Kidney Res Clin Pract > Volume 43(4); 2024 > Article
Kang: The 5th Asia Pacific AKI CRRT 2023: Best Movement to Critical Care, Save Lives
This editorial outlines the proceedings of the 5th Asia Pacific AKI CRRT (APAC 2023): “Best Movement to Critical Care, Save Lives.” This symposium is a valuable educational forum to discuss many critical issues in caring for acute kidney injury (AKI) with continuous renal replacement therapy (CRRT). An eminent international faculty of experts contribute their expertise to the discussion and presentation. This publication has been prepared to present the essential topics of the symposium, providing readers with a helpful overview of the scientific exchange held in Daegu, Republic of Korea.
APAC 2023 shared meaningful clinical experiences and provided an opportunity to review and discuss AKI epidemiology, diagnosis, treatment including CRRT, and novel management for critical care. The symposium begins with the basic practice of CRRT for physicians and nurses, presenting strategies for improving outcomes in AKI, challenges and controversies in renal support and CRRT, including innovative care for AKI patients, and future trends in CRRT and critical care. There are also outstanding basic and clinical research results on AKI, CRRT, general critical care, and nursing issues. Among them, this issue represents a valuable update on many of the critical issues relating to the novel biomarker for AKI patients who underwent CRRT, initiation and discontinuation of CRRT, machine learning or artificial intelligence-based approaches to diagnosis and prediction of the outcomes of AKI, and multidisciplinary approaches to caring for critically ill patients.
In this issue of Kidney Research and Clinical Practice, Lin et al. [1] present the role of biomarkers for AKI to move forward to precision medicine, which promises an early detection and initiation of AKI care. Pan et al. [2] introduce a multidisciplinary team approach to toptimize acute kidney disease treatment. Cheungpasitporn et al. [3] present the role of artificial intelligence and machine learning in early diagnosis and management of sepsis-associated AKI, highlighting the potential revolution in this field.
Among original research, Jeon et al. [4] propose a prediction model for successfully discontinuing CRRT using four variables: urine output, blood urea nitrogen, serum potassium, and mean arterial pressure. Interestingly, one cohort performed poorly among multicenter cohorts because attending physicians primarily controlled CRRT prescriptions and discontinuation. Therefore, active engagement of nephrologists and protocolized management for CRRT prescriptions might be helpful in the discontinuation of CRRT in AKI patients.
Three different clinical studies have proposed novel biomarkers or suggested epidemiological data for predicting mortality in patients with AKI requiring CRRT. Plasma presepsin and serum phosphate are related to predicting mortality in patients with AKI requiring CRRT [5,6]. Kim et al. [7] also suggest that advanced age is not a risk factor for mortality among elderly AKI patients undergoing CRRT.
There are safety concerns about using nafamostat mesylate anticoagulation in patients with bleeding tendencies. Kim et al. [8] have analyzed those concerns and found no differences between using nafamostat mesylate anticoagulation and no anticoagulation in patients with AKI who have bleeding tendencies. These data suggest that nafamostat mesylate is an effective and safe anticoagulant for CRRT in critically ill patients.
This issue, therefore, highlights the 5th Asia Pacific AKI CRRT conference and provides an overview of current expert opinion on the management of AKI patients undergoing CRRT and critical care.

Notes

Conflicts of interest

The author has no conflicts of interest to declare.

References

1. Lin KM, Su CC, Chen JY, et al. Biomarkers in pursuit of precision medicine for acute kidney injury: hard to get rid of customs. Kidney Res Clin Pract 2024;43:393–405.
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2. Pan SY, Huang TT, Jiang ZH, et al. Unveiling the enigma of acute kidney disease: predicting prognosis, exploring interventions, and embracing a multidisciplinary approach. Kidney Res Clin Pract 2024;43:406–416.
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3. Cheungpasitporn W, Thongprayoon C, Kashani KB. Artificial intelligence and machine learning’s role in sepsis-associated acute kidney injury. Kidney Res Clin Pract 2024;43:417–432.
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4. Jeon J, Ko EJ, Park H, et al. Validation of prediction model for successful discontinuation of continuous renal replacement therapy: a multicenter cohort study. Kidney Res Clin Pract 2024;43:528–537.
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5. Lee GB, Lee JW, Yoon SH, et al. Plasma presepsin for mortality prediction in patients with sepsis-associated acute kidney injury requiring continuous kidney replacement therapy. Kidney Res Clin Pract 2024;43:457–468.
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6. Lee YH, Lee S, Seo YJ, et al. Phosphate level predicts mortality in acute kidney injury patients undergoing continuous kidney replacement therapy and has a U-shaped association with mortality in patients with high disease severity: a multicenter retrospective study. Kidney Res Clin Pract 2024;43:492–504.
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7. Kim JH, Eum SH, Kim HW, et al. Mortality of elderly patients with acute kidney injury undergoing continuous renal replacement therapy: is age a risk factor? Kidney Res Clin Pract 2024;43:505–517.
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8. Kim T, Kim DE, Jo EM, et al. The role of nafamostat mesylate anticoagulation in continuous kidney replacement therapy for critically ill patients with bleeding tendencies: a retrospective study on patient outcomes and safety. Kidney Res Clin Pract 2024;43:469–479.
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ORCID iDs

Kyung Pyo Kang
https://orcid.org/0000-0001-8720-9701

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