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07:30
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08:15
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Targeting Persistent AKI and Promoting Recovery
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Chi-yuan HsuUnited States
Speaker
Targeting Persistent AKI and Promoting RecoveryDoes Mild to Moderate AKI Actually Cause CKD?
Jay KoynerUnited States
Speaker
Special lecture: 2026 KDIGO AKI Guideline UpdateI will be updating the audience on the major conceptual updates of the 2026 KDIGO AKI Guidelines. I will focus on Chapter 1 and 2, including the evolving definition of AKI/AKD, AKI trajectories, biomarkers, and risk prediction, together with selected key updates from Chapter 4 on nephrotoxin-associated kidney injuryTargeting Persistent AKI and Promoting RecoveryI have been working with my co-moderators to develop a case based presentation looking at the use of biomarkers to predict outcomes in a patient with dialysis requiring AKI. and we will be discussing the intracicies of providing AKI-care to those receiving dialysis and how best to wean patients from dialysis and the long term outpatient managment of these patients
Room 101C
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How Do I Use Hemadsorption in My Practice
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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)
Thomas RimmeléFrance
Speaker
Managing Patients with Sepsis: Modifying the Course with ECOSImmune Disorders of AKI Patients Following Various Types of Injuries ?How Do I Use Hemadsorption in My Practice
Room 101D
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Timing of Dialysis
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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.
Room 103
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08:20
12:30
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Do Ngoc SonVietnam
Speaker
Advancing ECCO₂R Therapy: Lessons from Vietnam for the Asia-Pacific RegionExtracorporeal carbon dioxide removal (ECCO2R) therapy has been used widely in many ICUs in the world. There has been huge evidence on the effectiveness of the ARDS, COPD exacerbation, bridge to lung transplantation. However, the use of this technology is still limited to center in the developed world. The first 2 ECCO2R cases have been carried out successfully at the Center for Critical Care Medicine of Bach Mai hospital in 2023. There is a lot enthusiasm of technology, especially in early, mild to moderate stages of ARDS, mechanical ventilation complication on the exacerbation of COPD etc.... The problem with these approaches is that there will be more expenses for the patient family and burden for ICU staff. The future of ECCO2R will be individualization and health insurance reimbursement.
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Kai-Fan TsaiTaiwan
Speaker
The Application of Novel Renal Biomarkers in Clinical and Environmental NephrologyOrganophosphate flame retardants (OPFRs) and phthalates are emerging organic pollutants and have “pseudo-persistent” properties in the environment. With widespread utilization in consumer products, OPFRs and phthalates have led to extensive human exposure, and their potential health hazard is a topic of increasing concern. However, the exposure pattern and health effects of OPFRs and phthalates are yet to be investigated in patients with renal disease in Taiwan. Since 2020, the research team at Kaohsiung Chang Gung Memorial Hospital has initiated a study project addressing OPFR and phthalates exposure in the population in Taiwan and its impact on renal diseases. We utilized novel renal biomarkers to detect the subtle renal injury associated with exposure to these environmental pollutants. In our analysis, exposure to these environmental pollutant was universal in the participants, with an overall detection rate of beyond 90%. The associations between OPFR and phthalate exposure and renal disease were identified in patients with chronic kidney disease (CKD), and urinary concentrations of these chemicals were correlated with urinary biomarkers of renal tubular injury and oxidative stress in the CKD population. Our findings highlight the multisystemic health impact of OPFR and phthalate exposure, which warrants particular attention and further investigations, and also underscore the role of novel renal biomarkers in environmental medicine.
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Kenichi KokuboJapan
Speaker
Developing Next-Generation Dialysis Technologies for Acute Kidney Care and Disaster PreparednessAcute kidney care and dialysis during disasters share several important challenges, including limited resources, the need for flexible treatment delivery, and the requirement for safe and stable extracorporeal circulation. From an engineering perspective, next-generation dialysis systems should provide greater flexibility, safety, and resilience under different clinical conditions. In this presentation, I will introduce next-generation dialysis technologies that our group is currently investigating and developing.
One of our major projects is a compact dialysis system being developed for home hemodialysis. The system combines dialysate recirculation with adsorption technologies to reduce water and dialysate requirements, together with integrated sensors for remote monitoring of both device operation and patient status.
These technologies may also be applicable beyond home hemodialysis. Their low infrastructure requirements and remote monitoring capabilities could facilitate dialysis during disasters, and the same platform could also be adapted for continuous renal replacement therapy (CRRT) in acute kidney care.
Another approach under investigation is the delivery of nitric oxide (NO) through the dialysate to improve antithrombogenicity during extracorporeal circulation. Because NO has an extremely short biological half-life, its antithrombotic effects may potentially be localized primarily to the extracorporeal circuit, with limited systemic effects after the blood returns to the patient. This characteristic could be particularly advantageous for patients at high risk of bleeding and may facilitate safer prolonged extracorporeal blood purification.
Although these technologies remain under development, they illustrate how engineering approaches can contribute to the future of kidney replacement therapy. Resource-efficient dialysis systems, integrated remote monitoring, and localized antithrombogenic strategies may enable more flexible and safer blood purification across home, acute care, and disaster settings.
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Takeshi MoriguchiJapan
Speaker
Blood Purification in Disasters: Japan’s Evolving Approach to Hospital Resilience, DMAT Coordination, and ICU-Based Renal Support[Background]
Disasters markedly increase the incidence of acute kidney injury (AKI) while simultaneously disrupting the critical lifelines required to deliver renal support. In Japan, most maintenance dialysis patients receive treatment in outpatient clinics rather than large hospitals. During major disasters, including the Noto Peninsula earthquake, the status of affected dialysis facilities and the number of patients requiring treatment were rapidly assessed. Dialysis networks allocated patients based on receiving capacity and arranged transfers outside the affected area when necessary. This demonstrates that disaster renal care relies as much on logistics, information sharing, and regional coordination as it does on dialysis techniques.
[Acute Care & Resource Requirements]
Acute renal replacement therapy for critically ill patients is typically provided in large hospitals and consumes substantial resources. Patients presenting with crush syndrome, rhabdomyolysis, trauma, shock, sepsis, heat-related illness, or multiple organ failure may require intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), or continuous renal replacement therapy (CRRT). These therapies strictly depend on electricity, water, replacement fluids, circuits, filters, catheters, anticoagulants, and trained medical staff. Prompt diagnosis, triage, and timely transfer to hospitals capable of acute blood purification are essential to effective disaster response.
