The impact of intraoperative hemoadsorption on acute kidney injury and renal replacement therapy in cardiovascular surgery: a systematic review and meta-analysis

Background/Introduction Cardiovascular surgery with cardiopulmonary bypass (CPB) is associated with several potential complications, including activation of inflammatory and coagulation pathways. Cytokine release plays a key role, contributing to microcirculation impairment, vasoplegia, organ dysfunction, and acute kidney injury (AKI). In this context, the intraoperative use of extracorporeal cytokine adsorbers has been studied to determine whether it impacts improving outcomes in cardiovascular surgery. Several studies have aimed to assess the effect of hemoadsorption during cardiac surgery on postoperative outcomes, but the results remain inconclusive. Purpose We aimed to perform a systematic review and meta-analysis comparing the incidence of AKI and the need for renal replacement therapy (RRT) in patients undergoing cardiovascular surgery with and without intraoperative hemoadsorption. Methods A comprehensive search of PubMed, Embase and Cochrane database was conducted to identify observational studies and randomized controlled trials (RCTs) comparing the use of cytokine adsorbers incorporated into the CPB circuit with standard surgical treatment during cardiac surgery. Statistical analysis was performed using Review Manager 5.1 with random-effects model. Heterogeneity was assessed with I² statistics. Results We included eighteen studies comprising 1863 patients, of whom 870 underwent hemoadsorption during CPB. The incidence of AKI was significantly lower in the hemoadsorption group (HA) compared to the control group (RR 0.66; 95% CI 0.49-0.87; P=0.003; figure 1A). Additionally, the subgroup analysis of observational studies and RCTs revealed that only the observational studies maintained a statistically significant reduction in the incidence of AKI (RR 0.52; 95% CI 0.38-0.70; P<0.0001; figure 1B). Although the need for RRT was lower in the HA group (RR 0.83; 95% CI 0.63-1.08; P=0.17; figure 2), this difference did not achieve statistical significance. Conclusion In patients undergoing cardiovascular surgery, intraoperative hemadsorption may be associated with a lower incidence of postoperative AKI and a reduced need for RRT when compared to standard surgical treatment. Further large-scale studies are needed to confirm these findings.