I-Jung Tsai

• The Missing Link: Navigating the Acute Kidney Disease (AKD) Window and Preventing CKD
  Jei-Wen Chang 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 Matsumoto Moderator The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsCore Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription
• Spotlight on Neonatal AKI: The AWAKEN Criteria, Unique Phenotypes, and Genetic Insights
  Chih-Chia Chen Speaker Spotlight on Neonatal AKI: The AWAKEN Criteria, Unique Phenotypes, and Genetic Insights

  Shotaro Matsumoto Moderator The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsCore Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription
• The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in Pediatrics
  Shotaro Matsumoto Speaker The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsCore Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription

  Min-Hua Tseng Moderator
• Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric Sepsis
  I-Jung Tsai Speaker Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric Sepsis

  Min-Hua Tseng Moderator
• Q&A

• Station 1 The Critical Initiation: Circuit Priming & Hemodynamic Management
  Ting-Yuan Chang 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.
• Station 2 Core Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription
  Shotaro Matsumoto Speaker The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsCore Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription
• Station 3 The Perfect Balance: Regional Citrate Anticoagulation (RCA) in Practice
  Hou-Xaun Emma Huang Speaker The Perfect Balance: Regional Citrate Anticoagulation (RCA) in Practice
• Station 4 Advanced Purification: Therapeutic Plasma Exchange (TPE) Concepts & Challenges
  Jhao-Jhuang Ding 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).