Hemoadsorption to prevent acute kidney injury in elective cardiac surgery: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis.

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).