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Afsar B, Afsar RE. Hypersensitive Reactions During Hemodialysis Treatment: What Do We Need to Know? Semin Dial 2024; 37:189-199. [PMID: 38433728 DOI: 10.1111/sdi.13197] [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: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
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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Affiliation(s)
- Baris Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Rengin Elsurer Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
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Rodríguez-Sanz A, Sánchez-Villanueva R, Domínguez-Ortega J, Álvarez L, Fiandor A, Nozal P, Sanz P, Pizarro-Sánchez MS, Andrés E, Cabezas A, Pérez-Alba A, Bajo MA, Selgas R, Bellón T. Characterization of hypersensitivity reactions to polysulfone hemodialysis membranes. Ann Allergy Asthma Immunol 2022; 128:713-720.e2. [PMID: 35288272 DOI: 10.1016/j.anai.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, cases have been reported in which unexpected systemic hypersensitivity reactions occurred in patients dialyzed with polysulfone- or polyethersulfone-biocompatible membranes in the absence of other risk factors. The pathomechanisms involved in these reactions are largely unknown. OBJECTIVE To characterize hypersensitivity reactions to polysulfone hemodialysis using clinical and laboratory data and to identify biomarkers suitable for endotype identification and diagnosis. METHODS We prospectively collected data from 29 patients with suspected hypersensitivity reactions to polysulfone hemodialysis membranes. Clinical laboratory parameters such as tryptase, blood cell counts, and complement levels were recorded. Acute samples were obtained from 18 cases for the ex vivo assessment of basophil activation by flow cytometry analysis of CD63, CD203, and FcεRI cell membrane expression. Serum cytokines and anaphylatoxin concentrations were evaluated in 16 cases by Luminex and cytometric bead array analysis. RESULTS Tryptase was elevated during the acute reaction in 4 cases. Evidence of basophil activation was obtained in 10 patients. Complement activation was found in only 2 cases. However, C5a serum levels tended to increase during the acute reaction in those patients with hypoxemia. Significantly higher serum levels of interleukin-6 were observed during the acute reactions to polysulfone hemodialysis (P = .0103). CONCLUSION Based on biomarker analysis, various endotypes were identified, including type I-like (with the involvement of mast cells or basophils), complement, and cytokine (interleukin-6) release-related reactions, with some patients showing mixed reactions. Further research is needed to unravel the exact mechanisms involved in the activation of these cellular and molecular pathways.
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Affiliation(s)
- Aranzazu Rodríguez-Sanz
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz-IdiPAZ, Madrid, Spain; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Javier Domínguez-Ortega
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz-IdiPAZ, Madrid, Spain; Allergy Service, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Álvarez
- Nephrology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Fiandor
- Allergy Service, Hospital Universitario La Paz, Madrid, Spain
| | - Pilar Nozal
- Immunology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Paloma Sanz
- Nephrology Service, Hospital Quirón Ruber Juan Bravo, Madrid, Spain
| | | | - Elena Andrés
- Nephrology Service, Hospital General Universitario de Albacete, Albacete, Spain
| | - Antonio Cabezas
- Nephrology Service, Hospital Universitario de Torrevieja, Torrevieja, Alicante, Spain
| | - Alejandro Pérez-Alba
- Nephrology Service, Hospital General Universitario de Castellón, Castellón, Spain
| | - M Auxiliadora Bajo
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain; Nephrology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael Selgas
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain; Nephrology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.
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