New Horizons in Neonatal & Pediatric AKI-AKD Continuum

Abstract List

20 Sep 2026 10:45 12:30
Room 103
Min-Hua TsengTaiwan Moderator
Shotaro MatsumotoJapan Moderator The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsExtracorporeal membrane oxygenation (ECMO) and continuous kidney replacement therapy (CKRT) support pediatric cardiopulmonary failure complicated by acute kidney injury (AKI) and fluid overload (FO). AKI and multiorgan dysfunction are increasingly viewed through bidirectional kidney-lung-heart crosstalk, extending in ECMO/CKRT patients to artificial organs: oxygenator, blood pump, and hemofilter. Kidney-lung crosstalk shares pathways of vascular rigidity, neurohormonal activation, tissue hypoxia, and aberrant immune signaling. Ventilator-induced biotrauma impairs renal function, while AKI worsens lung injury via fluid, acid-base, and cytokine derangements; positive-pressure ventilation further raises right-ventricular afterload and central venous pressure, reducing renal perfusion. Kidney-heart crosstalk (cardiorenal syndrome type 3) involves analogous inflammatory and neuroendocrine mechanisms and carries a high mortality risk in children. Beyond native organs, the oxygenator activates complement/inflammatory cascades via blood-biomaterial contact, and non-pulsatile pump flow causes shear-induced hemolysis, with free hemoglobin/iron contributing to AKI. CKRT-ECMO circuit connection requires attention to circuit pressures, embolism risk, and altered drug pharmacokinetics-challenges framed by the multiple organ support therapy (MOST) concept. Key management priorities include early correction of FO, standardized CKRT-ECMO integration per PCRRT-ICONIC and ADQI/ELSO consensus recommendations, lung-protective ventilation and conservative fluid management, and long-term renal/blood-pressure surveillance after ECMO. Research has evolved from single-center FO-mortality studies to consensus statements, the extracorporeal organ support concept, and the multicenter WE-ROCK registry, with recent work clarifying molecular mechanisms of sepsis-associated lung-kidney crosstalk. Future work should pursue biomarker-driven endotyping and integrated MOST platforms.Core Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & PrescriptionModality selection and dose prescription remain unresolved in pediatric continuous kidney replacement therapy (CKRT). Pediatric trials are scarce, so practice extrapolates from adult evidence, while 2026 KDIGO and Surviving Sepsis Campaign updates have reopened debate. Ronco's 2000 trial established an "at least 35 mL/kg/h" paradigm after showing improved survival with higher ultrafiltration, later refuted by the large ATN and RENAL trials, which found no survival benefit from higher intensity and more complications. KDIGO 2012 therefore recommended a delivered dose of 20-25 mL/kg/h, unchanged in the 2026 draft, which additionally now recommends against high-volume hemofiltration (HVHF) in adult septic AKI, reflecting negative IVOIRE trial and Cochrane review findings. For modality, CVVHDF has become dominant in the WE-ROCK pediatric registry, rising from 30% to 76% of prescriptions, though some favor CVVH for convective clearance; no modality shows a survival advantage. For dose, the 2026 KDIGO draft newly defines pediatric practice points: weight- rather than surface-area-based prescription to avoid inadvertent infant overdosing, initial effluent of 25-30 mL/kg/h, augmented dosing to 200 mL/kg/h for hyperammonemia, and an ultrafiltration-rate of maximal 2.5ml/kg/h. WE-ROCK data show prescribed doses far exceeding these targets without an observed dose-outcome association. Adding to this uncertainty, the 2026 pediatric Surviving Sepsis Campaign guideline newly recommends HVHF (>35 mL/kg/h) in septic shock, conditionally and with low certainty, reversing its 2020 position on a fragile three-trial meta-analysis (Fragility Index=1)-contrasting with adult evidence and the concurrent adult KDIGO recommendation against HVHF. Given risks such as dialytrauma and drug underdosing, this fragile signal warrants cautious application. This session invites participants to weigh this evidence and build a practical framework for individualizing modality and dose decisions at the bedside.

Workshop title:
Pediatric AKI & Extracorporeal Therapies: From Basics to Advanced Clinical Challenges

What will be covered:
This session covers neonatal and pediatric AKI-AKD continuum care, pediatric extracorporeal support, and practical extracorporeal therapy challenges. The workshop component includes circuit priming, hemodynamic management, modality selection, anticoagulation, and advanced purification strategies.

What participants will learn:

• How to approach neonatal and pediatric AKI-AKD phenotypes.

• How to select appropriate extracorporeal modalities for pediatric patients.

• How to manage circuit priming and hemodynamic challenges.

• How to apply regional citrate anticoagulation and understand therapeutic plasma exchange concepts in pediatric practice.

Take-home value:
Participants will gain a structured approach to pediatric extracorporeal therapy, from modality selection to advanced bedside troubleshooting.

Target audience:
Pediatric intensivists, pediatric nephrologists, clinical fellows, pediatric ICU teams, nurses, and postgraduate trainees.

 

課程名稱:
兒童 AKI 與體外治療：從基礎到進階臨床挑戰

教什麼:
本場次涵蓋新生兒與兒童 AKI-AKD 連續照護、兒科體外支持治療，以及兒科體外治療常見的臨床挑戰。工作坊內容包括迴路預充、血流動力學管理、治療模式選擇、抗凝策略與進階血液淨化治療。

學什麼:
• 辨識新生兒與兒童 AKI-AKD 的臨床表型。

• 依兒童病人狀況選擇合適的體外治療模式。

• 處理迴路預充與血流動力學不穩定等臨床問題。

• 應用區域性檸檬酸抗凝，並理解治療性血漿置換在兒科臨床的概念。\

得什麼:
帶回一套兒科體外治療的實用架構，從治療模式選擇到床邊疑難排除皆可應用。

適合對象:
兒科重症醫師、兒童腎臟科醫師、臨床研究員、兒科加護病房團隊、護理師與住院醫師。

 

Time Session
10:45
10:45
11:05
The Missing Link: Navigating the Acute Kidney Disease (AKD) Window and Preventing CKD
11:05
11:05
11:25
Spotlight on Neonatal AKI: The AWAKEN Criteria, Unique Phenotypes, and Genetic Insights
11:30
11:30
11:55
The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in Pediatrics
11:55
11:55
12:15
Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric Sepsis
12:15
12:15
12:30
Q&A