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Medina-González R, Zaragoza JJ, Hernández-Barajas EM, Correa-de Leon J, Claure-Del Granado R, Vazquez-Rangel A, Pineda-Segura LM, Franco-Garcia MK, Chávez-Alonso G, Gómez-Fregoso JA, Rodríguez-García FG, Navarro-Blackaller G, Alcantar-Vallin L, Gallardo-González AM, Abundis-Mora GJ, García-García G, Chávez-Iñiguez JS. Decrease in platelet count in patients with AKI and its association with major adverse kidney events. Ren Fail 2024; 46:2359643. [PMID: 38869010 DOI: 10.1080/0886022x.2024.2359643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION A reduction in platelet count in critically ill patients is a marker of severity of the clinical condition. However, whether this association holds true in acute kidney injury (AKI) is unknown. We analyzed the association between platelet reduction in patients with AKI and major adverse kidney events (MAKE). METHODS In this retrospective cohort, we included AKI patients at the Hospital Civil of Guadalajara, in Jalisco, Mexico. Patients were divided according to whether their platelet count fell >21% during the first 10 days. Our objectives were to analyze the associations between a platelet reduction >21% and MAKE at 10 days (MAKE10) or at 30-90 days (MAKE30-90) and death. RESULTS From 2017 to 2023, 400 AKI patients were included, 134 of whom had a > 21% reduction in platelet count. The mean age was 54 years, 60% were male, and 44% had sepsis. The mean baseline platelet count was 194 x 103 cells/µL, and 65% of the KDIGO3 patients met these criteria. Those who underwent hemodialysis (HD) had lower platelet counts. After multiple adjustments, a platelet reduction >21% was associated with MAKE10 (OR 4.2, CI 2.1-8.5) but not with MAKE30-90. The mortality risk increased 3-fold (OR 2.9, CI 1.1-7.7, p = 0.02) with a greater decrease in the platelets (<90 x 103 cells/µL). As the platelets decreased, the incidence of MAKE was more likely to increase. These associations lost significance when accounting for starting HD. CONCLUSION In our retrospective cohort of patients with AKI, a > 21% reduction in platelet count was associated with MAKE. Our results are useful for generating hypotheses and motivating us to continue studying this association with a more robust design.
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Affiliation(s)
- Ramón Medina-González
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Eduardo M Hernández-Barajas
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Juarez Correa-de Leon
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2 - CNS. IIBISMED, Facultad de Medicina, Universidad Mayor de San Simon, Cochabamba, Bolivia
| | - Armando Vazquez-Rangel
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | - Gael Chávez-Alonso
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Juan A Gómez-Fregoso
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Guillermo Navarro-Blackaller
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Luz Alcantar-Vallin
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Alejandro Martínez Gallardo-González
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Gabriela J Abundis-Mora
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Jonathan S Chávez-Iñiguez
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
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2
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Iftikhar H, Saleem M, O'Brien F. Anaphylaxis secondary to citric acid allergy in End Stage Renal Disease patient. CEN Case Rep 2024; 13:125-127. [PMID: 37498514 PMCID: PMC10982184 DOI: 10.1007/s13730-023-00812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023] Open
Abstract
Dialysis reactions are not uncommon in End Stage Renal Disease (ESRD) patients who are undergoing in-center hemodialysis. Here we report the first case of anaphylaxis related to citric acid solutions used for dialysis machine disinfection and descaling. The patient developed repeated episodes of anaphylactic reactions during hemodialysis only in the inpatient setting leading to respiratory failure needing intubation and anaphylactic shock. This had failed to resolve despite using various combinations of different dialysis machines and dialyzer membranes and only resolved after the elimination of citric acid from the dialysis circuit. This case highlights the importance of different allergens in dialysis circuits and emphasizes the importance of looking for alternative reasons for dialyzer reactions.
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Affiliation(s)
- Hassaan Iftikhar
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA.
