Anaesthesia, critical care & pain medicine · 2026
Hemoadsorption to prevent acute kidney injury in elective cardiac surgery: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis.
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Abou-Arab Osama, Beyls Christophe, Ibrahima Azrat, Appa Arvind, Alshatri Hamza Yaha, Colombel Juliette, Kamel Said, Moussa Mouhamed Djahoum, Besnier Emmanuel, Saleh Khaled, Mahjoub Yazine, Mallat Jihad
Аннотация
BACKGROUND: This meta-analysis aimed to evaluate whether intraoperative hemoadsorption during cardiopulmonary bypass (CPB) improves postoperative outcomes compared with the standard of care.
METHODS: We systematically searched EMBASE, PubMed, and the Cochrane Library for randomized controlled trials (RCTs) comparing hemoadsorption versus standard care in patients undergoing cardiac surgery with CPB. Data were analyzed using a frequentist approach and trial sequential analysis (TSA). The primary outcome was the incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) within 7 days after surgery. The protocol was prospectively registered in PROSPERO (CRD42025634991).
RESULTS: A total of six RCTs comprising 798 patients were included. Four RCTs (n = 723; 355 hemoadsorption, 368 control) reported CSA-AKI incidence, which did not significantly differ between groups (RR = 0.93 [95% CI: 0.71-1.21], p = 0.57; I² = 42.0%). Hemoadsorption was not associated with significant differences in secondary outcomes: interleukin-6, tumor necrosis factor, 28-day mortality, SOFA score, and ICU length of stay.
CONCLUSION: Hemoadsorption during CPB was not associated with a reduction in CSA-AKI or with improvement in secondary clinical outcomes in elective patients undergoing cardiac surgery. However, the accrued sample represented only 48% of the heterogeneity-adjusted required information size (1,491 patients), and the cumulative Z-curve crossed neither the monitoring nor the futility boundary.
REGISTRATION: PROSPERO International Register of Systematic Reviews (CRD42025634991; January 31, 2025).
METHODS: We systematically searched EMBASE, PubMed, and the Cochrane Library for randomized controlled trials (RCTs) comparing hemoadsorption versus standard care in patients undergoing cardiac surgery with CPB. Data were analyzed using a frequentist approach and trial sequential analysis (TSA). The primary outcome was the incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) within 7 days after surgery. The protocol was prospectively registered in PROSPERO (CRD42025634991).
RESULTS: A total of six RCTs comprising 798 patients were included. Four RCTs (n = 723; 355 hemoadsorption, 368 control) reported CSA-AKI incidence, which did not significantly differ between groups (RR = 0.93 [95% CI: 0.71-1.21], p = 0.57; I² = 42.0%). Hemoadsorption was not associated with significant differences in secondary outcomes: interleukin-6, tumor necrosis factor, 28-day mortality, SOFA score, and ICU length of stay.
CONCLUSION: Hemoadsorption during CPB was not associated with a reduction in CSA-AKI or with improvement in secondary clinical outcomes in elective patients undergoing cardiac surgery. However, the accrued sample represented only 48% of the heterogeneity-adjusted required information size (1,491 patients), and the cumulative Z-curve crossed neither the monitoring nor the futility boundary.
REGISTRATION: PROSPERO International Register of Systematic Reviews (CRD42025634991; January 31, 2025).