Meet the Expert 6

20 Sep 2026 07:30 08:15

Room 3

Timing of Dialysis

Ching-Chang Huang Moderator

Timing of Dialysis

Session Overview

Deciding when to discontinue or resume dialysis is one of the most challenging aspects of managing patients recovering from acute-on-chronic kidney disease. Premature discontinuation may lead to recurrent complications, whereas unnecessary continuation may expose patients to hypotension, vascular access complications, and delayed kidney recovery.

This session will feature an elderly patient with advanced CKD and Child-Pugh B cirrhosis who developed MSSA bacteremia-associated acute-on-chronic kidney disease. The course was complicated by severe uremic bleeding from a duodenal Dieulafoy’s lesion, requiring endoscopic clipping and urgent hemodialysis. Dialysis was subsequently discontinued after stabilization and improvement in urine output. Although kidney function continued to improve, the patient later developed asymptomatic pulmonary congestion.

What Will Be Covered

Practical criteria for liberation from kidney replacement therapy
The roles of urine output, solute clearance, volume status, and metabolic stability
Indications for resuming dialysis after initial discontinuation
Balancing the risk of recurrent uremic bleeding against dialysis-related hemodynamic stress
Assessment and management of congestion in patients with cirrhosis
Use of diuretics after dialysis discontinuation
Interpretation of asymptomatic pulmonary congestion
Clinical usefulness and limitations of the Furosemide Stress Test
Integrating clinical judgment with biomarkers and dynamic bedside assessment

What Participants Will Learn

Participants will learn how to determine whether kidney function is sufficient to support dialysis discontinuation and how to recognize when dialysis should be resumed. The session will also address how to manage persistent or recurrent congestion without relying solely on serum creatinine or urine output.

Target Audience

Nephrologists, intensivists, internists, hepatologists, fellows, residents, dialysis nurses, and other healthcare professionals involved in the management of acute-on-chronic kidney disease and kidney replacement therapy liberation.

停止透析與重新啟動的時機

課程簡介

對 acute-on-chronic kidney disease 病人而言，何時停止透析、何時需要重新啟動，是臨床上最困難的決策之一。過早停用可能造成尿毒症、體液過多或電解質異常再次惡化；但不必要地延長透析，也可能增加低血壓、血管通路併發症及腎功能恢復延遲的風險。

本場次將以一名合併 advanced CKD 與 Child-Pugh B 肝硬化的高齡病人為例。病人因 MSSA bacteremia 發生 acute-on-chronic kidney disease，後續出現嚴重尿毒性出血，並因十二指腸 Dieulafoy’s lesion 接受內視鏡止血及緊急 hemodialysis。病況穩定且尿量改善後停止透析，腎功能亦持續恢復，但後續影像顯示無症狀的肺部鬱血。

課程內容

停止 kidney replacement therapy 的實務判斷標準
尿量、溶質清除、體液狀態與代謝穩定度的評估
初次停止透析後，重新啟動治療的適應症
復發性尿毒性出血與透析相關血流動力學負荷之間的權衡
肝硬化病人的體液過多與肺部鬱血評估
停止透析後利尿劑的使用與調整
無症狀肺部鬱血的臨床判讀
Furosemide Stress Test 的實際用途與限制
如何整合臨床判斷、biomarkers 與床邊動態評估

參與者將學到

參與者將學習如何判斷病人的腎功能是否足以停止透析，以及在停用後應追蹤哪些指標，才能及早辨識重新啟動透析的需要。

課程亦將探討如何處理持續或再次出現的體液過多，並避免僅依賴 serum creatinine 或尿量作為透析決策的單一依據。

適合對象

腎臟科、重症醫學科、一般內科及肝膽胃腸科醫師、研究醫師、住院醫師、透析護理師，以及參與 acute-on-chronic kidney disease 與透析停止評估的醫療專業人員。

Time	Session

07:30 08:15	Timing of Dialysis Nattachai Srisawat 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. Ravindra Mehta Speaker Yun Tao Huang Presenter Room 4

Time

Session

07:30

08:15

Timing of Dialysis

Nattachai Srisawat 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.

Ravindra Mehta Speaker

Yun Tao Huang Presenter

Room 4

Meet the Expert 6

Abstract List