Efficacy of Hemoadsorption in Cardiac Surgery with Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Miguel A Samaniego-Laguna, Ivo Queiroz, Juan Pinilla et al.
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In 30 seconds
This systematic review and meta-analysis pooled 16 randomized controlled trials involving 1133 patients undergoing cardiac surgery with cardiopulmonary bypass. It assessed whether intraoperative hemoadsorption reduced acute kidney injury and other postoperative complications compared with bypass without hemoadsorption. Hemoadsorption was associated with a lower incidence of acute kidney injury (RR 0.75; 95% CI 0.59-0.96; p = 0.020). The analysis found no significant differences in renal replacement therapy, mortality, or the reported secondary outcomes. The authors conclude that further research is needed to establish the clinical relevance of the kidney injury finding and identify suitable patients.
Key findings
- Across 16 randomized trials, hemoadsorption reduced acute kidney injury incidence (RR 0.75; 95% CI 0.59-0.96; p = 0.020).
- Renal replacement therapy did not differ significantly between groups (RR 0.64; p = 0.58).
- Mortality did not differ significantly (RR 0.96; p = 0.861), and no significant effects were found for secondary outcomes.
Why it matters
Acute kidney injury is a key postoperative outcome in cardiac surgery, and the pooled randomized evidence suggests intraoperative hemoadsorption may reduce its incidence. However, the absence of significant differences in renal replacement therapy, mortality, and other reported outcomes means the kidney injury result does not yet establish broader clinical benefit.
What to keep in mind
The analysis found no significant effects on other major outcomes, and the authors state that further studies are needed to determine clinical relevance and optimal patient selection.