Introduction. Sepsis-associated
acute kidney injury (SA-AKI) is afrequent and severe complication of
sepsis with high mortality.Hemoadsorption has been increasingly used as an adjunct to continuousrenal replacement therapy (CRRT) to remove inflammatory mediators,but its clinical efficacy in SA-AKI remains uncertain. We conducteda
systematic review and meta-analysis to evaluate the effects ofhemoadsorption added to CRRT in critically ill patients with SA-AKI.Methods. Following PRISMA guidelines, we systematically searchedPubMed, EMBASE, Web of Science, Scopus, Cochrane Library,ClinicalTrials.gov, and WHO ICTRP through December ۱, ۲۰۲۵.Comparative studies evaluating
hemoadsorption plus CRRT versusstandard CRRT in septic patients with AKI were included. Theprimary outcome was mortality (۲۸-, ۶۰-, ۹۰-day, ICU, and in-hospital).Secondary outcomes included ICU and hospital length of stay, CRRTduration, changes in SOFA score, vasopressor dose, lactate, IL-۶,and procalcitonin. Random-effects meta-analyses were performed.Results. Fifteen studies involving ۳,۰۹۳ patients (۱,۵۰۹ hemoadsorptionplus CRRT; ۱,۵۸۴ CRRT alone) were included. Overall, hemoadsorptionwas not associated with a significant reduction in ۲۸-day mortality(RR = ۰.۷۹, ۹۵% CI: ۰.۶۱ to ۱.۰۲) or other mortality endpoints.However,
hemoadsorption significantly reduced SOFA score at ۴۸hours (MD = −۲.۷۹, ۹۵% CI: −۴.۰۰ to −۱.۵۸), IL-۶ levels at ۲۴ hours,and lactate levels at ۲۴ and ۴۸ hours compared with CRRT alone. Italso did not affect ICU or hospital length of stay or CRRT duration.Subgroup analyses suggested a significant reduction in ۲۸-daymortality with specific adsorption modalities (oXiris, oXiris plusCytoSorb, and HA۳۳۰-II), but not with polymyxin B.Conclusions. In critically ill patients with SA-AKI, addinghemoadsorption to CRRT improves short-term markers of organdysfunction and metabolic derangement but does not confer a clearmortality benefit. Future large, multicenter trials with standardizedprotocols are needed to determine whether specific patient subgroupsor adsorption modalities derive meaningful survival benefit.Introduction. Sepsis-associated
acute kidney injury (SA-AKI) is afrequent and severe complication of
sepsis with high mortality.Hemoadsorption has been increasingly used as an adjunct to continuousrenal replacement therapy (CRRT) to remove inflammatory mediators,but its clinical efficacy in SA-AKI remains uncertain. We conducteda
systematic review and meta-analysis to evaluate the effects ofhemoadsorption added to CRRT in critically ill patients with SA-AKI.Methods. Following PRISMA guidelines, we systematically searchedPubMed, EMBASE, Web of Science, Scopus, Cochrane Library,ClinicalTrials.gov, and WHO ICTRP through December ۱, ۲۰۲۵.Comparative studies evaluating
hemoadsorption plus CRRT versusstandard CRRT in septic patients with AKI were included. Theprimary outcome was mortality (۲۸-, ۶۰-, ۹۰-day, ICU, and in-hospital).Secondary outcomes included ICU and hospital length of stay, CRRTduration, changes in SOFA score, vasopressor dose, lactate, IL-۶,and procalcitonin. Random-effects meta-analyses were performed.Results. Fifteen studies involving ۳,۰۹۳ patients (۱,۵۰۹ hemoadsorptionplus CRRT; ۱,۵۸۴ CRRT alone) were included. Overall, hemoadsorptionwas not associated with a significant reduction in ۲۸-day mortality(RR = ۰.۷۹, ۹۵% CI: ۰.۶۱ to ۱.۰۲) or other mortality endpoints.However,
hemoadsorption significantly reduced SOFA score at ۴۸hours (MD = −۲.۷۹, ۹۵% CI: −۴.۰۰ to −۱.۵۸), IL-۶ levels at ۲۴ hours,and lactate levels at ۲۴ and ۴۸ hours compared with CRRT alone. Italso did not affect ICU or hospital length of stay or CRRT duration.Subgroup analyses suggested a significant reduction in ۲۸-daymortality with specific adsorption modalities (oXiris, oXiris plusCytoSorb, and HA۳۳۰-II), but not with polymyxin B.Conclusions. In critically ill patients with SA-AKI, addinghemoadsorption to CRRT improves short-term markers of organdysfunction and metabolic derangement but does not confer a clearmortality benefit. Future large, multicenter trials with standardizedprotocols are needed to determine whether specific patient subgroupsor adsorption modalities derive meaningful survival benefit.