[Systems & DMAT Integration]
This lecture highlights Japan’s evolving approach to disaster blood purification, developed through repeated experiences with earthquakes, tsunamis, floods, and other emergencies. Particular emphasis is placed on Disaster Base Hospitals, which are expected to maintain emergency functions through earthquake-resistant infrastructure, backup power, water supplies, medical stockpiles, robust communication networks, business continuity planning (BCP), and specialized personnel. Additionally, the role of Disaster Medical Assistance Teams (DMAT) will be discussed in evaluating hospital capabilities, supporting affected facilities, coordinating patient transport, and bridging field medicine with ICU-capable facilities.
[Conclusions]
From an ICU perspective, disaster blood purification requires a delicate balance between physiological benefit and logistical feasibility. Continuous therapies (CRRT) should be reserved for hemodynamically unstable patients requiring ongoing support, whereas intermittent therapies (IHD/PIRRT) are preferable when rapid correction of hyperkalemia or acidosis is needed, or when resources are limited. Ultimately, blood purification in disasters is a system-dependent form of organ support: a CRRT machine is only as strong as the hospital and regional lifelines behind it.
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Room 101C
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08:30
10:15
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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.
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Kianoush KashaniUnited States
Speaker
Practical Steps to Train (and Become) an AI-Era PhysicianAI in Critical Care Nephrology — State of the Art and the Path from Algorithm to BedsideCritical Care Nephrology: Literature ReviewChat GPT Applications in Critical Care Nephrology
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Sejoong KimSouth Korea
Speaker
Korean Big-Data Experience in AKI and CRRT OutcomesSouth Korea has established a robust nationwide health data infrastructure, enabling large-scale analyses of acute kidney injury (AKI) and continuous renal replacement therapy (CRRT). Leveraging the Health Insurance Review and Assessment Service (HIRA) and National Health Insurance Service (NHIS) databases, Korean researchers have characterized AKI incidence, risk factors, and short- and long-term outcomes across diverse clinical settings. Studies utilizing CRRT data have identified predictors of mortality, renal recovery, and progression to chronic kidney disease. These big-data approaches provide critical real-world evidence, informing clinical practice and guiding future interventional strategies in critically ill patients with AKI.Precision Volume Management in CRRT: Insights from Bioimpedance and BiomarkersOptimal fluid balance is critical in critically ill patients undergoing continuous renal replacement therapy (CRRT), yet accurate volume assessment remains challenging. Bioimpedance analysis (BIA) offers a non-invasive, objective method to quantify fluid overload and guide individualized ultrafiltration targets. Complementing BIA, emerging biomarkers provide dynamic, real-time insights into volume status and end-organ perfusion. Integrating these tools into a precision medicine framework may optimize fluid removal strategies, reduce complications, and improve survival outcomes in CRRT-dependent patients. Prospective validation of this combined approach is warranted.
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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.
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Lui ForniUnited Kingdom
Speaker
Sepsis Associated AKIBicarbonate in AKI: Use and MisuseAdapting CRRT for Patients with Electrolyte and ACID-Base Disorders
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Kathleen LiuUnited States
Speaker
How do I Manage Patients with Combined Kidney and Liver FailureKidney-Ventilator Interactions and Kidney Protective Ventilation /or Lung and Kidney CrosstalkHow Do I Care for the Patient with ARDS and AKIDe-escalating and Transitioning RRT: Best Practices
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Room 101AB
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Yin-Yi HanTaiwan
Speaker
Micronutrient Strategy in Critically Ill AKI Patients: Balancing Oxidative Stress, Inflammation, and CRRT LossesAcute kidney injury is common in critically ill patients and is frequently accompanied by systemic inflammation, oxidative stress, mitochondrial dysfunction, immune dysregulation, and metabolic instability. In this context, micronutrients are not merely supportive supplements; they serve as essential cofactors for antioxidant defense, immune competence, endothelial integrity, energy metabolism, and tissue repair. However, micronutrient management in critically ill patients with AKI is challenging because of increased requirements, difficulty in assessing deficiency, impaired renal clearance, and substantial losses during continuous renal replacement therapy (CRRT).
This lecture will discuss practical micronutrient strategies for critically ill patients with AKI, focusing on key nutrients such as thiamine, vitamin C, vitamin D, selenium, zinc, copper, and other trace elements. Their biological roles, potential CRRT-related losses, clinical relevance, and safety considerations will be reviewed. Based on current evidence and clinical experience, a risk-adapted, phase-based approach will be proposed to balance deficiency correction, metabolic resilience, and avoidance of excessive supplementation in this vulnerable population.
