The oXiris hemofilter is designed for extracorporeal blood purification, specifically for endotoxin and cytokine adsorption. While the Asia-Pacific oXiris Expert Meeting 2024 Consensus recommends its use in critically ill patients with sepsis or hyperinflammatory conditions, it currently advises against application in pediatric patients weighing less than 10 kg due to their limited circulating blood volume.

We evaluated a cohort of 6 pediatric patients (5 females, 1 male; ages ranging from 8 months to 13 years) between February to November in 2025. This study evaluated six pediatric patients with critical conditions, including EBV-hemophagocytic lymphohistiocytosis (HLH), toxic shock, Streptococcus pneumoniae hemolytic uremic syndrome (SpHUS), and pancreatitis, who developed acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) with Prismaflex and oXiris hemofilters. For patients under 30 kg, circuits were primed with packed red blood cells and fresh frozen plasma. We monitored serum IL-6 every 24 to 48 hours to assess sepsis progression and filter efficacy. Given the small sample size, non-parametric Wilcoxon signed-rank tests were utilized to analyze IL-6 trends at 24th and 48th hour post-initiation compared to baseline, providing insights into the inflammatory clearance of this specialized extracorporeal therapy in high-risk pediatric cases.

Median IL-6 levels were 1090(IQR, 166-5299), 2091(IQR, 125-11808), and 1015(IQR, 245-5126) pg/mL at 0, 24, and 48 hours. oXiris hemoadsorption reduced baseline IL-6 by 33.5% (IQR, 16.9%-50.7%), 81.6% (IQR, 54.5%-94.2%) and 93.5% (IQR, -18.2%-95.7%) at 24, 48, and 72 hours. Due to limited samples in two subsets, results showed a consistent downward (Fig.1) trend but lacked statistical significance. IL-6 decreased in three patients, though rebound occurred in two post-transplant cases after JAK inhibitor cessation. One pancreatitis patient showed no significant change. Four patients ultimately expired to their underlying critical illnesses, resulting in a mortality rate of 66.7%.

Despite lacking statistical significance due to small sample size and confounding factors like JAK2 inhibitor cessation, IL-6 levels showed a visible downward trend over time. These findings suggest that oXiris hemofilter, supported by appropriate blood priming, can effectively facilitate the clearance of inflammatory mediators in pediatric patients with sepsis and AKI requiring continuous kidney replacement therapy.