The effects of hemoadsorption in patients with sepsis-associated persistent severe AKI who require CRRT: A prospective, randomized controlled pilot study

Background: Sepsis-associated persistent severe acute kidney injury (S-PAKI) is marked by a sustained hyperinflammatory response and is associated with a poor prognosis. Hemoadsorption functions by removing circulating cytokines and other inflammatory mediators. This study aims to evaluate the impact of CVVH combined with hemoadsorption on the prognosis of patients with S-PAKI who need CRRT. Methods: This prospective, randomized, single-center pilot study involved 76 S-PAKI patients who required CRRT. Participants were randomly assigned to receive either CVVH combined with hemoadsorption (CVVH + HA group, n = 38) or conventional CVVH therapy (CVVH group, n = 38). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included changes in Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, renal functional prognosis, alterations in biomarker and cytokine levels, changes in hemodynamic parameters, as well as the duration of renal replacement therapy, mechanical ventilation, ICU stay, and overall hospital stay among survivors. Results: The CVVH + HA group showed a statistically non-significant trend to lower 30-day all-cause mortality compared to the CVVH group (36.8% vs. 52.6%, P = 0.159). A post hoc exploratory subgroup analysis revealed that among patients with Chemokine (C-C motif) ligand 14 (CCL14) levels greater than 1.3 ng/ml, the mortality risk in the CVVH + HA group was lower than that in the CVVH group. In terms of secondary outcomes, hemoadsorption therapy significantly decreased APACHE II and SOFA scores, enhanced cytokine clearance, and improved hemodynamic status; however, it did not lead to significant improvements in renal functional prognosis, nor did it shorten the duration of mechanical ventilation, renal replacement therapy, ICU stay, or overall hospital stay among survivors. Conclusions: In this pilot trial, hemoadsorption therapy did not significantly reduce 30-day mortality across the entire cohort. However, a post hoc exploratory subgroup analysis suggested a potential association with improved survival in patients with elevated urinary CCL14 levels. These exploratory, hypothesis-generating findings require confirmation in adequately powered, biomarker-guided randomized trials. Trial registration: ChiCTR2400093572, registered at the Chinese Clinical Trial Registry (ChiCTR) on December 09, 2024.