| | - Maryam Saleem
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
| | - Frank O'Brien
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
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3
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Pethő Á, Piecha D, Mészáros T, Urbanics R, Moore C, Canaud B, Rosivall L, Mollnes TE, Steppan S, Szénási G, Szebeni J, Dézsi L. A porcine model of hemodialyzer reactions: roles of complement activation and rinsing back of extracorporeal blood. Ren Fail 2021; 43:1609-1620. [PMID: 34882053 PMCID: PMC8667923 DOI: 10.1080/0886022x.2021.2007127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Hemodialysis reactions (HDRs) resemble complement-activation-related pseudoallergy (CARPA) to certain i.v. drugs, for which pigs provide a sensitive model. On this basis, to better understand the mechanism of human HDRs, we subjected pigs to hemodialysis using polysulfone (FX CorDiax 40, Fresenius) or cellulose triacetate (SureFlux-15UX, Nipro) dialyzers, or Dialysis exchange-set without membranes, as control. Experimental endpoints included typical biomarkers of porcine CARPA; pulmonary arterial pressure (PAP), blood cell counts, plasma sC5b-9 and thromboxane-B2 levels. Hemodialysis (60 min) was followed by reinfusion of extracorporeal blood into the circulation, and finally, an intravenous bolus injection of the complement activator zymosan. The data indicated low-extent steady rise of sC5b-9 along with transient leukopenia, secondary leukocytosis and thrombocytopenia in the two dialyzer groups, consistent with moderate complement activation. Surprisingly, small changes in baseline PAP and plasma thromboxane-B2 levels during hemodialysis switched into 30%-70% sharp rises in all three groups resulting in synchronous spikes within minutes after blood reinfusion. These observations suggest limited complement activation by dialyzer membranes, on which a membrane-independent second immune stimulus was superimposed, and caused pathophysiological changes also characteristic of HDRs. Thus, the porcine CARPA model raises the hypothesis that a second "hit" on anaphylatoxin-sensitized immune cells may be a key contributor to HDRs.
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Affiliation(s)
- Ákos Pethő
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Dorothea Piecha
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | | | | | - Christoph Moore
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.,School of Medicine, Montpellier University, Montpellier, France
| | - László Rosivall
- International Nephrology Research and Training Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Research Laboratory, Nordland Hospital Bodø and Faculty of Health Sciences and TREC, University of Tromsø, Tromsø, Norway.,Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Gábor Szénási
- International Nephrology Research and Training Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - János Szebeni
- SeroScience Ltd, Budapest, Hungary.,Nanomedicine Research and Education Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - László Dézsi
- SeroScience Ltd, Budapest, Hungary.,Nanomedicine Research and Education Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
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4
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Duayer IF, Araújo MJCLN, Nihei CH, Barcelos MAF, Braga O, Britto ZML, Elias RM. Dialysis-related thrombocytopenia: a case report. J Bras Nefrol 2021; 44:116-120. [PMID: 33657204 PMCID: PMC8943872 DOI: 10.1590/2175-8239-jbn-2020-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
Thrombocytopenia is frequently observed in hemodialysis patients, and its correct investigation and control remain a challenge. It is estimated that during the hemodialysis session there is a drop of up to 15% in the platelet count, with recovery after the end of treatment. This reduction in platelets is due to platelet adhesion and complement activation, regardless of the membrane material. Several studies with platelet surface markers demonstrate increased platelet activation and aggregation secondary to exposure to cardiopulmonary bypass. This case report describes a patient on hemodialysis who developed severe thrombocytopenia during hospitalization. Investigation and exclusion of the most common causes were carried out: heparin-related thrombocytopenia, adverse drug reaction, hypersplenism, and hematological diseases. Afterwards, the possibility of hemodialysis-related thrombocytopenia was raised, since the fall was accentuated during the sessions with partial recovery after the dialyzer change. Attention to the sterilization method and dialyzer reuse must be considered for correction. In the current case, reusing the dialyzer minimized the drop in platelet counts associated with hemodialysis.
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Affiliation(s)
| | | | | | | | - Osni Braga
- Hospital Nove de Julho, São Paulo, SP, Brasil
| | | | - Rosilene Mota Elias
- Hospital Nove de Julho, São Paulo, SP, Brasil.,Universidade de São Paulo, Hospital das Clínicas, São Paulo, SP, Brasil
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5
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Thrombocytopenia in a home hemodialysis patient with NxStage system. Int Urol Nephrol 2020; 53:189-190. [PMID: 32940812 DOI: 10.1007/s11255-020-02642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
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6
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Guo Q, Lou Y, Liu L, Luo P. How Can I Manage Thrombocytopenia in Hemodialysis Patient? A Review. Ther Apher Dial 2019; 24:352-360. [PMID: 31661590 DOI: 10.1111/1744-9987.13448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Qiaoyan Guo
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Yan Lou
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Lihua Liu
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Ping Luo
- Department of NephrologyJilin University Second Hospital Changchun China
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7
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Batalini F, Aleixo GF, Maoz A, Sarosiek S. Haemodialysis-associated thrombocytopenia: interactions among the immune system, membranes and sterilisation methods. BMJ Case Rep 2019; 12:e229594. [PMID: 31488440 PMCID: PMC6731774 DOI: 10.1136/bcr-2019-229594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 47-year-old man with severe thrombocytopenia. The differential diagnosis for thrombocytopenia is wide. The assessment includes an evaluation for falsely low platelet counts (pseudothrombocytopenia), immune-mediated platelet destruction, bone marrow dysfunction, or increased consumption and sequestration. After extensive and systematic workup, we found a relationship of his thrombocytopenia with haemodialysis. Although not widely recognised by clinicians, partly due to an incomplete understanding of its pathophysiology, haemodialysis is also a potential cause of thrombocytopenia. His platelet counts completely normalised after the substitution of his haemodialysis membrane. We concluded that our patient had haemodialysis-induced thrombocytopenia, most likely secondary to electron-beam sterilisation.
