Lecture Code : PG04-S4
Session Name : PG Education 4 - Acute Kidney Injury
Session Topic : PG Education 4 - Acute Kidney Injury
Date & Time, Place : June 11 (Thu) / 13:00-14:30 / Room 2 (GBR 102), 1F
Green Nephrology in the ICU: Sustainable Practices for AKI and CKRT Management
Harin Rhee
Pusan National University Hospital, Republic of Korea
Greening of intensive care is essential; however, it is often challenging in critically ill patients, as such efforts frequently require top-down support at the governmental or healthcare leadership level. Nevertheless, meaningful contributions can still be made through individual-level initiatives. This lecture will focus on potential physician-level strategies for the management of acute kidney injury (AKI) and continuous kidney replacement therapy (CKRT) from an environmental sustainability perspective.
CKRT is the most commonly used dialysis modality in the intensive care unit and requires substantial volumes of fluid, contributing to environmental burden. Therefore, prevention or early detection and management of AKI—before CKRT becomes necessary—represents a fundamental strategy for greening intensive care. This lecture will introduce recent studies on AKI prevention, including the BigpAK-2 and PROTECTION trials, which demonstrated effective preventive strategies in non-cardiac and cardiac surgery settings, respectively.
Optimization of CKRT prescription in accordance with Kidney Disease: Improving Global Outcomes (KDIGO) guideline–recommended dosing is another important step that can be implemented at the physician level. In South Korea, CKRT is often delivered at doses exceeding the recommended 20–25 mL/kg/hr. However, higher effluent volumes do not improve patient outcomes, as highlighted in the 2026 KDIGO AKI guidelines, and instead contribute to increased water consumption and plastic waste. This lecture will quantify the potential reduction in water use achievable through appropriate CKRT dosing.
Although individual physician-level efforts may seem modest, their cumulative impact on environmental sustainability could be substantial if widely adopted across healthcare systems worldwide.
Keywords: Green Nephrology, Acute kidney injury, Continuous Kidney Replacement Therapy