Hemodialysis-Associated Febrile Episodes: Surveillance before and after Major Alteration in the Water Treatment System

Gaynes, R; Friedman, Candace; Maclaren, C.; Foley, Kevin T.; Swartz, Richard D.

doi:10.1177/039139889001300807

Cited by 6 publications

(2 citation statements)

References 15 publications

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“…Sepsis-related fever is generally due to release of pyrogens and toxins by the pathogens which in turn trigger secretion of interleukins (IL) especially IL 1 and 6 and chemokines which cause thermogenesis and hypercatabolism. Some studies have documented this as well [26], [27]. Significant blood loss, chest pain and pruritus were the other minor complications documented and these have been documented in former similar studies [28], [29].…”

Section: Discussionmentioning

confidence: 61%

The Spectrum of Intradialysis Complications in Renal Patients Accessing Care in A Tertiary Hospital in South East Nigeria

Osineke¹,

Jisieike-Onuigbo

Ulasi

et al. 2023

CLINICMED

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Background: Haemodialysis (HD) is currently the most common mode of renal replacement therapy (RRT) in the Sub-Saharan Africa. It is however, fraught with many complications which sometimes cause morbidity and mortality outside the primary kidney problems. Hence, there must be concerted effort to identify them early. This would enable the clinician institute preventive measures or treat them efficiently when these adverse effects occur. Materials and Method: A prospective study was carried out among chronic kidney disease (CKD) and acute kidney injury (AKI) patients in failure assessing HD care at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi dialysis center. Subjects were one hundred and twenty six in number: 84 CKD and 42 AKI. Sixty five (65) were males while sixty one (61) were females. A total of three hundred and sixty nine (369) HD sessions were done. Sociodemographic data and medical history were obtained from each subject and relevant physical examinations and laboratory investigations were carried out prior to and intra dialysis for each subject. Results were analyzed using Statistical Package for Social Sciences (SPSS) software version 17. Results: Intradialytic complications occurred in 86 out of 126 subjects. The commonest intradialytic complication was hypotension (20.6% for patient-based analysis and 21.1% for session-based analysis). This was followed by hypertension (19.8% for patient-based analysis and 16.5% for session-based analysis). Other complications noted were fever (9.95%), chest pain (9.95%), cramps (1.0%) and seizure (1.0%). Conclusion: In this study population, intradialysis hypotension was the most common complication followed by intradialysis hypertension. Patients on HD should be assessed and monitored actively to identify and possibly prevent or treat these complications when they occur.

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Section: Discussionmentioning

confidence: 61%

The Spectrum of Intradialysis Complications in Renal Patients Accessing Care in A Tertiary Hospital in South East Nigeria

Osineke¹,

Jisieike-Onuigbo

Ulasi

et al. 2023

CLINICMED

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“…However, this was only apparent with high‐flux dialysis and the use of filtered dialysate, which corresponded to 10 fewer pyrogenic reactions in more than 28,000 treatments (19). Other authors have not found an association between pyrogenic reactions and the bacterial count or endotoxin level in the dialysate (20,21). Finally, LAL reactive material present in the blood, derived from cellulose‐based membranes, does not induce febrile reactions (22).…”

Section: Potential Clinical Consequencesmentioning

confidence: 94%

UNRESOLVED ISSUES IN DIALYSIS: Ultrapure Dialysate: Facts and Myths

Bommer

Jaber

2006

Seminars in Dialysis

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During hemodialysis, blood comes in contact with a large volume of dialysate. Since the purity of dialysate has been linked to acute and long-term complications in hemodialysis patients, the limit of bacterial and endotoxin contamination has been reduced in recent years. Questions have been raised as to whether ultrapure dialysate is required to prevent such complications; in particular, the chronic inflammatory status frequently found in chronically hemodialyzed patients. In vivo and in vitro data suggest that cytokine stimulation in the blood depends on the concentration of bacteria or endotoxin in the dialysate and on the endotoxin permeability of the dialysis membrane. It is not proven whether ultrapure dialysate reduces significantly proinflammatory cytokine generation compared with standard dialysate within the limits of recent recommendations, if rather impermeable dialysis membranes are used. Cuprophane membranes are more permeable to cytokine-inducing substances compared with synthetic membranes such as polysulfone and polyamide. Clinical reports have also attempted to link several acute and chronic complications of hemodialysis to dialysate purity. To date, however, there is no large randomized clinical trial demonstrating that ultrapure dialysate significantly reduces biomarkers of inflammation and other consequential putative complications, including dialysis-related amyloidosis, erythropoietin requirement, and cardiovascular morbidity and mortality. In conclusion, based on the existing clinical data, ultrapure dialysate is recommended in the setting of suboptimal bacteriologic quality of standard dialysate and the use of permeable dialysis membranes.

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Acute Complications of Hemodialysis and their Prevention and Treatment

Mujais

Ing

Kjellstrand

Replacement of Renal Function by Dialysis

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Hemodialysis-Associated Febrile Episodes: Surveillance before and after Major Alteration in the Water Treatment System

Cited by 6 publications

References 15 publications

The Spectrum of Intradialysis Complications in Renal Patients Accessing Care in A Tertiary Hospital in South East Nigeria

The Spectrum of Intradialysis Complications in Renal Patients Accessing Care in A Tertiary Hospital in South East Nigeria

UNRESOLVED ISSUES IN DIALYSIS: Ultrapure Dialysate: Facts and Myths

Acute Complications of Hemodialysis and their Prevention and Treatment

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