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08:20
12:30
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Do Ngoc Son
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 Tsai
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 Kokubo
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 Moriguchi
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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