The Role and Clinical Application of Novel Filters in Sepsis-Associated Acute Kidney Injury Blood Purification

Sepsis is a life-threatening clinical syndrome, and renal impairment associated with sepsis significantly increases patient mortality. Blood purification techniques are crucial in managing sepsis by removing inflammatory mediators and toxic substances from the bloodstream, thereby improving outcomes. Traditional modalities, including continuous renal replacement therapy, hemodialysis, and hemoperfusion, have demonstrated clinical efficacy in this context. Recent advancements in blood purification filters have enhanced sepsis treatment strategies. This review assesses the mechanisms and clinical applications of novel filters such as the oXiris filter, AN69ST membrane, CytoSorb, Hemopurifier, and others, focusing on their effectiveness in eliminating toxins and inflammatory mediators. The oXiris filter has demonstrated superior capacity to remove small molecular toxins, pro-inflammatory cytokines, and endotoxins while promoting renal protection and enhancing microcirculation. In contrast, the AN69ST membrane and CytoSorb filters have shown promising efficacy in cytokine clearance, though their ability to remove endotoxins is limited. The Hemopurifier specifically targets endotoxins like lipopolysaccharides, effectively suppressing inflammatory responses and mitigating renal damage. Furthermore, the integration of Extracorporeal Carbon Dioxide Removal (ECCO2R) with continuous renal replacement therapy (CRRT) offers benefits, including the regulation of carbon dioxide levels, maintenance of acid-base balance, and enhanced clearance of inflammatory factors from circulation. Additionally, selective removal of lipopolysaccharides (LPS) can alleviate leukopenia and immune dysregulation, preserving renal function. This review aims to provide clinical guidance for optimizing individualized treatment protocols to enhance survival rates and improve the quality of life for patients with sepsis-related AKI. Incorporating these advanced filtration technologies into routine clinical practice can transform sepsis management and pave the way for innovative therapeutic strategies in critical care.