Dialyzer Reactions
Dialyzer Reactions
Reactions attributed to the hemodialyzer are generally divided into two types:
Type A – anaphylactoid reaction
- Increased risk in patients with a history of atopy, high IgE levels, eosinophilia and allergic reactions during dialysis1
Type B – mild reaction
Diagnosis
Type A reaction
- Severe and rapid in onset
- Rare (7.0 per 1000 patient year2)
- Established by three major criteria or two major and one minor criterion
- Major criteria3
- Onset within 20 minutes of starting dialysis
- Dyspnea
- Burning/heat sensation at the access site or throughout the body
- Angioedema
- Minor criteria
- Reproducible during subsequent dialysis when using the same type or brand of dialyzer
- Urticaria
- Rhinorrhea or lacrimation
- Abdominal cramping
- Itching
- Major criteria3
- Etiology- Use of ethylene oxide (ETO) for sterilization of dialyzer and polyacrylonitrile membranes (PAN) membranes, especially AN69 in patients on ACE-inhibitors
Type B reaction
- Primary symptoms are chest and back pain
- Occurs 20-40 minutes into the dialysis treatment
- Disappears or lessens dramatically during the subsequent hours of dialysis4
- Pathogenesis of type B reaction is not clear
- May be related to complement activation
- Current data do not support the role of membrane biocompatibility in development of type B reactions5
Treatment
- Symptomatic and supportive
- Discontinue HD and discard the blood, oxygen, anti-histamines, epinephrine and corticosteroids
- HD can be initiated after stabilization with a more biocompatible membrane and a hemodialyzer not sterilized with ETO (ethylene oxide)6
Prevention
- Avoid combination of PAN membrane and angiotensin converting enzyme inhibitor (ACEI) use
- Use of ARBs (angiotensin receptor blockers) and dialysate with 3.5 mEq/L calcium may lower the risk7
References:
- Kraske GK, Shinaberger JH, Klaustermeyer WB. Severe hypersensitivity reaction during hemodialysis. Ann Allergy Asthma Immunol 78: 217-220, 1997
- Bright RA, Torrence ME, McMlellan WM. Preliminary survey of the occurrence of anaphylactoid reactions during haemodilaysis. Nephrol Dial Transplant 14:799-800, 1999
- Daugirdas JT, Ing TS. First-use reactions during hemodialysis: A definition of subtypes. Kidney Int 33(suppl 24) S37-S43, 1988
- Jaber BL, Pereira BJG. Dialysis reactions. Semin Dial 10:158-165, 1997
- Locatelli F, Manzoni C. Biocompatibility in haemodialysis: Fact and fiction. Curr Opin Nephrol Hyperten 6:528-532, 1997
- Dumler F, Zasuwa G, Levin NW. Effect of dialyzer reprocessing methods on complement activation and hemodialyzer-related symptoms. Artif Organs 11:128-31, 1987
- Van der Niepen P, Sennesael JS, Verbeelen DL. Prevention of anaphylactoid reactions to high flux membrane dialysis and ACE inhibitors by calcium. Nephrol Dial Transplant 9:87-89, 1994