Jin-Shuen Chen

• Opening
  Ji-Tseng FangTaiwan Moderator
• 專題一｜重塑生命韌性：從 ICU 治療到回歸社會的康復之路
  守護腎臟機能：高品質 CRRT 提升恢復率並減輕長期透析負擔之臨床探討
  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。

  Jin-Shuen ChenTaiwan Moderator
• 專題二｜從血液淨化邁向多器官支持療法 品質賦能：高品質血液淨化技術最佳化重症預後之臨床實踐
  從血液淨化邁向多器官支持療法，以品質指標、治療成效監測與真實世界資料最佳化重症預後之臨床實踐
  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

  Fang-Ming HungTaiwan Moderator
• 專題三｜Transforming Critical Kidney Care Through Data-Driven Insights and Quality Improvement Driving Quality: Core Metrics, Benchmarking & Datasets Developing & Implementing Quality Standards in AKI Care: Experience from UK
  Lui ForniUnited Kingdom Speaker Sepsis Associated AKIBicarbonate in AKI: Use and MisuseAdapting CRRT for Patients with Electrolyte and ACID-Base Disorders

  Ravindra MehtaUnited States Speaker

  Shih-Chi KuTaiwan Moderator
• 共同宣言簽署儀式
  「急性腎損傷照護數位提升共同宣言」 持續優化器官支持治療與連續性照護品質，攜手推動台灣腎臟與重症醫療體系之穩健與長遠發展
• Closing
  Jin-Shuen ChenTaiwan Speaker

• Welcome & Opening remarks
  Ravindra MehtaUnited States Speaker

  Jin-Shuen ChenTaiwan Speaker

  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.
• Organ Crosstalk in AKI
  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.
• Kidney-Ventilator Interactions and Kidney Protective Ventilation /Lung and Kidney Crosstalk
  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
• Hepatorenal Syndrome: Recognition and Management or Disordered Physiology or Iatrogenic Failure
  Mitra NadimUnited States Speaker Hepatorenal Syndrome: Recognition and Management or Disordered Physiology or Iatrogenic FailureManaging Patients With Combined Kidney and Liver FailureHow do I Manage Patients with Acute Liver Failure
• Special Lecture: 50 Years of CRRT: A Journey Through Innovation
  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)
• Q & A

• Opening
  Wen-Chin LeeTaiwan Speaker
• Advancing ECCO2R Therapy: Lessons from Vietnam for the Asia-Pacific Region
  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.

  Jin-Shuen ChenTaiwan Moderator
• The Application of Novel Renal Biomarkers in Clinical and Environmental Nephrology
  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.

  Te-Chao FangTaiwan Moderator
• Coffee break
• Developing Next-Generation Dialysis Technologies for Acute Kidney Care and Disaster Preparedness
  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.

  Shih-Hua LinTaiwan Moderator
• Blood Purification in Disasters: Japan’s Evolving Approach to Hospital Resilience, DMAT Coordination, and ICU-Based Renal Support
  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.

  Chia-Te LiaoTaiwan Moderator
• Closing Remarks
  Lung-Chih LiTaiwan Speaker