risk PhenotypesAcute kidney disease (AKD) represents a critical transition between acute kidney injury (AKI) and chronic kidney disease. Drawing on real-world evidence from cardiac surgery, acute decompensated heart failure, and ECMO cohorts, this talk will illustrate how kidney recovery trajectories and AKD phenotypes identify patients at high risk for long-term kidney and cardiovascular events. It will also discuss opportunities to improve post-AKI care, including earlier resumption of RAAS inhibitors and emerging evidence for GLP-1 receptor agonists and SGLT2 inhibitors. Recognizing AKD may help transform post-AKI care from passive observation toward proactive cardiorenal risk management.
  • Talk 2: Can the Kidney Truly Recover After AKI? Fluid Management, Critical Illness, and the AKD Continuum
    Nurul Zaynah NordinMalaysia Speaker Can the Kidney Truly Recover After AKI? Fluid Management, Critical Illness, and the AKD Continuum
  • Talk 3: Immune-Mediated Repair After AKI: From Recovery to AKD Progression
    Kyungho LeeSouth Korea Speaker Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs))
  • Talk 4: Preventable AKI and AKD: A Philippine Perspective on Early Recognition and Risk Reduction
    Maria Erika RamirezPhilippines Speaker Preventable AKI and AKD: A Philippine Perspective on Early Recognition and Risk ReductionThis presentation examines acute kidney injury and acute kidney disease in the Philippine setting, highlighting practical, low-cost strategies for early recognition and risk reduction to prevent progression to chronic kidney disease.
  • Panel Discussion / Q&A: How Should Asia-Pacific Build Better Post-AKI/AKD Recovery and Prevention Pathways?
    Jia-Jin ChenTaiwan Speaker From AKI to AKD: Recovery Pathways and High-Risk PhenotypesAcute kidney disease (AKD) represents a critical transition between acute kidney injury (AKI) and chronic kidney disease. Drawing on real-world evidence from cardiac surgery, acute decompensated heart failure, and ECMO cohorts, this talk will illustrate how kidney recovery trajectories and AKD phenotypes identify patients at high risk for long-term kidney and cardiovascular events. It will also discuss opportunities to improve post-AKI care, including earlier resumption of RAAS inhibitors and emerging evidence for GLP-1 receptor agonists and SGLT2 inhibitors. Recognizing AKD may help transform post-AKI care from passive observation toward proactive cardiorenal risk management.
    Kyungho LeeSouth Korea Speaker Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs))
    Maria Erika RamirezPhilippines Speaker Preventable AKI and AKD: A Philippine Perspective on Early Recognition and Risk ReductionThis presentation examines acute kidney injury and acute kidney disease in the Philippine setting, highlighting practical, low-cost strategies for early recognition and risk reduction to prevent progression to chronic kidney disease.
    Nurul Zaynah NordinMalaysia Speaker Can the Kidney Truly Recover After AKI? Fluid Management, Critical Illness, and the AKD Continuum
  • Chair's Synthesis and Take-Home Points
    Tai-Shuan LaiTaiwan Speaker