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Chih-Yi HsuTaiwan
Speaker
Energy and Protein Prescription in AKI During CRRT: Precision Nutrition Support vs Predictive Estimation急性腎損傷（AKI）合併連續性腎臟替代治療（CRRT）患者常處於高度代謝壓力與蛋白質分解狀態，且CRRT過程中會增加胺基酸、葡萄糖及微量營養素流失，使能量與蛋白質需求更加複雜。傳統以預測公式進行營養處方，於此族群可能產生顯著誤差，無法反映個別病人的動態代謝變化。近年來，精準營養支持概念逐漸受到重視，強調依據間接熱量測定、氮平衡及臨床病程進行個別化調整。本演講將比較預測估算與精準營養策略於CRRT病人中的應用，並探討其臨床可行性與實務整合，以提升重症營養照護品質。
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Tsui-Yin TungTaiwan
Speaker
Preoperative Metabolic Optimization: Can Amino Acid Supplementation Reduce Postoperative AKI?研究與統合分析證實，手術中靜脈輸注胺基酸顯著降低AKI風險。機制為激發腎儲備功能、優化腎臟灌注。此方案安全且具成本效益，縮短住院天數。雖未降低死亡率，仍是Level 1實證的可行方式。
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Kai-Yin HungTaiwan
Speaker
肝腎症候群的營養策略: 蛋白限制、醣類與代謝調控肝腎症候群合併急性腎損傷（HRS-AKI）是晚期肝硬化最嚴重的併發症之一，即使在血管收縮劑治療、體外器官支持與肝臟移植持續進步下，仍伴隨顯著死亡風險。不同於結構性腎損傷，HRS-AKI 的病理基礎在於嚴重的循環功能失調、全身性發炎、內皮損傷與逐步加劇的代謝異常，營養治療應被視為整體疾病管理的重要一環。肝硬化患者常見蛋白熱量營養不良、肌少症、高代謝與加速飢餓狀態，當急性腎損傷發生時，這些代謝異常進一步惡化，導致免疫功能下降、氨清除能力受損、腎功能恢復延遲、加護病房住院時間延長及死亡率上升。由於腹水、周邊水腫與液體負荷，傳統以體重、BMI 或白蛋白進行的營養評估常具誤導性；現在評估更強調乾體重推估、肌肉量與肌肉品質、功能性評估，以及肝病專屬營養篩檢工具。現有證據支持在可行時儘早啟動腸道營養、避免長時間禁食、提供足夠能量，並即使存在肝性腦病變仍維持充足蛋白質攝取。蛋白限制已不再被建議，維持骨骼肌對氨代謝、代謝韌性與重症恢復相當重要。 營養處方應依疾病階段、腎臟替代治療、肝移植狀態及代謝需求變化進行個別化調整。
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Shu-Tzu ChenTaiwan
Speaker
Post-AKI Nutritional Recovery: Preventing Sarcopenia and Slowing AKI-to-CKD TransitionIt is a misconception that patients recovering from acute kidney injury should avoid a high-protein diet that may increase the risk of sarcopenia. However, this concept is not supported by current evidence. Adequate protein intake helps preserve lean body mass by reducing muscle protein breakdown, but high protein intake alone does not stimulate muscle hypertrophy. Excessive protein consumption may only increase nitrogenous waste production and impose an unnecessary metabolic burden on the recovering kidneys. The most effective strategy for increasing muscle mass is resistance exercise combined with appropriate nutritional supplement.
Carbohydrate intake before exercise helps reduce muscle protein breakdown, while adequate carbohydrate with a small amount of protein after exercise effectively stimulates muscle protein synthesis and promotes muscle growth. This lecture will review the physiological mechanisms underlying skeletal muscle hypertrophy and discuss evidence-based exercise and nutritional strategies for the prevention and treatment of sarcopenia in patients with kidney disease, with particular emphasis on those recovering from acute kidney injury.
急性腎損傷恢復期的病人不適合攝取高蛋白質飲食可能導致肌少症發生是錯誤的觀念，因為增加蛋白質攝取才能增加肌肉量避免肌少症發生並不正確。足夠的蛋白質可避免肌肉分解，但不會增加肌肉量。增加肌肉量不需要大量的蛋白質，過多的蛋白質只會產生較多的含氮廢物增加腎臟負擔。增加肌肉量需要阻力運動與運動前、後正確的營養補充;運動前補充糖類可避免肌肉耗損，運動後補充足夠的糖與少量蛋白質就能有效增加肌肉量。本次演講內容以增加肌肉組成的生理機制為基礎，重點說明預防或治療腎臟病人肌少症的運動營養補充策略。Panel Discussion: From ICU to Community – Building a Renal Nutrition Care ContinuumPatients with acute kidney injury (AKI), especially those requiring intensive care and kidney replacement therapy, are at high risk of malnutrition, muscle wasting, and functional decline. However, nutritional care is often fragmented during the transition from acute illness to recovery and long-term kidney care. This panel will discuss strategies to establish a continuum of renal nutrition care from ICU to community, including individualized nutrition support during AKI, protein and energy management , post-AKI nutritional recovery , and multidisciplinary approaches to improve long-term outcomes and quality of life.
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Shu-Tzu ChenTaiwan
Speaker
Post-AKI Nutritional Recovery: Preventing Sarcopenia and Slowing AKI-to-CKD TransitionIt is a misconception that patients recovering from acute kidney injury should avoid a high-protein diet that may increase the risk of sarcopenia. However, this concept is not supported by current evidence. Adequate protein intake helps preserve lean body mass by reducing muscle protein breakdown, but high protein intake alone does not stimulate muscle hypertrophy. Excessive protein consumption may only increase nitrogenous waste production and impose an unnecessary metabolic burden on the recovering kidneys. The most effective strategy for increasing muscle mass is resistance exercise combined with appropriate nutritional supplement.
Carbohydrate intake before exercise helps reduce muscle protein breakdown, while adequate carbohydrate with a small amount of protein after exercise effectively stimulates muscle protein synthesis and promotes muscle growth. This lecture will review the physiological mechanisms underlying skeletal muscle hypertrophy and discuss evidence-based exercise and nutritional strategies for the prevention and treatment of sarcopenia in patients with kidney disease, with particular emphasis on those recovering from acute kidney injury.
急性腎損傷恢復期的病人不適合攝取高蛋白質飲食可能導致肌少症發生是錯誤的觀念，因為增加蛋白質攝取才能增加肌肉量避免肌少症發生並不正確。足夠的蛋白質可避免肌肉分解，但不會增加肌肉量。增加肌肉量不需要大量的蛋白質，過多的蛋白質只會產生較多的含氮廢物增加腎臟負擔。增加肌肉量需要阻力運動與運動前、後正確的營養補充;運動前補充糖類可避免肌肉耗損，運動後補充足夠的糖與少量蛋白質就能有效增加肌肉量。本次演講內容以增加肌肉組成的生理機制為基礎，重點說明預防或治療腎臟病人肌少症的運動營養補充策略。Panel Discussion: From ICU to Community – Building a Renal Nutrition Care ContinuumPatients with acute kidney injury (AKI), especially those requiring intensive care and kidney replacement therapy, are at high risk of malnutrition, muscle wasting, and functional decline. However, nutritional care is often fragmented during the transition from acute illness to recovery and long-term kidney care. This panel will discuss strategies to establish a continuum of renal nutrition care from ICU to community, including individualized nutrition support during AKI, protein and energy management , post-AKI nutritional recovery , and multidisciplinary approaches to improve long-term outcomes and quality of life.
Room 101D
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Yen-Ta HuangTaiwan
Speaker
From Guidelines to Bayesian Trials: How Should We Interpret Polymyxin B Hemoadsorption in Sepsis?Polymyxin B hemoadsorption has occupied an unusually contested place in sepsis care, and the way authoritative bodies describe it has shifted over time. This talk traces that evolution—from the 2020 Taiwan AKI consensus through the 2021 and 2026 Surviving Sepsis Campaign guidelines—and uses the changing recommendations as a lens on the methodological debates that underlie them.