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Affiliation(s)
- Felipe Batalini
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Asaf Maoz
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Shayna Sarosiek
- Section of Hematology Oncology & Women’s Health Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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8
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Delgado Córdova M, Blanco N, Azaña C. Hypotension in hemodialysis secondary to a reaction to synthetic membranes. Nefrologia 2018. [PMID: 29530463 DOI: 10.1016/j.nefro.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Natalia Blanco
- Servicio de Nefrología, Hospital Quirónsalud A Coruña, A Coruña, España
| | - Claudia Azaña
- Servicio de Nefrología, Hospital Quirónsalud A Coruña, A Coruña, España
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9
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Del Giorno R, Berwert L, Pianca S, Bianchi G, Giannini O, Gabutti L. Comparative analysis of the long-term effect of two families of high-flux polysulfone dialysers on platelet count: a retrospective cross-sectional study. Ther Clin Risk Manag 2017; 13:1415-1422. [PMID: 29081657 PMCID: PMC5652913 DOI: 10.2147/tcrm.s143708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Thrombocytopenia is a potential complication of hemodialysis (HD), and its occurrence has been described even with highly biocompatible polysulfone (PSf) membranes. Dialysis units routinely monitor platelet (PLT) count at the beginning of HD sessions. However, considering that the long-term effects on PLT count could easily be missed, the prevalence of HD-related thrombocytopenia could be underestimated. In the present study, we aimed to investigate the following: 1) the long-term impact of HD treatment on PLT count, comparing two families of dialysis membranes made up of similar PSfs; 2) whether the switch between the dialysis membranes studied significantly affects PLT count; and 3) the prevalence and the risk of HD-induced thrombocytopenia according to the dialysis membranes used. Methods A cross-sectional retrospective study was performed comprising 157 adult chronic HD patients. The HD membranes under investigation were of the series FX, Helixone® Fresenius (Filters A), and Polyflux® Gambro (Filters B). Patients were treated in 4 dialysis units in Southern Switzerland. Data were collected from a centralized computing platform. Findings PLT count significantly differs between Filters A and B with, respectively, 188 (153–243) ×10E9/L versus 214 (179–255) ×10E9/L (p=0.036). The prevalence of thrombocytopenia was higher for Filter A compared with Filter B (28.4% versus 12.8%; p<0.001). The switch from Filter A to Filter B significantly affected PLT count: from 189 (146–217) ×10E9/L to 217 (163–253) ×10E9/L (p<0.001; analysis on 26 patients). A linear random-intercept model confirmed the results (β coefficient =35.214; SE =5.956; p<0.001). In a mixed-effects logistic regression model, the risk of thrombocytopenia for Filter B was 0.157 (CI =0.056–0.442). Discussion Our data suggest that among the PSf membranes studied, the FX membrane induced a lasting decrease in PLT count and caused significantly more thrombocytopenia. Prospective studies are warranted to verify our findings.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine, Nephrology and Dialysis Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona
| | - Lorenzo Berwert
- Department of Internal Medicine, Nephrology and Dialysis Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona
| | - Silvio Pianca
- Nephrology Unit, Civico Hospital, Ente Ospedaliero Cantonale, Lugano
| | - Giorgia Bianchi
- Nephrology Unit, La Carità Hospital, Ente Ospedaliero Cantonale, Locarno
| | - Olivier Giannini
- Nephrology Unit, Beata Vergine Hospital, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Nephrology and Dialysis Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona
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10
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Abe M, Hamano T, Wada A, Nakai S, Masakane I. High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry. Am J Nephrol 2017; 46:82-92. [PMID: 28675885 DOI: 10.1159/000478032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little information is available regarding the type of dialyzer which results in good prognosis. This study is aimed at investigating the association between 7 types of dialyzers and 2-year mortality. METHODS We conducted a cohort study using data from a nationwide registry of the Japanese Society for Dialysis Therapy. Subjects were 136,676 patients on maintenance hemodialysis (HD) between 2009 and 2011 who underwent maintenance HD for at least 2 years and were treated with one of the following 7 types of high-performance membrane dialyzers: cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause 2-year mortality, adjusting for potential confounders. RESULTS Data were adjusted using basic factors, with PS as a reference group, and the hazard ratio (HR) was significantly higher in CTA, PMMA, PAN, and EVAL groups. Further data adjustment for Kt/V yielded the same results as were obtained from data adjusted for basic factors. After further adjustment for nutrition- and inflammation-related factors, HR was significantly lowered for the PES and PMMA groups compared with the PS group (HR 0.88; 95% CI 0.82-0.94 and HR 0.84 95% CI 0.76-0.93, respectively). After propensity score matching, HR for the PES and PMMA groups was significantly lowered compared with the PS group. CONCLUSIONS The use of different membrane types may affect mortality. Further long-term prospective studies are needed to clarify whether the PES and PMMA membranes can improve prognosis.
