Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery: Systematic Review and Meta-analysis

Cardiovascular surgery with cardiopulmonary bypass (CPB) is associated with several potential complications, including the activation of inflammatory and coagulation pathways, which may lead to acute kidney injury (AKI). In this context, the intraoperative use of extracorporeal cytokine adsorbers has been studied for their potential benefits; however, their association with renal outcomes remains unclear. The authors aimed to perform a systematic review and meta-analysis comparing the AKI incidence and the need for renal replacement therapy in patients undergoing cardiovascular surgery with and without intraoperative hemoadsorption (HA). A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to identify observational studies and randomized controlled trials (RCTs) comparing the use of cytokine adsorbers incorporated into the CPB circuit (eg, CytoSorb and Jafron HA series) with standard surgical treatment during cardiac surgery. Statistical analysis was performed using Review Manager, version 5.4. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The authors included 17 studies-7 of which were RCTs-comprising a total of 1,797 patients, 826 of whom underwent HA during CPB. The incidence of AKI was lower with HA in the overall analysis, driven by observational data, whereas RCTs did not show a statistically significant reduction (overall RR, 0.66; 95% CI, 0.49-0.87; p = 0.008). The need for renal replacement therapy did not differ significantly between groups (RR, 0.83; 95% CI, 0.63-1.11; p = 0.19). Intraoperative HA may be associated with a lower AKI incidence in observational studies, but randomized data do not confirm a causal benefit. Larger, standardized trials are required to determine the effect on renal outcomes.