The 5th Asia Pacific AKI CRRT 2023: Best Movement to Critical Care, Save Lives
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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.
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Conflicts of interest
The author has no conflicts of interest to declare.