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Affiliation(s)
- Masanori Abe
- The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Nihon University School of Medicine, Tokyo, Japan
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11
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Shu KH, Kao TW, Chiang WC, Wu VC. A case of anaphylactic shock induced by FX60 polysulfone hemodialyzer but not F6-HPS polysulfone hemodialyzer. Hemodial Int 2014; 18:841-5. [DOI: 10.1111/hdi.12184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kai-Hsiang Shu
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Tze-Wah Kao
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Wen-Chih Chiang
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Vin-Cent Wu
- Division of Nephrology; Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
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12
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Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int 2012; 82:147-57. [DOI: 10.1038/ki.2012.130] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Affiliation(s)
- John T Daugirdas
- Department of Medicine, University of Illinois at Chicago, Illinois 60527, USA.
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14
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POSADAS MA, HAHN D, SCHLEUTER W, PAPARELLO J. Thrombocytopenia associated with dialysis treatments. Hemodial Int 2011; 15:416-23. [DOI: 10.1111/j.1542-4758.2011.00561.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Bacelar Marques ID, Pinheiro KF, de Freitas do Carmo LP, Costa MC, Abensur H. Anaphylactic reaction induced by a polysulfone/polyvinylpyrrolidone membrane in the 10th session of hemodialysis with the same dialyzer. Hemodial Int 2011; 15:399-403. [PMID: 21624039 DOI: 10.1111/j.1542-4758.2011.00553.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The majority of severe hypersensitivity reactions in hemodialysis patients have occurred due to sensitization to ethylene oxide or to nonbiocompatible membrane dialyzers. The use of polysulfone dialyzers rarely causes hypersensitivity reactions. In the present study, we describe a case of severe life-threatening reactions induced by polysulfone dialyzers (from different manufacturers subjected to a variety of sterilization methods), which occurred after 9 sessions of hemodialysis with the same prescription, exemplifying the complexity of such reactions.
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16
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Coentrão L, Martins P, Leblanc A, Botelho C, Carvalho BA, Pestana M. Treatment of severe dialysis reactions with the AN69-ST membrane: biocompatibility does matter. NDT Plus 2010; 3:298-299. [PMID: 28657048 PMCID: PMC5477941 DOI: 10.1093/ndtplus/sfq005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/15/2010] [Accepted: 01/18/2010] [Indexed: 12/05/2022] Open
Abstract
Dialysis reactions with biocompatible membranes are rare, and complement activation has been suggested to be a culprit. We report here a case of an incident haemodialysis patient with asthma disease who experienced severe adverse reactions late into dialysis session, with different synthetic membranes (FX 80, Fresenius; Polyflux 17L, Gambro; FX 10, Fresenius; BLS 512, Bellco-Sorin). After replacing the dialyser by the surface-treated AN69 membrane (Nephral ST 500, Hospal), the dialysis sessions became uneventful. The case reinforces the need for biocompatible dialysers with high permeability and adsorptive capacity in susceptible patients experiencing severe dialysis reactions with synthetic membranes.
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Affiliation(s)
- Luís Coentrão
- Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Hospital de S. João EPE, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Martins
- Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Hospital de S. João EPE, Porto, Portugal
| | - Ana Leblanc
- Imunoalergology Department, Hospital S. João EPE, Porto, Portugal
| | - Carmen Botelho
- Imunoalergology Department, Hospital S. João EPE, Porto, Portugal
| | - Berta Aguiar Carvalho
- Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Hospital de S. João EPE, Porto, Portugal
| | - Manuel Pestana
- Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Hospital de S. João EPE, Porto, Portugal
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