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08:30
12:30
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Micronutrient Strategy in Critically Ill AKI Patients: Balancing Oxidative Stress, Inflammation, and CRRT Losses
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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Energy and Protein Prescription in AKI During CRRT: Precision Nutrition Support vs Predictive Estimation
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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Coffee Break
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Preoperative Metabolic Optimization: Can Amino Acid Supplementation Reduce Postoperative AKI?
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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Nutrition in Hepato-Renal Syndrome: Protein Restriction, Keto-Analogues, and Metabolic Modulation
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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Post-AKI Nutritional Recovery: Preventing Sarcopenia and Slowing AKI-to-CKD Transition
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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Panel Discussion: From ICU to Community – Building a Renal Nutrition Care Continuum
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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開場
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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重症腎臟醫學的能力架構：里程碑與 EPAs
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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AI 時代的重症腎臟醫學人才培育：重新設計學習與評量
Training the Critical Care Nephrology in the AI Era: Redesigning Learning and Assessment
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從 AI 工具到可信賴教育系統：以建構重症腎臟醫學為例
From AI Tools to a Trustworthy Education System
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綜合討論
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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總結致詞
Room 103
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14:00
15:30
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