Efficacy of Hemoadsorption Therapy in Patients With Sepsis-associated Acute Kidney Injury: A Systematic Review and Meta-analysis

Abstract

Introduction. Sepsis-associated acute kidney injury (SA-AKI) is a
frequent and severe complication of sepsis with high mortality.
Hemoadsorption has been increasingly used as an adjunct to continuous
renal replacement therapy (CRRT) to remove inflammatory mediators,
but its clinical efficacy in SA-AKI remains uncertain. We conducted
a systematic review and meta-analysis to evaluate the effects of
hemoadsorption added to CRRT in critically ill patients with SA-AKI.
Methods. Following PRISMA guidelines, we systematically searched
PubMed, EMBASE, Web of Science, Scopus, Cochrane Library,
ClinicalTrials.gov, and WHO ICTRP through December 1, 2025.
Comparative studies evaluating hemoadsorption plus CRRT versus
standard CRRT in septic patients with AKI were included. The
primary outcome was mortality (28-, 60-, 90-day, ICU, and in-hospital).
Secondary outcomes included ICU and hospital length of stay, CRRT
duration, changes in SOFA score, vasopressor dose, lactate, IL-6,
and procalcitonin. Random-effects meta-analyses were performed.
Results. Fifteen studies involving 3,093 patients (1,509 hemoadsorption
plus CRRT; 1,584 CRRT alone) were included. Overall, hemoadsorption
was not associated with a significant reduction in 28-day mortality
(RR = 0.79, 95% CI: 0.61 to 1.02) or other mortality endpoints.
However, hemoadsorption significantly reduced SOFA score at 48
hours (MD = −2.79, 95% CI: −4.00 to −1.58), IL-6 levels at 24 hours,
and lactate levels at 24 and 48 hours compared with CRRT alone. It
also did not affect ICU or hospital length of stay or CRRT duration.
Subgroup analyses suggested a significant reduction in 28-day
mortality with specific adsorption modalities (oXiris, oXiris plus
CytoSorb, and HA330-II), but not with polymyxin B.
Conclusions. In critically ill patients with SA-AKI, adding
hemoadsorption to CRRT improves short-term markers of organ
dysfunction and metabolic derangement but does not confer a clear
mortality benefit. Future large, multicenter trials with standardized
protocols are needed to determine whether specific patient subgroups
or adsorption modalities derive meaningful survival benefit.