From an evidence-based medicine standpoint, the controversy is less about the device than about how we generate and grade evidence. I will first examine the frequentist evidence base, including our network meta-analysis of blood purification therapies for severe infection and sepsis/septic shock published in Critical Care Medicine. I will outline what a network meta-analysis adds—coherent ranking across multiple modalities, indirect comparison, and explicit quantification of heterogeneity—while being candid about its limitations, including reliance on the transitivity assumption, sparse networks, and the fragility of mortality estimates pooled from heterogeneous trials.
I will then turn to the recently reported TIGRIS trial, which used a Bayesian, enrichment-based phase 3 design with prespecified borrowing from the EUPHRATES treatable cohort. I will highlight the strengths of the Bayesian presentation—direct posterior probabilities of benefit, transparent incorporation of prior evidence, and efficiency in a rare, mechanistically defined phenotype—alongside the cautions it demands: sensitivity to prior choice, the open-label design, and the gap between a high posterior probability and a confirmed effect.
Bringing these strands together, the talk offers a multifaceted, methodology-driven reading of polymyxin B hemoadsorption in sepsis, and a transferable framework for clinicians facing the increasingly common situation in which guidelines, frequentist syntheses, and Bayesian trials appear to diverge.從治療執行到品質治理：連結式重症腎臟照護與資料驅動決策
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Competency Frameworks in Critical Care Nephrology: Milestones and Entrustable Professional Activities (EPAs)
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
Yen-Ta HuangTaiwan
Moderator
From Guidelines to Bayesian Trials: How Should We Interpret Polymyxin B Hemoadsorption in Sepsis?Polymyxin B hemoadsorption has occupied an unusually contested place in sepsis care, and the way authoritative bodies describe it has shifted over time. This talk traces that evolution—from the 2020 Taiwan AKI consensus through the 2021 and 2026 Surviving Sepsis Campaign guidelines—and uses the changing recommendations as a lens on the methodological debates that underlie them.
From an evidence-based medicine standpoint, the controversy is less about the device than about how we generate and grade evidence. I will first examine the frequentist evidence base, including our network meta-analysis of blood purification therapies for severe infection and sepsis/septic shock published in Critical Care Medicine. I will outline what a network meta-analysis adds—coherent ranking across multiple modalities, indirect comparison, and explicit quantification of heterogeneity—while being candid about its limitations, including reliance on the transitivity assumption, sparse networks, and the fragility of mortality estimates pooled from heterogeneous trials.
I will then turn to the recently reported TIGRIS trial, which used a Bayesian, enrichment-based phase 3 design with prespecified borrowing from the EUPHRATES treatable cohort. I will highlight the strengths of the Bayesian presentation—direct posterior probabilities of benefit, transparent incorporation of prior evidence, and efficiency in a rare, mechanistically defined phenotype—alongside the cautions it demands: sensitivity to prior choice, the open-label design, and the gap between a high posterior probability and a confirmed effect.
Bringing these strands together, the talk offers a multifaceted, methodology-driven reading of polymyxin B hemoadsorption in sepsis, and a transferable framework for clinicians facing the increasingly common situation in which guidelines, frequentist syntheses, and Bayesian trials appear to diverge.從治療執行到品質治理：連結式重症腎臟照護與資料驅動決策
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Training the Critical Care Nephrology in the AI Era: Redesigning Learning and Assessment
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From AI Tools to a Trustworthy Education System
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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
Yen-Ta HuangTaiwan
Speaker
From Guidelines to Bayesian Trials: How Should We Interpret Polymyxin B Hemoadsorption in Sepsis?Polymyxin B hemoadsorption has occupied an unusually contested place in sepsis care, and the way authoritative bodies describe it has shifted over time. This talk traces that evolution—from the 2020 Taiwan AKI consensus through the 2021 and 2026 Surviving Sepsis Campaign guidelines—and uses the changing recommendations as a lens on the methodological debates that underlie them.
From an evidence-based medicine standpoint, the controversy is less about the device than about how we generate and grade evidence. I will first examine the frequentist evidence base, including our network meta-analysis of blood purification therapies for severe infection and sepsis/septic shock published in Critical Care Medicine. I will outline what a network meta-analysis adds—coherent ranking across multiple modalities, indirect comparison, and explicit quantification of heterogeneity—while being candid about its limitations, including reliance on the transitivity assumption, sparse networks, and the fragility of mortality estimates pooled from heterogeneous trials.
I will then turn to the recently reported TIGRIS trial, which used a Bayesian, enrichment-based phase 3 design with prespecified borrowing from the EUPHRATES treatable cohort. I will highlight the strengths of the Bayesian presentation—direct posterior probabilities of benefit, transparent incorporation of prior evidence, and efficiency in a rare, mechanistically defined phenotype—alongside the cautions it demands: sensitivity to prior choice, the open-label design, and the gap between a high posterior probability and a confirmed effect.
Bringing these strands together, the talk offers a multifaceted, methodology-driven reading of polymyxin B hemoadsorption in sepsis, and a transferable framework for clinicians facing the increasingly common situation in which guidelines, frequentist syntheses, and Bayesian trials appear to diverge.從治療執行到品質治理：連結式重症腎臟照護與資料驅動決策
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Room 103
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10:15
10:45
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10:45
11:30
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Sejoong KimSouth Korea
Moderator
Korean Big-Data Experience in AKI and CRRT OutcomesSouth Korea has established a robust nationwide health data infrastructure, enabling large-scale analyses of acute kidney injury (AKI) and continuous renal replacement therapy (CRRT). Leveraging the Health Insurance Review and Assessment Service (HIRA) and National Health Insurance Service (NHIS) databases, Korean researchers have characterized AKI incidence, risk factors, and short- and long-term outcomes across diverse clinical settings. Studies utilizing CRRT data have identified predictors of mortality, renal recovery, and progression to chronic kidney disease. These big-data approaches provide critical real-world evidence, informing clinical practice and guiding future interventional strategies in critically ill patients with AKI.Precision Volume Management in CRRT: Insights from Bioimpedance and BiomarkersOptimal fluid balance is critical in critically ill patients undergoing continuous renal replacement therapy (CRRT), yet accurate volume assessment remains challenging. Bioimpedance analysis (BIA) offers a non-invasive, objective method to quantify fluid overload and guide individualized ultrafiltration targets. Complementing BIA, emerging biomarkers provide dynamic, real-time insights into volume status and end-organ perfusion. Integrating these tools into a precision medicine framework may optimize fluid removal strategies, reduce complications, and improve survival outcomes in CRRT-dependent patients. Prospective validation of this combined approach is warranted.
