Dialysis‐associated allergic reactions during continuous renal replacement therapy and hemodialysis: A case report

Abstract

Dialyzer reactions are long-appreciated complications of dialysis. Despite advances in dialysis machines and membranes, these life-threatening reactions still occur. It is imperative to recognize potential dialyzer reactions when assessing adverse dialysis events as reexposure to dialytic treatments could be life threatening. We present the case of a 72-year old woman with dialysis-requiring anuric acute kidney injury who experienced acute hypotension and cardiopulmonary arrest during both continuous renal replacement therapy and a subsequent hemodialysis treatment. We concluded that she had an anaphylactic reaction to an unidentified component of the dialysis equipment. Identification, work up, treatment, and reporting of dialyzer reactions are discussed in the context of this case.

Anaphylactoid reaction during hemodiafiltration on AN69 membrane in a patient with atypical hemolytic uremic syndrome: A pediatric case report

“…Multiple factors are considered when evaluating dialyzer reactions, including type of dialyzer membrane, sterilizing agent, antiseptics, medications, the microbiological quality of dialysate, endotoxins/bacterial products, and heparin. 1,9,10 Ethylene oxide, used in gas sterilization of dialysis membranes, has been reported to cause AR. 1,11 In our case, both membranes were sterilized with ethylene oxide; therefore, AR was not due to this agent.…”

“…1,9,10 Ethylene oxide, used in gas sterilization of dialysis membranes, has been reported to cause AR. 1,11 In our case, both membranes were sterilized with ethylene oxide; therefore, AR was not due to this agent. The patient did not receive ACEI, and the swift improvement of her condition excludes underlying sepsis.…”

“…Numerous publications have focused on ARs in patients dialyzed with AN69 membranes, both with 4,10,12,13 and without concomitant ACEI intake. 1,5,12,14 The pathophysiology is largely thought to be associated with the generation of bradykinin, and considering the fact that ACEI prevent the degradation of bradykinin, it is likely the ACEI use potentiates its accumulation. 7 There are two hypotheses: the first hypothesis suggests that AR is due to contact between patient plasma and endotoxins.…”

“…7 Such cases of AR are demonstrated to regress when the AN69 membrane is replaced by another membrane. 1,10,12,13 Diagnosis of dialyzer reaction relies upon clinical history and exclusion of other causes. Hypersensitivity markers include eosinophil count, tryptase, total/allergen-specific IgE, C3, and C4; however, the duration of elevation of such markers can vary.…”

“…Hypersensitivity reactions (HSR) related to hemodialysis have been described in the last decades. [1][2][3][4][5] Polyacrylonitrile (AN69) membrane-associated reactions in hemodialysis patients receiving angiotensin converting enzyme inhibitors (ACEI) have been reported in adult patients. [2][3][4][5] Underlying reasons are suggested to be the induction of bradykinin release and reduced degradation of bradykinin in the presence of ACEI.…”