VII. Products used in dialysis


Dialyzers prepared with raw cellulose, copper, ammoniac, and other chemical products.
 
Incidence
3.3/year/1000 patients.
 
First-use syndrome: 3 to 5% of dialysed patients.
 
Risk factors
Use of new cellulose.
  • Insufficient rinsing before dialysis.
     
  • Previous exposure to the same type of hemodialyzer.
     
  • Atopy (more rapid onset and more pronounced complement activation).
Clinical manifestations
First-use syndrome: chest and back pain, hypotension, nausea, vomiting, abdominal cramps, shortness of breath.
 
General: hypotension.
 
Respiratory: dyspnea, wheezing.
 
Cutaneous: pruritus, urticaria, edema.
 
Digestive: nausea, vomiting, abdominal pain.
 
Mechanisms
Complement activation via the alternative pathway.
 
Ethyleneoxide has an increased allergenicity after contact with cuprammonium cellulose dialyzers.
 
Management
Use of reused dialyzers lower complement activation.

References

  1. Kraske G.K, Shinaberger J.H, Klaustemeyer W.B, "Severe hypersensitivity reaction during hemodialysis", Ann. Allergy. Asthma. Immunol., 1997; 78 (2): 217-20 
  2. Rockel A, Klinke B, Hertel J, Baur X, Thiel C, Abdelhamid S, Fiegel P, Walb D, "Allergy to dialysis materials", Nephrol. Dial. Transplant., 1989; 4 (7): 646-52 
  3. Daugirdas J.T, Ing T.B, Roxe D.M, "Severe anaphylactoid reactions to cuprammonium cellulose hemodialyzers", Arch. Intern. Med., 1985; 145: 489-94. 
  4. Bhat K, Lee S.M.K, Lozano J, "Anaphylactic reaction on subsequent exposure to cuprophan hollow-fiber dialyzer: a case report", Ann. Allergy, 1984; 52: 282. 
  5. Hakim R.M, Breillatt J, Lazarus J.M, Port F.K, "Complement activation and hypersensitivity reactions to dialysis membranes", N. Engl. J. Med., 1984; 311: 1178-82

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.