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08:00
12:30
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(Pre-Congress Workshop)
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Ashita TolwaniUnited States
Speaker
The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure
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Manish KaushikSingapore
Speaker
Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT
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Ashita TolwaniUnited States
Speaker
The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure
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Manish KaushikSingapore
Speaker
Patient Selection, Modality, DoseAccess, Membrane, CircuitSevere Hypernatremia and Hyperkalemia in AKI Requiring KRTPrecision Solute Control and Dynamic Dosing with CRRT
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Ashita TolwaniUnited States
Speaker
The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure
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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
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Ashita TolwaniUnited States
Speaker
The ABC of the CRRT PrescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and Acid-Base DisordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Managing Patients With Combined Kidney and Liver Failure
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Keith Wille
Speaker
Connectology with Hybrid Systems: ECMO, Apheresis, ECCO2RExtracorporeal life support technologies are increasingly used in critical care settings, with integrating extracorporeal membrane oxygenation (ECMO), apheresis, and extracorporeal carbon dioxide removal (ECCO₂R) to provide multi-organ support. This session explores the principles, clinical applications, and challenges of extracorporeal systems and their integration into CRRT, focusing on the interaction between ECMO and renal replacement therapy (CRRT), the role of ECCO2R in respiratory failure, and the combination of apheresis for immunomodulation. Through discussion, participants will gain an understanding of patient selection, circuit configurations, anticoagulation strategies, and the physiological considerations that impact patient outcomes. Emphasis will be placed on optimizing patient management, recognizing complications, and developing a structured approach to hybrid extracorporeal therapy.AKI in Mechanical Circulatory SupportAcute kidney injury (AKI) is a frequent and important complication of cardiogenic shock and is strongly associated with adverse outcomes. Its pathogenesis is multifactorial, reflecting reduced cardiac output and renal perfusion, venous congestion, neurohormonal activation, systemic inflammation, vasopressor exposure, and hemodynamic instability. Mechanical circulatory support (MCS) may interrupt this cycle by restoring cardiac output, reducing venous congestion, and decreasing vasopressor requirements; however, MCS itself may contribute to kidney injury through hemolysis, embolic events, limb ischemia and rhabdomyolysis, bleeding, contrast exposure, and device-related hemodynamic disturbances. This presentation will review the mechanisms and clinical impact of AKI across commonly used temporary and durable MCS platforms, including intra-aortic balloon pumps, microaxial flow pumps, temporary ventricular assist devices, and durable LVADs. Particular emphasis will be placed on identifying potentially reversible contributors to AKI, understanding the relationship between timing of circulatory support and renal recovery, and managing patients who require concurrent kidney replacement therapy. Practical considerations for CRRT, including vascular access, anticoagulation, ultrafiltration, and interactions between CRRT and MCS, will also be discussed.
How do I care for the Patient with ARDS and AKIAcute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) frequently coexist in critically ill patients and together are associated with substantial morbidity and mortality. Their management is closely intertwined: mechanical ventilation, positive end-expiratory pressure, hemodynamic support, and fluid administration may influence renal perfusion and venous congestion, while AKI and fluid accumulation can worsen pulmonary edema, impair gas exchange, and complicate ventilator management. This presentation will provide a practical approach to the patient with concurrent ARDS and AKI, integrating pulmonary and kidney-focused strategies. Key topics will include lung-protective ventilation and its renal consequences, assessment and management of volume status, the role of conservative fluid strategies and de-resuscitation, and the use of diuretics and kidney replacement therapy to achieve fluid-balance goals. Attention will be given to when and how continuous renal replacement therapy can support fluid management in patients with severe respiratory failure, including those with hemodynamic instability. The session will emphasize coordinated decision-making between critical care and nephrology teams to balance lung protection, kidney perfusion, and overall organ support.
