Meet the Expert 4

Targeting Persistent AKI and Promoting Recovery

Session Overview

Recovery after severe acute kidney injury (AKI) is often prolonged and unpredictable, particularly in patients who remain dialysis-dependent after hospital discharge. Effective post-AKI care requires continued assessment of kidney recovery, individualized dialysis management, appropriate medication adjustment, and close coordination between hospital teams and community dialysis units.

This session will feature an elderly patient with coronary artery disease, diabetes, hypertension, recent NSAID exposure, and rapidly progressive kidney dysfunction caused by MPO-ANCA-associated pauci-immune glomerulonephritis. Despite immunosuppressive therapy, plasma exchange, and rituximab induction, the patient remained dialysis-dependent at discharge following a complicated hospital course.

What Will Be Covered

• Assessment of kidney recovery in dialysis-dependent acute kidney disease
• Clinical and laboratory indicators suggesting renal recovery
• Timing of initiation or resumption of renin-angiotensin system inhibitors
• Structured handoff from the hospital to community dialysis units
• Individualization of dialysis frequency, ultrafiltration, and treatment intensity
• Strategies for dialysis weaning and trial discontinuation
• Recognition and management of dialysis-related electrolyte depletion
• Long-term follow-up after severe AKI and AKD

What Participants Will Learn

Participants will learn how to distinguish persistent kidney injury from evolving recovery and how to adjust dialysis prescriptions accordingly. The session will also provide a practical approach to medication management, communication with outpatient dialysis teams, and the safe transition from dialysis-dependent AKD toward kidney replacement therapy liberation.

Target Audience

Nephrologists, internists, intensivists, fellows, residents, dialysis nurses, and other healthcare professionals involved in post-AKI follow-up, outpatient dialysis care, and kidney recovery assessment.

持續性 AKI 的照護與腎功能恢復策略

課程簡介

嚴重急性腎損傷（acute kidney injury, AKI）後的腎功能恢復往往漫長且難以預測，尤其是出院時仍需接受透析治療的病人。這類病人的後續照護不只是繼續安排透析，更需要持續評估腎功能是否恢復、調整透析處方與藥物，並確保住院團隊與社區透析院所之間有良好的照護銜接。

本場次將以一名合併冠狀動脈疾病、糖尿病、高血壓及近期 NSAID 使用史的高齡病人為例。病人因 MPO-ANCA-associated pauci-immune glomerulonephritis 出現快速惡化的腎功能障礙，雖接受免疫抑制治療、plasma exchange 與 rituximab induction，經歷複雜住院病程後，出院時仍依賴透析。

課程內容

• Dialysis-dependent acute kidney disease 病人的腎功能恢復評估
• 判斷腎功能開始恢復的臨床與實驗室指標
• Renin-angiotensin system inhibitor 開始或恢復使用的時機
• 從住院醫療團隊轉銜至社區透析院所的交班重點
• 透析頻率、超濾量與治療強度的個別化調整
• 透析減量、試停與停止治療的實務策略
• 透析相關電解質流失的辨識與處理
• 嚴重 AKI 與 AKD 後的長期追蹤

參與者將學到

參與者將學習如何區分持續性腎損傷與逐步恢復中的腎功能，並據此調整透析處方與追蹤策略。

課程亦將說明如何安排藥物治療、建立清楚的出院交班內容，並與社區透析團隊共同規劃安全的透析減量與停止治療流程。

適合對象