Impact of Adsorptive Blood Purification on Kidney Outcomes

Acute kidney injury (AKI) is a common complication in hospitalized patients, associated with significant short-term morbidity and mortality, and for which the only current therapeutic strategies are supportive. Of the common causes of AKI, cardiac surgery–associated AKI has been an appealing target for novel therapeutics, in part because the timing of the surgical insult is established and therapies can be offered before, during, or after the surgical procedure. AKI occurs in up to 30% of patients undergoing cardiac surgery. A number of different mechanisms have been proposed to contribute to cardiac surgery–associated AKI, including ischemia-reperfusion, inflammation, oxidative stress, and exposure to toxic mediators such as cell-free hemoglobin. Numerous therapies, including steroids, statins, n-acetylcysteine, remote ischemic preconditioning, and mesenchymal stromal cell therapy, have been tested for the prevention or early treatment of cardiac surgery–associated AKI, without apparent benefit.