VinCent WuTaiwan
Moderator
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.
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Chi-yuan HsuUnited States
Speaker
Targeting Persistent AKI and Promoting RecoveryDoes Mild to Moderate AKI Actually Cause CKD?
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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.
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Raj ChakravarthiIndia
Speaker
Pregnancy-Associated AKIManaging the Heart Failure Patient With Worsening Renal Function (WRF)
Room 101AB
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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.
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Jei-Wen ChangTaiwan
Speaker
The Missing Link: Navigating the Acute Kidney Disease (AKD) Window and Preventing CKDThe paradigm of acute kidney injury (AKI) has shifted dramatically over the past decade. Once regarded as a transient event, AKI is now recognized as the initiating step in a continuum that progresses through acute kidney disease (AKD) to chronic kidney disease (CKD). Representing the "missing link" in this spectrum, AKD—defined as persistent kidney dysfunction or injury lasting between 7 and 90 days after AKI—constitutes a critical, modifiable window during which timely intervention may interrupt disease progression and prevent irreversible kidney damage.
This continuum is particularly pivotal in neonates and children. The developing kidney possesses unique developmental vulnerabilities, including incomplete nephrogenesis, reduced nephron endowment, and functional immaturity. Conditions such as prematurity, congenital anomalies of the kidney and urinary tract (CAKUT), hypoxic-ischemic injury, sepsis, congenital heart disease, and nephrotoxin exposure further compound the risk of maladaptive repair and incomplete recovery. Even following apparent clinical recovery, maladaptive repair and interstitial fibrosis may persist, increasing the lifelong risk of CKD, hypertension, and cardiovascular disease.
This lecture will review the evolving concepts, epidemiology, and pathophysiological mechanisms of the AKI–AKD–CKD continuum, with an emphasis on neonatal and pediatric populations. Emerging biomarkers for the early detection of persistent kidney injury, risk stratification, and practical post-AKI management—including nephrotoxin stewardship, structured surveillance, and multidisciplinary follow-up—will be discussed. Recognizing AKD as a distinct clinical entity shifts the focus from treating AKI to promoting kidney recovery, offering a unique opportunity to preserve long-term kidney health and prevent CKD.
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.
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Chih-Chia ChenTaiwan
Speaker
Spotlight on Neonatal AKI: The AWAKEN Criteria, Unique Phenotypes, and Genetic InsightsNeonatal acute kidney injury (AKI) is a common and clinically significant complication in the neonatal intensive care unit (NICU), and is associated with increased mortality, prolonged hospitalization, and adverse long-term renal and neurodevelopmental outcomes. However, diagnosing AKI in neonates remains particularly challenging because the neonatal kidney is still undergoing maturation, and serum creatinine levels are influenced by maternal creatinine, gestational age, and the physiological postnatal decline in creatinine. This lecture will first review the evolution of neonatal AKI definitions, from early diagnostic approaches based on absolute serum creatinine values to the currently adopted modified KDIGO criteria. The limitations of current diagnostic criteria, including the delayed rise in serum creatinine and difficulties in establishing baseline renal function, will also be discussed.
The second part of the lecture will focus on the clinical phenotypes of neonatal AKI. Rather than representing a single disease entity, neonatal AKI is a heterogeneous syndrome influenced by multiple factors, including prematurity, patent ductus arteriosus, and nephrotoxic medications. The differences between oliguric and non-oliguric AKI with also be discussed. Current evidence regarding the impact of neonatal AKI on both short-term outcomes and long-term renal health and neurodevelopment, together with the limitations of existing studies, will also be reviewed.
Finally, the speech will highlight recent advances in the genetic susceptibility and precision medicine of neonatal AKI. Rapid developments in genomics and artificial intelligence are providing new insights into why neonates with similar clinical exposures develop markedly different degrees of kidney injury, while facilitating more accurate risk stratification and predictive modeling. By integrating clinical characteristics, biomarkers, and genetic information, the diagnosis and management of neonatal AKI are expected to evolve beyond traditional disease definitions toward phenotype-based classification and precision medicine.
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.
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Shotaro MatsumotoJapan
Speaker
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.
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I-Jung TsaiTaiwan
Speaker
Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric SepsisSepsis and hyperinflammatory syndromes remain leading causes of mortality in critically ill children, frequently complicated by multiorgan dysfunction syndrome and acute kidney injury. While continuous kidney replacement therapy (CKRT) is the cornerstone for managing fluid overload and solute clearance, standard modalities cannot adequately address the underlying dysregulated immune response driven by a profound cytokine storm. Recently, a significant paradigm shift has occurred in critical care nephrology, transitioning from conventional renal support toward advanced extracorporeal blood purification (EBP) techniques. Current literature emphasizes the clinical benefits of actively removing endotoxins and excessive cytokines to restore immune homeostasis. Modalities utilizing hemoadsorption membranes have demonstrated promising outcomes in adult studies, showing rapid hemodynamic stabilization and successful modulation of inflammatory markers in septic shock. However, literature regarding EBP in pediatric populations remains notably sparse. This knowledge gap is largely attributed to the physiological and technical challenges of pediatric care, particularly the high risks of hemodynamic instability associated with large extracorporeal circuit volumes in children weighing less than 10 kilograms. Standardized protocols for pediatric EBP are still lacking, necessitating cautious technical adaptations, such as targeted blood priming strategies. This presentation will review the current literature on EBP in sepsis, explore the physiological rationale behind targeted hemoadsorption, and discuss the practical challenges of applying these therapies in pediatrics. By moving beyond traditional renal replacement, we aim to highlight how integrating advanced blood purification into pediatric CKRT can safely modulate systemic inflammation, potentially improving clinical outcomes for vulnerable critically ill children.