    WEIHUNG LinTaiwan Speaker 重症腎臟醫學的能力架構：里程碑與 EPAs 重症腎臟醫學的能力架構：里程碑與可信賴專業活動（EPAs） 林威宏醫師 醫學系副系主任｜教學中心主任｜內科部副部長｜一般內科主任 成功大學醫學院附設醫院 重症腎臟醫學要求臨床醫師在高度不確定、時間敏感且跨專業的情境中，整合急性腎損傷、腎替代治療、電解質與酸鹼異常、液體與血流動力學，以及倫理與溝通等多重能力。傳統以訓練年資、授課主題或病例數為主的課程，往往無法回答最關鍵的問題：受訓醫師究竟能在何種督導程度下，安全且一致地完成真實臨床任務？ 本演講將介紹一套適用於重症醫學專科訓練的「重症腎臟醫學核心能力框架」草案。此框架以能力導向醫學教育為基礎，將 ACGME 六大核心能力整合至六個臨床領域，建構18項可信賴專業活動（entrustable professional activities, EPAs）及五階段里程碑。L4定義為完訓時可被信賴執行的目標層級；在臺灣ICU主治醫師覆核文化下，對應於間接督導及次日覆核，L5則代表完訓後的進階專家發展。七項涉及病人安全的核心任務被列為must-pass EPAs，包括腎臟替代療法的適應症與時機、CRRT處方、CRRT劑量調整與治療藥物監測、危急電解質異常、以床邊超音波及VExUS評估液體反應性與靜脈充血、敗血症相關AKI，以及腎臟替代療法撤除與緩和醫療。 評量採多工具、縱向及多來源的整合式評量，結合病例討論、mini-CEX、DOPS、模擬式OSCE、360度回饋與學習歷程；罕見但高風險的臨床情境，可由模擬、病歷回顧或結構式病例討論補足。建議的完訓門檻為七項must-pass EPAs全數達L4、18項中至少15項達L4，其餘至少達L3，並完成跨團隊品質改善成果。 此框架將訓練焦點由「教過多少、做過幾例」轉向「能否在適當督導下可靠完成臨床工作」，並透過可觀察表現、持續回饋與縱向進展，支持可辯護的信賴決策，同時為後續AI輔助學習與可信賴教育系統提供由臨床專業所界定的能力基礎。 關鍵詞：能力導向醫學教育、重症腎臟醫學、可信賴專業活動、里程碑、整合式評量 Competency Frameworks in Critical Care Nephrology: Milestones and Entrustable Professional Activities (EPAs) Wei-Hung Lin, MD, PhD Vice Chair, Department of Medicine, College of Medicine, National Cheng Kung University Director, Education Center Deputy Director, Department of Internal Medicine Chief, Division of General Internal Medicine National Cheng Kung University Hospital (NCKUH), College of Medicine, National Cheng Kung University Critical care nephrology requires clinicians to integrate acute kidney injury, renal replacement therapy, electrolyte and acid–base disorders, fluid and hemodynamic management, and ethically complex communication in time-sensitive, uncertain, and interprofessional settings. Traditional curricula based on training duration, covered topics, or case numbers do not adequately answer a fundamental question: What clinical work can a trainee be trusted to perform, and at what level of supervision? This lecture introduces a proposed competency-based framework for postgraduate training in critical care nephrology. The framework maps the six Accreditation Council for Graduate Medical Education core competencies across six clinical domains and organizes authentic workplace practice into 18 entrustable professional activities (EPAs) with five developmental milestone levels. Level 4 (L4) represents the graduation target—interpreted in the Taiwanese ICU context as indirect supervision with next-day attending review—whereas L5 denotes aspirational post-training expertise. Seven safety-critical EPAs require achievement of L4: determining the indications and timing of renal replacement therapy; prescribing continuous renal replacement therapy (CRRT); adjusting CRRT dose and therapeutic drug monitoring; managing life-threatening electrolyte disorders; assessing fluid responsiveness and venous congestion using point-of-care ultrasound (POCUS) and venous excess ultrasound (VExUS); managing sepsis-associated AKI; and leading decisions on withdrawal of renal replacement therapy and palliative care. Assessment is programmatic, longitudinal, and multisource, combining case-based discussion, mini-CEX, direct observation of procedural skills, simulation-based OSCEs, multisource feedback, and a longitudinal portfolio. Simulation, chart review, and structured case conferences can address low-frequency, high-risk clinical exposures. Proposed graduation standards require all seven must-pass EPAs and at least 15 of 18 EPAs to reach L4, with the remainder at L3 or above, plus documented interprofessional quality-improvement work. By shifting the focus from content coverage and case counting to observable performance, feedback, progression, and defensible entrustment decisions, the framework provides a clinically defined foundation for subsequent AI-enabled learning and trustworthy education systems. Keywords: competency-based medical education; critical care nephrology; entrustable professional activities; milestones; programmatic assessment
3F South Lounge

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