# The ADVanced Organ Support (ADVOS) hemodialysis system balances blood pH within 24 h in patients with multiple organ failure and hypercapnic acidosis

## TL;DR

A new hemodialysis system called ADVOS can correct blood pH and reduce carbon dioxide levels in critically ill patients with multiple organ failure and acidosis within 24 hours.

## Contribution

The study demonstrates that the ADVOS system can rapidly correct acidosis and hypercapnia in patients with multiple organ failure.

## Key findings

- The median time to achieve blood pH ≥7.35 was 4 hours using the ADVOS system.
- All patients showed a significant increase in blood pH after 24 hours of treatment.
- ADVOS sessions achieved a median CO2 removal rate of 55 mL/min.

## Abstract

Severe hypercapnia, especially when associated with acidosis, should be avoided or actively managed, as it is an independent risk factor in critically ill patients. The ADVOS multi hemodialysis system offers the potential to correct acidosis and hypercapnia through customizable pH and bicarbonate content within the dialysate fluid. The aim of this work is to analyze the exact timing for pH correction and the main factors leading to it in patients with multiple organ failure (MOF) and hypercapnic acidosis treated with ADVOS.

Patients with MOF and metabolic or hypercapnic acidosis (pH < 7.35) were included over a study period of 13 months. All patients received at least one treatment with ADVOS hemodialysis system for at least 24 h. The primary outcome was the time to blood pH ≥ 7.35.

24 patients with a median age of 61 years and a median SOFA score of 15 points were included. The results of 134 ADVOS sessions, with a median of 5 sessions per patient, were analyzed. Median time to blood pH ≥ 7.35 was 4 h; a significant blood pH increase within 24 h was reached in all patients (7.21 before vs. 7.39 after, p < 0.01).

A single session of ADVOS corrected blood pH and supported the reduction of pCO2 with a median CO2 removal of 55 mL/min in patients with multiple organ failure and hypercapnic acidosis.

The online version contains supplementary material available at 10.1186/s40635-025-00820-1.