Hypersensitivity reactions to acetate in the bicarbonate dialysate in a patient undergoing pre-dilution online hemodiafiltration

Kato, Akihiko; Takita, Takako; Furuhashi, Mitsuyoshi

doi:10.1007/s13730-015-0185-y

Cited by 2 publications

(1 citation statement)

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“…We should consider the allergic reaction to acetate as the cause of recurrent fever after dialysis when using acetatecontaining bicarbonate dialysate. We found 11 case reports of hypersensitivity reactions related to acetate dialysate (summarized in Table 1) [4][5][6][7][8][9][10][11][12][13][14]. However, as seen in this case, fever is atypical, and has been reported only in two cases.…”

Section: Discussionmentioning

confidence: 90%

Hypersensitivity reactions to bicarbonate dialysate containing acetate: a case report with literature review

Nishiuchi¹,

Shima²,

Fukata

et al. 2020

CEN Case Rep

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Although hemodialysis-hypersensitivity reactions have various causes, only a few cases of hypersensitivity to acetate dialysate accompanied by fever have been reported. We present the case of a 69-year-old hemodialysis patient who was admitted due to fever after dialysis. He had undergone online hemodiafiltration using acetate-free citrate-containing dialysate. After admission, we switched to acetate-containing bicarbonate dialysate. He was diagnosed with pneumonia and treated with ceftriaxone. However, fever that occurred post dialysis persisted, displaying a gradual elevation in CRP level and eosinophils (up to 9.7 mg/dL and 3774 cells/μL, respectively). After a series of negative workups for infection and dialysis membrane allergy, we suspected that acetate-containing bicarbonate dialysate to be the cause of the allergic reaction and switched to acetate-free bicarbonate dialysate. Consequently, eosinophil count decreased and the fever abated. The drug-induced lymphocyte stimulation test finding (for acetate dialysate) was positive, and he was diagnosed with acetate dialysate-induced hypersensitivity reactions. The condition was not detected earlier due to the complications associated with pneumonia.

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