Efficacy of Hemoadsorption Therapy in Patients With Sepsis-associated Acute Kidney Injury: A Systematic Review and Meta-analysis

Introduction. Sepsis-associated acute kidney injury (SA-AKI) is afrequent and severe complication of sepsis with high mortality.Hemoadsorption has been increasingly used as an adjunct to continuousrenal replacement therapy (CRRT) to remove inflammatory mediators,but its clinical efficacy in SA-AKI remains uncertain. We conducteda systematic review and meta-analysis to evaluate the effects ofhemoadsorption added to CRRT in critically ill patients with SA-AKI.Methods. Following PRISMA guidelines, we systematically searchedPubMed, EMBASE, Web of Science, Scopus, Cochrane Library,ClinicalTrials.gov, and WHO ICTRP through December 1, 2025.Comparative studies evaluating hemoadsorption plus CRRT versusstandard CRRT in septic patients with AKI were included. Theprimary outcome was mortality (28-, 60-, 90-day, ICU, and in-hospital).Secondary outcomes included ICU and hospital length of stay, CRRTduration, changes in SOFA score, vasopressor dose, lactate, IL-6,and procalcitonin. Random-effects meta-analyses were performed.Results. Fifteen studies involving 3,093 patients (1,509 hemoadsorptionplus CRRT; 1,584 CRRT alone) were included. Overall, hemoadsorptionwas not associated with a significant reduction in 28-day mortality(RR = 0.79, 95% CI: 0.61 to 1.02) or other mortality endpoints.However, hemoadsorption significantly reduced SOFA score at 48hours (MD = −2.79, 95% CI: −4.00 to −1.58), IL-6 levels at 24 hours,and lactate levels at 24 and 48 hours compared with CRRT alone. Italso did not affect ICU or hospital length of stay or CRRT duration.Subgroup analyses suggested a significant reduction in 28-daymortality with specific adsorption modalities (oXiris, oXiris plusCytoSorb, and HA330-II), but not with polymyxin B.Conclusions. In critically ill patients with SA-AKI, addinghemoadsorption to CRRT improves short-term markers of organdysfunction and metabolic derangement but does not confer a clearmortality benefit. Future large, multicenter trials with standardizedprotocols are needed to determine whether specific patient subgroupsor adsorption modalities derive meaningful survival benefit.