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Room 103
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11:30
12:25
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Chih-Hsiang ChangTaiwan
Moderator
重塑生命韌性：從 ICU 治療到回歸社會的康復之路急性腎損傷的照護目標不應止於 ICU 存活或成功脫離連續性腎臟替代治療（CRRT），而應延伸至腎功能恢復、身體功能重建與重返家庭及社會。高品質 CRRT 是此一照護路徑的起點，包括適切的治療時機與劑量、血流動力學穩定、液體管理、抗凝策略及治療中斷監測，以降低治療相關傷害並提升腎臟恢復機會。然而，出院後追蹤中斷、急性腎損傷病程辨識不足及跨專業資訊斷裂，仍使患者面臨慢性腎臟病、長期透析、再住院及功能衰退的風險。因此，台灣應建立從 ICU 延伸至社區的急性腎損傷整合照護政策：以標準化品質指標確保 CRRT 治療品質；透過電子警示、風險分層與跨院資料串接辨識高風險患者；並於出院後整合腎臟功能、藥物、營養、復健及病人報告結果的追蹤。最終政策成效不僅應評估死亡率與透析依賴，更應納入腎功能恢復、再住院、生活品質及重返社會，將急性期救命治療轉化為可衡量、可持續的生命韌性照護。
Room 101AB
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12:40
13:45
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Yu-Wei ChenTaiwan
Speaker
Initiating Acute PD in the ICU: What Actually Works in Practice
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Chih-Hsiang ChangTaiwan
Speaker
重塑生命韌性：從 ICU 治療到回歸社會的康復之路急性腎損傷的照護目標不應止於 ICU 存活或成功脫離連續性腎臟替代治療（CRRT），而應延伸至腎功能恢復、身體功能重建與重返家庭及社會。高品質 CRRT 是此一照護路徑的起點，包括適切的治療時機與劑量、血流動力學穩定、液體管理、抗凝策略及治療中斷監測，以降低治療相關傷害並提升腎臟恢復機會。然而，出院後追蹤中斷、急性腎損傷病程辨識不足及跨專業資訊斷裂，仍使患者面臨慢性腎臟病、長期透析、再住院及功能衰退的風險。因此，台灣應建立從 ICU 延伸至社區的急性腎損傷整合照護政策：以標準化品質指標確保 CRRT 治療品質；透過電子警示、風險分層與跨院資料串接辨識高風險患者；並於出院後整合腎臟功能、藥物、營養、復健及病人報告結果的追蹤。最終政策成效不僅應評估死亡率與透析依賴，更應納入腎功能恢復、再住院、生活品質及重返社會，將急性期救命治療轉化為可衡量、可持續的生命韌性照護。
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Room 101AB
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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.
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Yen-Ta HuangTaiwan
Speaker
From Guidelines to Bayesian Trials: How Should We Interpret Polymyxin B Hemoadsorption in Sepsis?Polymyxin B hemoadsorption has occupied an unusually contested place in sepsis care, and the way authoritative bodies describe it has shifted over time. This talk traces that evolution—from the 2020 Taiwan AKI consensus through the 2021 and 2026 Surviving Sepsis Campaign guidelines—and uses the changing recommendations as a lens on the methodological debates that underlie them.
From an evidence-based medicine standpoint, the controversy is less about the device than about how we generate and grade evidence. I will first examine the frequentist evidence base, including our network meta-analysis of blood purification therapies for severe infection and sepsis/septic shock published in Critical Care Medicine. I will outline what a network meta-analysis adds—coherent ranking across multiple modalities, indirect comparison, and explicit quantification of heterogeneity—while being candid about its limitations, including reliance on the transitivity assumption, sparse networks, and the fragility of mortality estimates pooled from heterogeneous trials.
I will then turn to the recently reported TIGRIS trial, which used a Bayesian, enrichment-based phase 3 design with prespecified borrowing from the EUPHRATES treatable cohort. I will highlight the strengths of the Bayesian presentation—direct posterior probabilities of benefit, transparent incorporation of prior evidence, and efficiency in a rare, mechanistically defined phenotype—alongside the cautions it demands: sensitivity to prior choice, the open-label design, and the gap between a high posterior probability and a confirmed effect.
Bringing these strands together, the talk offers a multifaceted, methodology-driven reading of polymyxin B hemoadsorption in sepsis, and a transferable framework for clinicians facing the increasingly common situation in which guidelines, frequentist syntheses, and Bayesian trials appear to diverge.從治療執行到品質治理：連結式重症腎臟照護與資料驅動決策
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Room 101C
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HF440 Next Generation Symposium Innovation Across the Kidney Care Continum
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Thomas RimmeléFrance
Speaker
Managing Patients with Sepsis: Modifying the Course with ECOSImmune Disorders of AKI Patients Following Various Types of Injuries ?How Do I Use Hemadsorption in My Practice
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Room 101D
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14:00
15:30
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Personalized Fluid Management with CRRT
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Nuttha LumlertgulThailand
Speaker
Solution and Fluid BalanceUtility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRTPersonalized Fluid Management with CRRT
Room 101AB
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Managing the Heart Failure Patient With Worsening Renal Function (WRF)
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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)
Raj ChakravarthiIndia
Speaker
Pregnancy-Associated AKIManaging the Heart Failure Patient With Worsening Renal Function (WRF)
Room 101C
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Adapting CRRT for Patients with Electrolyte and ACID-Base Disorders
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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.
Lui ForniUnited Kingdom
Speaker
Sepsis Associated AKIBicarbonate in AKI: Use and MisuseAdapting CRRT for Patients with Electrolyte and ACID-Base Disorders
Room 101D
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Chung-Kuan WuTaiwan
Speaker
SGLT-2 抑制劑於慢性腎臟病之臨床應用與保護機轉 The role of SGLT2 inhibitors in the treatment of diabetic and non-diabetic kidney disease
Diabetic kidney disease is a major cause of chronic kidney disease and end-stage kidney disease. In addition to hyperglycemia and metabolic abnormalities, its pathophysiology involves glomerular hyperfiltration, increased intraglomerular pressure, excessive tubular workload, and renal inflammation. Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) reduce glucose and sodium reabsorption in the proximal tubule, restore tubuloglomerular feedback, lower intraglomerular pressure, decrease tubular workload, and may attenuate renal inflammation. These mechanisms contribute to cardiovascular and kidney protection beyond their glucose-lowering effects. In addition, the sustained beneficial effects extend to non-diabetic kidney disease. Large clinical trials and meta-analyses have demonstrated that SGLT2 inhibitors reduce albuminuria, slow kidney function decline, and decrease cardiovascular and renal adverse events. These benefits were observed in addition to standard treatment with renin–angiotensin system inhibitors.
