Incidence of Hypersensitivity Reactions During Hemodialysis

Abstract

Background/Aims: A recent alert from Spanish health authorities warned of a higher incidence of reported hypersensitivity reactions to hemodialysis membranes with polysulfone, in the 2017 review of acute reactions to dialyzers found only published reports in the 21^st century on polysulfone and its derivatives. The aim is to assess/evaluate the current incidence and characteristics of hypersensitivity reactions in hemodialysis patients. Methods: A retrospective multicentre study in 9 Spanish hospitals evaluated patients in whom a hypersensitivity reaction required a change in dialyzer membrane. Results: A total of 37 patients out of 1561 (2.37%) had hypersensitivity reactions and clinical, epidemiological and analytical data were available for 33 patients (2.11%). The membranes involved were polysulfone (n=23), polynephron (n=8), polyethersulfone (n=1) and polyacrylonitrile (n=1). This distribution reflected the frequency of use of membranes in the participating dialysis units. The reactions were described as type A in 18 cases and type B in 15 cases. There were no significant differences between the two types in clinical symptoms, the composition of the membrane involved, the method of sterilization, the season, or the time during the session in which they occurred. The most frequent symptom was dyspnea/breathlessness (64% of reactions). Eosinophilia was common (74%). 54% of the reactions occurred within the first 30 minutes of hemodialysis, 64% occurred during the first year of dialysis, and 54% required discontinuation of dialysis session. Cellulose triacetate was used as an alternative dialyzer in 78% of the cases. Conclusion: The incidence of hypersensitivity reactions was in the range found in reports from 20 years ago and is observed associated with synthetic membranes, not just polysulfones. Cellulose triacetate appears to be a good alternative for these patients.

Study of Biocompatibility of Membranes in Online Hemodiafiltration

“…Recently, a new-generation of dialyzer with a CTA membrane has entered the market, with an increase in the coefficient of ultrafiltration (72 mL/h/mm Hg) that allows online HDF [18]. In recent years, intolerance reactions (e.g., hypotension, desaturation) and allergies to synthetic dialyzers have been reported in a small percentage of patients [19][20][21], leading to the reintroduction of cellulose dialyzers such as CTA dialyzers.…”

The removal capacity of asymmetric cellulose triacetate during post-dilution online hemodiafiltration

“…Hypersensitivity reactions to synthetic membranes continue to be observed [ 1 ] and typically disappear following replacement of the dialysis membrane with a different type, usually cellulose triacetate. Previous studies have described the low purification ability of β2-microglobulin and its limited use in online hemodiafiltration (OL-HDF) with symmetric cellulose dialyzers [ 2 ].…”

Dialyzer first use reaction with polysulfone membrane: Moving beyond ethylene oxide

“…Use of ethylene oxide for sterilizing dialyzers showed a decreasing trend and the more biocompatible polysulfone membranes became more widely used since the turn of the century. However, in 2018, Esteras et al .,[ 3 ] in a retrospective study in Spain across nine dialysis centers, found 37 (2.37%) reported cases out of 1561 patients in a two year period form August 2015 to August 2017 which is the around the same incidence as the two earlier described studies done more than 20 years back. Most of the reported reactions, after the year 2000, have been to polysulfone membranes, which is unsurprising, as it is the most widely used membrane now-a-days.…”