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

Nishiuchi, Yoko; Shima, Hisato; Fukata, Yoshio; Tao, Tomohiro; Okamoto, Takuya; Takamatsu, Norimichi; Okada, Kazuyoshi; Murata, Jun

doi:10.1007/s13730-020-00466-w

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…All of them have been linked to adverse outcomes in this population [30][31][32]. Compared with acetic-acid-bufered A concentrates in standard bicarbonate HD, CiaHD has been reported to enhance HD efciency and reduce systemic infammation and vascular smooth muscular cell (VSMC) dysfunction [33,34]. Furthermore, CiaHD has been one attempt to improve the HD-procedure's biocompatibility and restore immunity in end-stage renal disease (ESRD) [23,35].…”

Section: Discussionmentioning

confidence: 99%

Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study

Shen,

Schmaderer,

Ossadnik

et al. 2023

International Journal of Nephrology

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Introduction. Due to chronic inflammation, maintenance hemodialysis (MHD) patients continue to show excess mortality. Acetate-free citrate-buffered A concentrates could be a way to improve the biocompatibility of the procedure, reduce chronic inflammation, and thus in the long term improve the prognosis of patients. Methods. Using a pre-post design (3 months of acetate followed by 3 months of citrate-acidified A concentrates in standard bicarbonate-based dialysate hemodialysis, CiaHD) and linear mixed model analysis in 61 stable HD patients, we assessed the impact of CiaHD on counts and phenotypes of peripheral T cells and monocytes by flow cytometry. Results. Switching to CiaHD left C-reactive protein (CRP) levels and leucocyte counts unaffected. However, CiaHD increased lymphocyte counts ex vivo. Furthermore, we found a decrease in total CD3+CD4+CD69+ ((109/L), mean ± SD: acetate, 0.04 ± 1.0 versus citrate, 0.02 ± 0.01; P = 0.02) activated cells, while the number of CD28+ T cells remained stable. No differences were noted regarding T-cell exhaustion marker expression, CD14+CD16+ monocyte counts, and PMN-MDSCs. Conclusion. Compared with acetate, CiaHD has a minor impact on lymphocyte counts and CD4+T-cell activation, which was independent of systemic CRP and ionized magnesium, calcium levels, and other dialysis prescription modalities.

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Section: Discussionmentioning

confidence: 99%

Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study

Shen,

Schmaderer,

Ossadnik

et al. 2023

International Journal of Nephrology

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“…Other allergens -Hypersensitivity reactions to dialysis membranes may not depend on the main membrane component but to any component of dialysis machinery including acetate [79], latex [80,81], topical bovine thrombin [82], nickel [83], povidone-iodine [28], polyvinylpyrrolidone [47], lidocaine [28], bisphenol A [84],…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Hypersensitive Reactions During Hemodialysis Treatment: What Do We Need to Know?

Afsar,

Afsar

2024

Seminars in Dialysis

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Kidney replacement therapies (KRTs) including hemodialysis (HD) are one of the treatment options for most of the patients with end‐stage kidney disease. Although HD is vital for these patients, it is not hundred percent physiological, and various adverse events including hypersensitivity reactions may occur. Fortunately, these reactions are rare in total and less when compared to previous decades, but it is still very important for at least two reasons: First, the number of patients receiving kidney replacement treatment is increasing globally; and the cumulative number of these reactions may be substantial. Second, although most of these reactions are mild, some of them may be very severe and even lead to mortality. Thus, it is very important to have basic knowledge and skills to diagnose and treat these reactions. Hypersensitivity reactions can occur at any component of dialysis machinery (access, extracorporeal circuit, medications, etc.). The most important preventive measure is to avoid the allergen. However, even with very specific test, sometimes the allergen cannot be found. In mild conditions, HD can be contained with non‐specific treatment (topical creams, antihistaminics, corticosteroids). In more severe conditions, treatment must be stopped immediately, blood should not be returned to patient, drugs must be stopped, and rules of general emergency treatment must be followed.

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“…Non-infectious causes for fever include hypersensitivity reactions to components of the extracorporeal circuit, including the dialyzer membranes and dialysates in patients on HD [5,6]. We recently reported the usefulness of the drug-induced lymphocyte stimulation test (DLST) in the diagnosis of hypersensitivity reaction related to acetate dialysate [7]. However, due to the lack of established diagnostic methods, the causes of hypersensitivity reactions to components of the extracorporeal circuit might not be evident in some cases.…”

Section: Introductionmentioning

confidence: 99%

A complicated case of Serratia marcescens catheter-related bloodstream infection misdiagnosed as hypersensitivity reactions to bicarbonate dialysate containing acetate

Shima¹,

Okamoto²,

Inoue³

et al. 2021

CEN Case Rep

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Recurrent fever during/post-dialysis can occur due to infectious or non-infectious causes. We present the case of a 79-year-old patient who had persistent post-dialysis fever after long-term tunneled central venous catheterization with acetate-containing bicarbonate dialysate. Drug-induced lymphocyte stimulation test (DLST) was positive for acetate dialysate, and he was suspected of having acetate dialysate-induced hypersensitivity reaction. However, switching to acetate-free dialysate did not attenuate the fever. Since Serratia marcescens had been isolated twice from the blood, catheter-related bloodstream infection (CRBSI) was suspected. The culture of the catheter tip confirmed CRBSI caused by S. marcescens. Elevation of β-d-glucan levels and appearance of pulmonary nodular shadow on chest computed tomography images indicated complicated fungal infections. Administration of antibiotics and antifungals led to resolution of the pulmonary nodular shadow with attenuation of fever and C-reactive protein levels. DLST for acetate dialysate was negative, and its reuse did not aggravate the symptoms; hence, the first result was considered false-positive. An indwelling catheter is a risk factor for S. marcescens-related CRBSI, which leads to post-dialysis fever. Hypersensitivity reactions to dialysates must be diagnosed considering the clinical course and DLST results.

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

Cited by 6 publications

References 15 publications

Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study

Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study

Hypersensitive Reactions During Hemodialysis Treatment: What Do We Need to Know?

A complicated case of Serratia marcescens catheter-related bloodstream infection misdiagnosed as hypersensitivity reactions to bicarbonate dialysate containing acetate

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