Key topics of the presentation include:
1. The physiological roles of SGLT1 and SGLT2 in the intestine and proximal renal tubule
2. The mechanisms by which SGLT2 inhibition reduces intraglomerular pressure, tubular workload, and renal inflammation
3. Cardiovascular and renal outcomes from the clinical trial, and relevant meta-analyses
4. The role of SGLT2 inhibitors in the comprehensive management of patients with type 2 diabetes and chronic kidney disease according to the KDIGO guideline
Overall, SGLT2 inhibitors have evolved from glucose-lowering agents into a fundamental component of cardiovascular and kidney risk management in diabetic kidney disease. Their timely use, based on kidney function, albuminuria, cardiovascular risk, and the overall comorbidity profile, may help delay kidney disease progression and improve long-term clinical outcomes.
The role of SGLT2 inhibitors in the treatment of diabetic and non-diabetic kidney disease
Diabetic kidney disease is a major cause of chronic kidney disease and end-stage kidney disease. In addition to hyperglycemia and metabolic abnormalities, its pathophysiology involves glomerular hyperfiltration, increased intraglomerular pressure, excessive tubular workload, and renal inflammation. Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) reduce glucose and sodium reabsorption in the proximal tubule, restore tubuloglomerular feedback, lower intraglomerular pressure, decrease tubular workload, and may attenuate renal inflammation. These mechanisms contribute to cardiovascular and kidney protection beyond their glucose-lowering effects. In addition, the sustained beneficial effects extend to non-diabetic kidney disease. Large clinical trials and meta-analyses have demonstrated that SGLT2 inhibitors reduce albuminuria, slow kidney function decline, and decrease cardiovascular and renal adverse events. These benefits were observed in addition to standard treatment with renin–angiotensin system inhibitors.
Key topics of the presentation include:
1. The physiological roles of SGLT1 and SGLT2 in the intestine and proximal renal tubule
2. The mechanisms by which SGLT2 inhibition reduces intraglomerular pressure, tubular workload, and renal inflammation
3. Cardiovascular and renal outcomes from the clinical trial, and relevant meta-analyses
4. The role of SGLT2 inhibitors in the comprehensive management of patients with type 2 diabetes and chronic kidney disease according to the KDIGO guideline
Overall, SGLT2 inhibitors have evolved from glucose-lowering agents into a fundamental component of cardiovascular and kidney risk management in diabetic kidney disease. Their timely use, based on kidney function, albuminuria, cardiovascular risk, and the overall comorbidity profile, may help delay kidney disease progression and improve long-term clinical outcomes.
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Ming-Tso YenTaiwan
Speaker
GLP-1 受體促效劑在腎臟與心血管代謝保護的新進展The coexistence of type 2 diabetes mellitus, obesity, chronic kidney disease (CKD), and cardiovascular disease has prompted a shift from isolated glycemic management toward integrated cardiovascular–kidney–metabolic (CKM) risk reduction. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide effective glycemic control and weight reduction, while accumulating evidence supports clinically meaningful cardiovascular and renal benefits beyond their metabolic effects. In randomized cardiovascular outcome trials and meta-analyses, GLP-1 RAs have reduced major adverse cardiovascular events (MACE), all-cause mortality, albuminuria, and composite kidney outcomes, with generally consistent effects across baseline CKD categories.
This presentation will review the current evidence for GLP-1 RA–mediated cardiorenal protection, with emphasis on recent outcome trials, including SELECT and FLOW. Particular attention will be given to the FLOW trial, which evaluated kidney outcomes as a prespecified primary endpoint and demonstrated a reduction in clinically relevant kidney-disease outcomes among patients with type 2 diabetes and CKD treated with semaglutide. The potential mechanisms underlying these benefits will also be discussed, including weight loss, improved insulin sensitivity, blood-pressure reduction, attenuation of systemic and vascular inflammation, improved endothelial function, and possible direct effects on intrarenal hemodynamics, oxidative stress, and immunometabolic pathways.
The presentation will further examine the complementary roles of GLP-1 RAs and sodium–glucose cotransporter-2 (SGLT2) inhibitors in CKM risk management. Available evidence suggests that the cardiovascular and kidney benefits of GLP-1 RAs may persist irrespective of background SGLT2 inhibitor use, although the extent of additive benefit and the optimal sequencing or combination strategy require further investigation. Practical issues—including gastrointestinal adverse effects, volume depletion, acute kidney injury risk in the setting of severe gastrointestinal intolerance, gallbladder disease, nutritional status, sarcopenia, and treatment monitoring in advanced CKD—will also be addressed.
By integrating mechanistic insights with contemporary clinical-trial data, this lecture will discuss how GLP-1 RAs may be incorporated into individualized treatment strategies for patients with diabetes, obesity, CKD, and high cardiovascular risk. The presentation will also emphasize that treatment decisions should remain patient-centered and evidence-based, recognizing that cardiovascular and renal effects may differ among individual agents, populations, and clinical indications.
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Kuang-Yu WeiTaiwan
Speaker
新型鉀離子結合劑 Lokelma 的應用Over the past decade, treatment of chronic kidney disease (CKD) and heart failure has evolved towards an integrated approach to cardiorenal protection that includes renin–angiotensin–aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), sodium–glucose cotransporter 2 (SGLT2) inhibitors and more individualized strategies for dietary potassium intake. RAAS inhibitors remain a cornerstone of treatment, and clinical trials have generally demonstrated the greatest benefits when these drugs are prescribed at maximally tolerated doses. However, the risk of hyperkalaemia frequently limits their initiation, dose optimization and continued use, thereby reducing the potential kidney and cardiovascular benefits of treatment.
Hyperkalaemia should therefore be regarded as a manageable complication of cardiorenal therapy rather than an automatic indication to reduce or discontinue RAAS inhibition. Contemporary management includes correction of reversible causes together with individualized dietary interventions, diuretics, SGLT2 inhibitors and potassium-lowering therapies. The aim of these strategies is not merely to achieve a transient reduction in blood potassium, but to enable patients to initiate and maintain guideline-directed treatment. When further inhibition of the RAAS pathway is indicated, an MRA can be added to a maximally tolerated angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In individuals at increased risk of hyperkalemia, the non-steroidal MRA may offer a more favorable potassium profile than steroidal MRAs.
