A dual-function membrane for a complex disease
Sepsis is characterized by a dynamic and heterogeneous immune response. Excessive release of cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α, together with circulating endotoxins and damage-associated molecular patterns, fuels a self-perpetuating inflammatory loop. This process contributes to vasoplegia, capillary leak, microcirculatory dysfunction, and progressive organ failure, often limiting the effectiveness of pharmacological therapies alone.
The oXiris® membrane was developed to address this complexity. Built on a modified acrylonitrile and sodium methallyl sulfonate (AN69) platform, the membrane integrates diffusion and convection , as in standard dialysis, with adsorptive properties that allow binding and removal of endotoxin and a broad spectrum of inflammatory mediators. A polyethyleneimine coating provides a positive surface charge that enhances endotoxin adsorption, while a heparin-grafted surface improves hemocompatibility and reduces thrombogenicity.
“This technology allows clinicians to provide renal support while simultaneously modulating the inflammatory milieu,” the authors explain, positioning oXiris® as more than a conventional dialysis filter. This study was led by Dr. Silvia De Rosa and was published online on February 27, 2026, in the Journal of Intensive Medicine .
Evidence from sepsis and septic shock
Most available clinical data on oXiris® come from observational studies, small randomized trials, and registry analyses in patients with septic shock and sepsis-associated acute kidney injury . Across these studies, use of the membrane has been associated with consistent early physiological improvements , including:
Several meta-analyses suggest a possible reduction in short-term mortality, although the overall certainty of evidence remains low due to study heterogeneity and limited sample sizes. Importantly, the authors stress that oXiris® should not be viewed as a stand-alone therapy, but rather as an adjunct to timely antibiotics, source control, and optimized supportive care .
Beyond sepsis: broader intensive care applications
The review also summarizes emerging evidence for oXiris® in other clinical scenarios characterized by severe inflammation. In cardiac surgery–associated acute kidney injury , a recent randomized trial reported a significantly lower incidence of postoperative kidney injury in high-risk patients treated with extracorporeal blood purification using oXiris® during cardiopulmonary bypass.
In severe COVID-19 and viral infections , observational studies show rapid reductions in IL-6 levels, improved hemodynamics, and better oxygenation, although these physiological benefits have not consistently translated into improved survival. In contrast, randomized trials in cardiogenic shock and patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have yielded neutral or mixed results, highlighting that the effectiveness of extracorporeal immunomodulation is highly context- and phenotype-dependent.
Selecting the right patient, at the right time
A recurring theme of the review is that patient selection and timing are critical . The authors suggest that the greatest potential benefit may be seen in patients with:
Expert consensus recommends early initiation—within the first 6 to 12 hours after shock onset—followed by close reassessment of clinical response. Meaningful improvement in vasopressor dose, lactate levels, and inflammatory biomarkers within 24 to 48 hours should guide continuation, while lack of response should prompt treatment reconsideration.
Limitations and unanswered questions
Despite promising signals, important challenges remain. Adsorption is inherently non-selective and may lead to unintended removal of antibiotics or beneficial immune mediators, making therapeutic drug monitoring essential. Costs, technical complexity, and variability in expertise across centers also limit widespread implementation. Most importantly, large, adequately powered randomized controlled trials are still lacking , leaving uncertainty regarding long-term outcomes and cost-effectiveness.
Toward precision extracorporeal therapy
The authors conclude that no single extracorporeal device can fully address the biological complexity of sepsis. Future strategies may increasingly rely on precision, phenotype-guided approaches , including sequential or combined extracorporeal therapies tailored to dominant inflammatory drivers.
In this evolving landscape, the oXiris® membrane represents an important step toward integrating organ support with immunomodulation. While not a cure for sepsis, it offers clinicians a valuable tool to stabilize the sickest patients—provided it is used judiciously, in experienced centers, and within a framework of ongoing reassessment and research.
Reference
DOI: https://doi.org/10.1016/j.jointm.2025.11.005
Journal of Intensive Medicine
Literature review
Not applicable
Clinical applications of oXiris membranes: Targeting inflammation and renal dysfunction in ICU patients
27-Feb-2026
Sergio Lassola has given presentations at national and international conferences and has received support from Estor. Salvatore Lucio Cutuli has received support from Vantive and Estor. Silvia De Rosa has received support from Vantive, Estor, Fresenius Medical, and Toray. Règinald Philippe declares no conflicts of interest. The authors declare that they have no other financial or personal relationships that could inappropriately influence (bias) the content or conduct of this study. Given her role as Editorial Board Member, Silvia De Rosa had no involvement in the peer-review of this article and has no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to another journal editor.