SynthesisCritical care (London, England)2026
Intraoperative hemoadsorption and cardiac surgery-associated acute kidney injury: an updated systematic review and meta-analysis with trial sequential analysis.
Synthesis in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
backgroundCardiac 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.
methodsAn 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.
resultsFifteen 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, I
conclusionsIntraoperative 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.
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