Hemoadsorption is an extracorporeal blood purification therapy that uses special cartridges with sorbent materials [1]. It can selectively or non-selectively remove substances from a patient’s bloodstream, which may result in a significant benefit in critical care patients. The direct contact of the blood or plasma with various sorbents allows different mechanisms by which hemoadsorption operates [2]. The advancements in biocompatibility of these sorbents over recent years are noteworthy as they enhance the safety and efficacy of the therapy [3]. New devices and emerging applications further highlight the evolving landscape of hemoadsorption, indicating its potential as an important additional option to standard care [4]. The ability to integrate these devices safely and easily into various extracorporeal circuits further enhances their utility in clinical practice. There are various commercially available hemoadsorption devices with sorbents (granules, beads, or fibers) having different chemical-physical properties. The high surface area relative to volume of these sorbents is a critical factor as it allows for enhanced interactions with target substances (adsorbate), ultimately improving the effectiveness of the therapy [5].
Hemoadsorption therapies have diverse clinical applications in various systemic hyperinflammatory conditions, including sepsis and septic shock, non-infectious vasoplegic shock, acute respiratory distress syndrome, rhabdomyolysis, severe burns, severe acute pancreatitis, liver failure, and drug elimination for antithrombotic reversal [6]. Single-mode, combined, or sequential applications of different hemoadsorbers underscore the versatility of this therapeutic approach [7].
While randomized controlled trials (RCTs), consensus statements, and meta-analyses have shown that hemoadsorption is associated with improved clinical features, it has not consistently demonstrated a survival benefit, particularly in ICU septic patients, which raises important considerations regarding the endpoints used in clinical studies. Relying solely on mortality reduction as an endpoint may not adequately capture the therapy’s effectiveness as survival can be influenced by numerous confounding variables.
For this reason, different endpoints, including biochemical, biological, clinical, and functional end-points, should be considered in the immediate future for studies on hemoadsorption in intensive care. Hemoadsorption in the pediatric population has also been studied, indicating that this therapy may also offer promising results in younger patients, with improvements in clinical outcomes and survival [8]. This highlights the need for continued research to explore the efficacy and safety of hemoadsorption across different age groups and clinical scenarios.
Although hemoadsorption is widely utilized due to its theoretical rationale, the lack of clear evidence supporting its efficacy remains a significant barrier to its routine use. To address these limitations, there is a need for well-designed clinical trials that focus on several critical aspects, including the kinetics and transport properties of sorbents, the mechanisms of adsorption, potential side effects, and the optimal timing of treatment. Such research is essential to establish a clearer understanding of how hemoadsorption can be effectively integrated into clinical practice [9].
Additionally, identifying specific patient groups that may benefit from hemoadsorption therapy, along with developing a more standardized administration protocol, could enhance the therapy’s effectiveness and safety. This targeted approach may help clinicians make more informed decisions regarding the use of hemoadsorption in various clinical scenarios [10]. Patient’s endotyping will be crucial to a well-designed series of studies where enrichment strategies will seek to solve the puzzle of today’s missing pieces of evidence.
This thematic collection aims to provide the readers with an update of the current applications of these technologies across various fields of critical care nephrology. Focusing on basic mechanisms of hemoadsorption and both pre-clinical and clinical approaches allows for a comprehensive exploration of this technique, highlighting not only existing practices but also potential future developments and innovations in the field. This dual perspective can enrich the understanding of hemoadsorption’s role in patient care and stimulate further research and discussion among clinicians and researchers.
We are grateful to Karger publishers for allowing the publication of the entire collection of articles, which underwent a thorough peer review process in the interest of maximal scientific quality. We are particularly grateful to the reviewers who helped optimize manuscripts and maintain the high quality of the published articles.
Conflict of Interest Statement
The authors declare there is no conflict of interest related to the present manuscript and provide the following disclosures: Vedran Premuzic has received speaker and/or consulting honoraria from Fresenius Medical Care, Baxter Healthcare Corp, and Cytosorbents, all unrelated to this manuscript. Claudio Ronco has received support for acting as an advisory board member for ASAHI, Baxter, GE, Jafron, and Medtronic and speaker fees from Astute, bioMérieux, B. Braun, Cytosorbents, ESTOR, FMC, and Toray, all unrelated to this manuscript. Prof. Claudio Ronco was a member of the journal’s Editorial Board at the time of submission.
Funding Sources
There are no sources to declare.
Author Contributions
V.P. is the corresponding author and has contributed to the preparation of the manuscript (writing, editing of text, approval of the final manuscript, all the above). C.R. has contributed to writing, editing of text, and approval of the final manuscript. The authors read and approved the final manuscript.