Beyond their established cardiorenal benefits, SGLT2 inhibitors reduce the risk of serious hyperkalemia and could therefore facilitate continued treatment with RAAS inhibitors and MRAs. Novel potassium binders, including sodium zirconium cyclosilicate and patiromer, effectively reduce blood potassium levels and prevent recurrent hyperkalaemia, thereby enabling sustained or intensified RAAS inhibitor therapy in patients with CKD and heart failure. Sodium zirconium cyclosilicate has also been shown to control predialysis hyperkalaemia in patients receiving haemodialysis. Emerging evidence suggests that potassium binders may have additional effects, including reductions in aldosterone levels, systolic blood pressure and urinary albumin excretion with patiromer, and increased serum bicarbonate concentrations with sodium zirconium cyclosilicate. By mitigating the risk of hyperkalemia, potassium binders could also enable some patients with CKD to adopt healthier potassium-rich, plant-predominant dietary patterns.
Room 102
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Pediatric Extracorporeal Therapies: From Basics to Advanced Clinical Challenges
I-Jung TsaiTaiwan
Moderator
Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric SepsisSepsis and hyperinflammatory syndromes remain leading causes of mortality in critically ill children, frequently complicated by multiorgan dysfunction syndrome and acute kidney injury. While continuous kidney replacement therapy (CKRT) is the cornerstone for managing fluid overload and solute clearance, standard modalities cannot adequately address the underlying dysregulated immune response driven by a profound cytokine storm. Recently, a significant paradigm shift has occurred in critical care nephrology, transitioning from conventional renal support toward advanced extracorporeal blood purification (EBP) techniques. Current literature emphasizes the clinical benefits of actively removing endotoxins and excessive cytokines to restore immune homeostasis. Modalities utilizing hemoadsorption membranes have demonstrated promising outcomes in adult studies, showing rapid hemodynamic stabilization and successful modulation of inflammatory markers in septic shock. However, literature regarding EBP in pediatric populations remains notably sparse. This knowledge gap is largely attributed to the physiological and technical challenges of pediatric care, particularly the high risks of hemodynamic instability associated with large extracorporeal circuit volumes in children weighing less than 10 kilograms. Standardized protocols for pediatric EBP are still lacking, necessitating cautious technical adaptations, such as targeted blood priming strategies. This presentation will review the current literature on EBP in sepsis, explore the physiological rationale behind targeted hemoadsorption, and discuss the practical challenges of applying these therapies in pediatrics. By moving beyond traditional renal replacement, we aim to highlight how integrating advanced blood purification into pediatric CKRT can safely modulate systemic inflammation, potentially improving clinical outcomes for vulnerable critically ill children.
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Ting-Yuan ChangTaiwan
Speaker
The Critical Initiation: Circuit Priming & Hemodynamic ManagementThis workshop addresses the critical first steps of initiating continuous kidney replacement therapy (CKRT) in pediatric patients. Topics include selecting an appropriate CKRT machine, determining hemofilter size, and designing the extracorporeal circuit. Special emphasis is placed on preventing hemodynamic instability during blood priming and circuit initiation, including calculation of the patient's circulating blood volume relative to the extracorporeal volume to avoid hypovolemic shock from excessive extracorporeal blood sequestration. Participants will learn practical decision-making frameworks for safe circuit priming strategies tailored to children of different body sizes.
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Shotaro MatsumotoJapan
Speaker
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.
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Hou-Xuan HuangTaiwan
Speaker
The Perfect Balance: Regional Citrate Anticoagulation (RCA) in PracticeRegional Citrate Anticoagulation (RCA) is widely used, effective and safe for pediatric continuous kidney replacement therapy(CKRT). There are many well-established RCA protocols around the world depending on the citrate products and the CKRT machines available. During this session, we will walk through the principles of RCA and I will present a simple and practical protocol using Prismaflex machine and Regiocit product. We will also closely examine and possible electrolyte and acid-base derangement when RCA is used and introduce the monitoring strategy to ensure a smooth and safe CKRT treatment.
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Jhao-Jhuang DingTaiwan
Speaker
Advanced Purification: Therapeutic Plasma Exchange (TPE) Concepts & ChallengesTherapeutic plasma exchange (TPE) is the most widely used therapeutic apheresis modality in critically ill children, yet it remains technically demanding and conceptually distinct from diffusion- and convection-based renal replacement. This hands-on station reviews the core principles of TPE—one-compartment kinetics, the rationale for a 1.0–1.5 plasma-volume exchange, and how molecular size and protein binding determine what TPE can and cannot remove—and links them to evidence-based indications from the ASFA guidelines relevant to pediatric practice (e.g., thrombotic microangiopathies, ANCA-associated and anti-GBM disease, autoimmune neurologic disease, and liver failure). Emphasis is placed on the practical challenges unique to children: vascular access and circuit sizing, blood priming for small patients, choice of replacement fluid (albumin vs. fresh frozen plasma), anticoagulation with citrate versus heparin, and the recognition and management of complications such as hypocalcemia, coagulopathy, and hemodynamic instability. Through short clinical cases, participants will practice prescribing and troubleshooting TPE at the bedside.
By the end of this station, participants will be able to: 1. Explain the pharmacokinetic basis of TPE and justify the prescribed exchange volume and frequency. 2. Select appropriate ASFA-supported indications for TPE in pediatric AKI/critical-care settings and distinguish TPE from CRRT modalities. 3. Prescribe TPE for a child—vascular access, replacement fluid, anticoagulation—and adjust for body size. 4. Recognize and manage common complications (hypocalcemia, coagulopathy, hypotension, reactions).
Room 103
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Yu-Chang YEHTaiwan
Speaker
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.
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Yu-Chen ChuangTaiwan
Speaker
AI-Assisted Reference Management and Graphical Abstract CreationBy the end of this case-based learning session, participants will be able to apply the IMPACT framework to systematically evaluate the appropriateness, reliability, and potential risks of generative AI tools in ICU clinical contexts, while using AI-assisted workflows for reference management and graphical abstract creation to enhance research communication and citation potential.
Room 105
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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.
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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.
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Kyungho LeeSouth Korea
Speaker
Drug Exposures: Concerns in Kidney Safety (PPI vs Potassiumcompetitive acid blockers (P-CABs))
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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.
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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.
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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.
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Room 101AB
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