To evaluate the efficacy of intraoperative hemoadsorption (HA) during cardiopulmonary bypass (CPB) in reducing acute kidney injury (AKI) and other major postoperative complications in patients undergoing cardiac surgery.

Systematic review and meta-analysis of randomized controlled trials (RCTs) conducted in accordance with PRISMA guidelines, with a protocol registered in PROSPERO (CRD42025638656).

Multicountry, multi-institutional hospital-based studies of patients undergoing cardiac surgery with CPB.

A total of 1133 patients from 16 RCTs comparing CPB with versus without intraoperative HA.

Intraoperative HA using sorbent-based devices (e.g., CytoSorb, oXiris, Jafron HA 380).

Primary outcomes included AKI incidence, renal replacement therapy requirement, and mortality. Secondary outcomes included intensive care unit/hospital length of stay, postoperative delirium, stroke, sepsis, and reoperation. HA significantly reduced the incidence (RR 0.75; 95% CI 0.59-0.96; p = 0.020). No significant differences were observed for renal replacement therapy (RR 0.64; p = 0.58) or mortality (RR 0.96; p = 0.861). No significant effects were found for secondary outcomes.

Intraoperative HA during CPB reduces the risk of AKI but does not significantly affect other major postoperative outcomes. Further studies are needed to determine its clinical relevance and optimal patient selection.