Acute Onset of Decreased Vision and Hearing Traced to Hemodialysis Treatment With Aged Dialyzers

Hutter, Joseph C.; Kuehnert, Matthew J.; Wallis, Roland R.; Lucas, Anne D.; Sen, Sumit; Jarvis, William R.

doi:10.1001/jama.283.16.2128

Cited by 44 publications

(39 citation statements)

References 17 publications

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“…However, our study has shown significant depression in hearing threshold after 3 sessions of hemodialysis. Also, the presence of correlation between the post-treatment pure tone threshold and duration of illness and serum creatinine levels which was not found with the dosage of diuretics and blood pressure is similar to the report of Gatland et al [5] and Hutter et al [6]. Gatland et al [5] reported decrease in threshold in 22/31 ears after dialysis but found no correlation with weight changes.…”

Section: Discussionsupporting

confidence: 85%

“…The cochlea in patients under the treatment with hemodialysis has been reported to be susceptible to various insults and the patients frequently exhibit some degree of sensorineural hearing loss, although the responsible etiological factor(s) still remain controversial [5,6]. In addition, the concurrent existence of these factors in each patient make conclusions difficult on the significance of each variable.…”

Section: Discussionmentioning

confidence: 99%

“…The fluctuation was said to be due to treatment induced changes in fluid and electrolyte composition of endolymph. Hutter et al [6] reported acute onset hearing loss and neurologic symptoms within 24 hours after haemodialysis in 7 patients. They concluded that the injury was associated with exposure to aged cellulose acetate membranes of dialyzers, allowing acetate degradation product to enter the blood.…”

Section: Discussionmentioning

confidence: 99%

“…The aetiopathogenetic mechanisms reported included osmotic alteration resulting in loss of hair cells, collapse of the endolymphatic space, oedema and atrophy of specialized auditory cells and in some, complications of haemodialysis have been hypothesized [2][3][4]. The role of hemodialysis in the causation of sensorineural hearing loss (SHL) is controversial; some authors have reported a depression in hearing threshold after hemodialysis while others are of the opinion that there was no relation between the two [4][5][6]. We have in the past reported 2 cases of CRF patients who developed acute SHL following hemodialysis [7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of hemodialysis on the hearing function of patients with chronic renal failure

Lasisi¹,

Bl²,

Osowole³

et al. 2008

African Journal of Health Sciences

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SUMMARYSensorineural hearing impairment (SHI) has been reported in chronic renal failure (CRF) patients with a prevalence of 20-40%. The aetiopathogenetic mechanisms reported included osmotic alteration resulting in loss of hair cells and in some, complications of haemodialysis have been hypothesized . We have in the past reported 2 cases of CRF patients who developed acute SHL following hemodialysis. This is a report of investigation of the effect of hemodialysis on the hearing function of CRF patients using pure tone audiometry findings. Thirty-three CRF patients were recruited for Pure Tone Audiometry (PTA) at admission and after three sessions of hemodialysis. The pure tone audiometry was done with a computer audiometer BA 20 Kamplex in the sound -proof (acoustic) booth in the ENT clinic. The duration of illness, dosage of diuretics and blood pressure were also noted. Similar age and sex-matched control were selected among volunteers who were otherwise clinically healthy. The data was processed using the Statistical Package for the Social Sciences (SPSS Inc, Chicago, Illinois, USA). Thirty-three CRF patients treated with haemodialysis and 28 healthy controls completed the study, 34 males and 27 females, age range was 16 -72 years, mean of 45.30 (SD16.20) for subjects and 49.7 for controls. Hearing loss was found in 22/34 (67%) at recruitment and 27/34 (79%) after 3 sessions of hemodialysis. There was a significant difference between the mean pre-and posthemodialysis PTA values, P =0.0008. There was also a significant correlation between posthemodialysis hearing threshold and (i) duration of illness (P = 0.00340) and (ii) creatinine levels of the patients (P=0.035). In conclusion, there was a significant depression in the hearing threshold of patients with CRF following three sessions of hemodialysis. This could be caused by changes induced by hemodialysis or effects of the duration and severity of disease.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of hemodialysis on the hearing function of patients with chronic renal failure

Lasisi¹,

Bl²,

Osowole³

et al. 2008

African Journal of Health Sciences

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“…An investigation by the CDC and the FDA identified the use of old cellulose acetate (CA) dialyzers as the common link in this incident. 1 Toxic degradation products of CA dialysis membranes were identified as the likely cause of this tragedy. This hypothesis was based on a number of premises.…”

Section: Introductionmentioning

confidence: 99%

Identifying toxic degradation products in cellulose acetate dialyzers

Lucas

Kalson

Hutter

et al. 2000

J. Biomed. Mater. Res.

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In September 1996, seven patients at Hospital A suffered conjunctivitis, hearing loss, diminished vision, and headaches 7-24 h after hemodialysis treatment. Eleven-year-old dialysis modules were identified as a common link between these patients. Degradation of the cellulose acetate (CA) material was identified as the cause of this incident. Degradation products were characterized from retrieved CA dialysis membranes. A series of synthesized CA degradation products was tested in vitro to assess toxicity. Based on the toxicity of the material preparations to the cells, animal tests were performed on selected CA degradation extracts and compared to extracts from actual dialysis membranes. Rabbits were IV-injected with extracts from a 13-year-old dialyzer, synthesized model compounds, and compared to controls. Ophthamological evaluation of the rabbits showed eye injury (iritis/ciliary flush) when the animals were treated with the old dialyzer or synthesized model compounds. Isolation and characterization of a toxic fraction from both of these extracts strongly indicated that oxidative stress at some point in the storage or manufacture of CA dialyzers created degradation products that reproduced some of the patient symptoms identified at Hospital A.

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Aged Dialyzers and Vision Loss

Cruickshanks

2000

Arch Ophthalmol

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Acute Onset of Decreased Vision and Hearing Traced to Hemodialysis Treatment With Aged Dialyzers

Abstract: Severe patient injury was associated with exposure to aged cellulose acetate membranes of dialyzers, allowing cellulose acetate degradation products to enter the blood. Clinicians should be aware that aged cellulose acetate membranes may cause severe adverse reactions.

Cited by 44 publications

References 17 publications

Effect of hemodialysis on the hearing function of patients with chronic renal failure

Effect of hemodialysis on the hearing function of patients with chronic renal failure

Identifying toxic degradation products in cellulose acetate dialyzers

Aged Dialyzers and Vision Loss

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