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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)
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Room 101D
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13:30
15:30
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Zsolt MolnárHungary
Speaker
Managing Patients with Sepsis: modifying the course with ECOSA dysregulated host response to infection is central to the pathophysiology of sepsis and may culminate in life-threatening organ dysfunction. Given that this process is largely characterized by concurrent pro- and anti-inflammatory activation, immunomodulatory strategies have long been explored in sepsis research. Among these, extracorporeal removal of circulating cytokines, inflammatory mediators and other soluble factors through non-specific hemoadsorption with macroporous styrene-divinylbenzene sorbents has been proposed as a potential therapeutic approach. Its adoption into clinical practice has largely been based on pathophysiological considerations rather than on evidence from large, well-designed randomized clinical trials. Over the past 15 years, most of the available evidence has been predominantly derived from small, single-center cohorts, reports from registries and heterogeneous prospective studies with substantial variability in patients’ selection, timing, and treatment intensity. In addition, the precise mechanisms of action of hemoadsorption remain incompletely understood. Although several meta-analyses have attempted to synthesize the existing data, the overall quality and heterogeneity of the included studies limit the strength and reliability of their conclusions. As a result, current guideline recommendations are largely based on expert opinions rather than high-certainty evidence. This presentation aims to provide a concise overview of the biological rationale, current evidence, and contemporary clinical practice related to hemoadsorption in sepsis.Multimodal individualized hemodynamic managementAchieving hemodynamic stability in the critically ill patents has a pivotal role in ensuring positive outcomes. The pathomechanism is complex and include impaired
myocardial contractility, relative or absolute intravascular hypovolaemia, bradycardia, and thus eventually impaired blood flow. Arterial pressure can be monitored continuously, which makes it the most important and feasible tool to assess circulation in real time. A given level of the mean arterial pressure (MAP) is often regarded as the main target to be normalized in several guidelines. However, it is not the sole
determinant of organ perfusion pressure and, although coupled to blood flow, is not a surrogate of blood flow or tissue perfusion. Conversely, normotension does not guarantee adequate organ blood flow and may just mimic ‘occult hypoperfusion’. Therefore, achieving hemodynamic coherence between macro- and microcirculation should be our pivotal aim during resuscitation and hemodynamic management. This requires a complex approach that is called multimodal, individualised, contextualised management that takes into account all measurable components of oxygen delivery and consumption, organ perfusion and cardiac output. How to do it at the bedside, will be presented on this lecture.
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Keith Wille
Speaker
Connectology with Hybrid Systems: ECMO, Apheresis, ECCO2RExtracorporeal life support technologies are increasingly used in critical care settings, with integrating extracorporeal membrane oxygenation (ECMO), apheresis, and extracorporeal carbon dioxide removal (ECCO₂R) to provide multi-organ support. This session explores the principles, clinical applications, and challenges of extracorporeal systems and their integration into CRRT, focusing on the interaction between ECMO and renal replacement therapy (CRRT), the role of ECCO2R in respiratory failure, and the combination of apheresis for immunomodulation. Through discussion, participants will gain an understanding of patient selection, circuit configurations, anticoagulation strategies, and the physiological considerations that impact patient outcomes. Emphasis will be placed on optimizing patient management, recognizing complications, and developing a structured approach to hybrid extracorporeal therapy.AKI in Mechanical Circulatory SupportAcute kidney injury (AKI) is a frequent and important complication of cardiogenic shock and is strongly associated with adverse outcomes. Its pathogenesis is multifactorial, reflecting reduced cardiac output and renal perfusion, venous congestion, neurohormonal activation, systemic inflammation, vasopressor exposure, and hemodynamic instability. Mechanical circulatory support (MCS) may interrupt this cycle by restoring cardiac output, reducing venous congestion, and decreasing vasopressor requirements; however, MCS itself may contribute to kidney injury through hemolysis, embolic events, limb ischemia and rhabdomyolysis, bleeding, contrast exposure, and device-related hemodynamic disturbances. This presentation will review the mechanisms and clinical impact of AKI across commonly used temporary and durable MCS platforms, including intra-aortic balloon pumps, microaxial flow pumps, temporary ventricular assist devices, and durable LVADs. Particular emphasis will be placed on identifying potentially reversible contributors to AKI, understanding the relationship between timing of circulatory support and renal recovery, and managing patients who require concurrent kidney replacement therapy. Practical considerations for CRRT, including vascular access, anticoagulation, ultrafiltration, and interactions between CRRT and MCS, will also be discussed.
How do I care for the Patient with ARDS and AKIAcute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) frequently coexist in critically ill patients and together are associated with substantial morbidity and mortality. Their management is closely intertwined: mechanical ventilation, positive end-expiratory pressure, hemodynamic support, and fluid administration may influence renal perfusion and venous congestion, while AKI and fluid accumulation can worsen pulmonary edema, impair gas exchange, and complicate ventilator management. This presentation will provide a practical approach to the patient with concurrent ARDS and AKI, integrating pulmonary and kidney-focused strategies. Key topics will include lung-protective ventilation and its renal consequences, assessment and management of volume status, the role of conservative fluid strategies and de-resuscitation, and the use of diuretics and kidney replacement therapy to achieve fluid-balance goals. Attention will be given to when and how continuous renal replacement therapy can support fluid management in patients with severe respiratory failure, including those with hemodynamic instability. The session will emphasize coordinated decision-making between critical care and nephrology teams to balance lung protection, kidney perfusion, and overall organ support.
Nuttha LumlertgulThailand
Speaker
Solution and Fluid BalanceUtility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRTPersonalized Fluid Management with CRRT
Room 103
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