Intraoperative hemoadsorption and cardiac surgery-associated acute kidney injury: an updated systematic review and meta-analysis with trial sequential analysis

Why clinicians should know about it

• Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 26 July 2026): Hemoadsorption effect on CSA-AKI after cardiac surgery
• Picked for Critical Care and Intensive Care Medicine (top studies of the week, 26 July 2026): Hemoadsorption systematic review for cardiac surgery AKI
• Picked for Family Practice (top studies of the week, 26 July 2026).
• Picked for Public Health, Environmental and Occupational Health (top studies of the week, 26 July 2026).
• Picked for Surgery (top studies of the week, 26 July 2026).
• Picked for Nephrology (top studies of the week, 26 July 2026).
• Picked for Urology (top studies of the week, 26 July 2026): Hemoadsorption does not significantly reduce cardiac surgery‑associated AKI

Abstract

BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) following cardiopulmonary bypass (CPB) remains a high-risk complication with limited effective management. Hemoadsorption is increasingly used as an adjunctive therapy due to its potent cytokines clearance in experimental settings, yet its clinical efficacy is debated. This study aimed to evaluate the effect of hemoadsorption versus standard care on CSA-AKI and other major outcomes in adult cardiac surgery patients. METHODS: An updated systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to 8 February 2025. Eligible RCTs enrolled adult patients undergoing cardiac surgery and compared intraoperative hemoadsorption with standard care, with reported outcomes including CSA-AKI and other major endpoints. Pooled estimates were synthesized using inverse-variance random-effects models, with heterogeneity quantified by I² statistics. Subgroup, sensitivity and trial sequential analyses (TSA) were further performed. RESULTS: Fifteen RCTs were included, of which nine reported CSA-AKI (947 patients). Hemoadsorption was not associated with a statistically significant reduction in CSA-AKI (RR 0.80, 95% CI 0.63-1.03, P = 0.08, I2 = 40%, GRADE: very low). The finding was sensitive to model choice and the inclusion of two studies (Diab 2022 and Abou-Arab 2025). Subgroup analyses revealed no significant interaction by device type. TSA indicated that the required information size was not reached. No significant differences were observed for CSA-AKI Stage 1 (RR 0.72, 95% CI 0.49-1.05, P = 0.09, I2 = 16%), Stage 2 (RR 0.66, 95% CI 0.30-1.43, P = 0.29, I2 = 11%), Stage 3 (RR 0.43, 95% CI 0.17-1.05, P = 0.06, I2 = 0%), or renal replacement therapy (RR 0.52, 95% CI 0.22-1.25, P = 0.15, I2 = 0%). Mortality and other clinical endpoints were comparable between groups. Among exploratory outcomes, only an overall reduction in IL-8 was noted (MD -18.23, 95% CI -31.90 to -4.56, P = 0.009, I2 = 40%). CONCLUSIONS: Intraoperative hemoadsorption did not significantly reduce CSA-AKI or improve clinical outcomes in adult cardiac surgery. Although trends favored severe AKI, very low certainty evidence and insufficient information preclude definitive conclusions, warranting further large-scale RCTs. REGISTRATION: PROSPERO identifier CRD420250651941.

Abstract as published, via PubMed.