{"id":2847,"date":"2020-03-26T03:52:06","date_gmt":"2020-03-26T08:52:06","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=1223"},"modified":"2025-05-09T15:50:42","modified_gmt":"2025-05-09T20:50:42","slug":"dialyzer-reactions","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/dialyzer-reactions\/","title":{"rendered":"Dialyzer Reactions"},"content":{"rendered":"<h4>Dialyzer Reactions<\/h4>\n<p>Reactions attributed to the hemodialyzer are generally divided into two types:<\/p>\n<p><em>Type A <\/em>&#8211; anaphylactoid reaction<\/p>\n<ul>\n<li>Increased risk in patients with a history of atopy, high IgE levels, eosinophilia and allergic reactions during dialysis<sup>1<\/sup><\/li>\n<\/ul>\n<p><em>Type B<\/em> &#8211; mild reaction<\/p>\n<h4>Diagnosis<\/h4>\n<p><em>Type A reaction<\/em><\/p>\n<ul>\n<li>Severe and rapid in onset<\/li>\n<li>Rare (7.0 per 1000 patient year<sup>2<\/sup>)<\/li>\n<li>Established by three major criteria or two major and one minor criterion\n<ul>\n<li>Major criteria<sup>3<\/sup>\n<ul>\n<li>Onset within 20 minutes of starting dialysis<\/li>\n<li>Dyspnea<\/li>\n<li>Burning\/heat sensation at the access site or throughout the body<\/li>\n<li>Angioedema<\/li>\n<\/ul>\n<\/li>\n<li>Minor criteria\n<ul>\n<li>Reproducible during subsequent dialysis when using the same type or brand of dialyzer<\/li>\n<li>Urticaria<\/li>\n<li>Rhinorrhea or lacrimation<\/li>\n<li>Abdominal cramping<\/li>\n<li>Itching<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Etiology- Use of ethylene oxide (ETO) for sterilization of dialyzer and polyacrylonitrile membranes (PAN) membranes, especially AN69 in patients on ACE-inhibitors<\/li>\n<\/ul>\n<p><em>Type B reaction<\/em><\/p>\n<ul>\n<li>Primary symptoms are chest and back pain<\/li>\n<li>Occurs 20-40 minutes into the dialysis treatment<\/li>\n<li>Disappears or lessens dramatically during the subsequent hours of dialysis<sup>4<\/sup><\/li>\n<li>Pathogenesis of type B reaction is not clear\n<ul>\n<li>May be related to complement activation<\/li>\n<\/ul>\n<\/li>\n<li>Current data do not support the role of membrane biocompatibility in development of type B reactions<sup>5<\/sup><\/li>\n<\/ul>\n<h4>Treatment<\/h4>\n<ul>\n<li>Symptomatic and supportive<\/li>\n<li>Discontinue HD and discard the blood, oxygen, anti-histamines, epinephrine and corticosteroids<\/li>\n<li>HD can be initiated after stabilization with a more biocompatible membrane and a hemodialyzer not sterilized with ETO (ethylene oxide)<sup>6<\/sup><\/li>\n<\/ul>\n<h4>Prevention<\/h4>\n<ul>\n<li>Avoid combination of PAN membrane and angiotensin converting enzyme inhibitor (ACEI) use<\/li>\n<li>Use of ARBs (angiotensin receptor blockers) and dialysate with 3.5 mEq\/L calcium may lower the risk<sup>7<\/sup><\/li>\n<\/ul>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4>References:<\/h4>\n<ol>\n<li>Kraske GK, Shinaberger JH, Klaustermeyer WB. Severe hypersensitivity reaction during hemodialysis. <em>Ann Allergy Asthma Immunol<\/em>\u00a0 78: 217-220, 1997<\/li>\n<li>Bright RA, Torrence ME, McMlellan WM. Preliminary survey of the occurrence of anaphylactoid reactions during haemodilaysis. <em>Nephrol Dial Transplant<\/em>\u00a0 14:799-800, 1999<\/li>\n<li>Daugirdas JT, Ing TS. First-use reactions during hemodialysis: A definition of subtypes. <em>Kidney Int<\/em>\u00a0 33(suppl 24) S37-S43, 1988<\/li>\n<li>Jaber BL, Pereira BJG. Dialysis reactions. <em>Semin Dial<\/em>\u00a0 10:158-165, 1997<\/li>\n<li>Locatelli F, Manzoni C. Biocompatibility in haemodialysis: Fact and fiction. <em>Curr Opin Nephrol Hyperten<\/em> 6:528-532, 1997<\/li>\n<li>Dumler F, Zasuwa G, Levin NW. Effect of dialyzer reprocessing methods on complement activation\u00a0and hemodialyzer-related symptoms. <em>Artif Organs<\/em>\u00a0 11:128-31, 1987<\/li>\n<li>Van der Niepen P, Sennesael JS, Verbeelen DL. Prevention of anaphylactoid reactions to high flux membrane dialysis and ACE inhibitors by calcium. <em>Nephrol Dial Transplant<\/em> 9:87-89, 1994<\/li>\n<\/ol>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[128],"tags":[60],"language":[41],"articles":[230],"class_list":["post-2847","article","type-article","status-publish","format-standard","hentry","category-articles","tag-intradialytic","language-english","articles-hemodialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Dialyzer Reactions - AREP Asia Pacific<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/dialyzer-reactions\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dialyzer Reactions - AREP Asia Pacific\" \/>\n<meta property=\"og:description\" content=\"Dialyzer Reactions Reactions attributed to the hemodialyzer are generally divided into two types: Type A &#8211; 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