What are the signs and symptoms associated with dialyzer reactions?

Signs and Symptoms Associated with Dialyzer Reactions

Dialyzer reactions present with a constellation of symptoms including dyspnea, hypotension, chest pain, bronchospasm, hypoxia, pruritus, urticaria, and abdominal symptoms, typically occurring within the first 30 minutes of dialysis treatment. 1

Types of Dialyzer Reactions

Type A (Hypersensitivity Reactions)

• Incidence: 4/100,000 dialysis procedures 2
• Characteristics:
  • More severe, potentially life-threatening
  • True allergic/anaphylactic responses
  • Signs and symptoms:
    • Dyspnea (69% of cases) 1
    • Hypotension (66%) 1
    • Hypoxia (44%) 1
    • Bronchospasm (25%) 1
    • Chest pain (22%) 1
    • Pruritus and/or urticaria (22%) 1
    • Abdominal symptoms including nausea, vomiting, diarrhea (22%) 1
    • In severe cases: cardiorespiratory arrest 3, 4

Type B (Non-specific Reactions)

• Incidence: 3-5/100 dialysis procedures 2
• Characteristics:
  • Milder, less severe
  • Non-allergic in nature
  • Signs and symptoms:
    • Burning sensation 2
    • Leukopenia 2
    • Thrombocytopenia 2
    • Oxygen desaturation 2

Timing of Reactions

• Most reactions occur within the first 30 minutes of starting dialysis 1
• Can occur as early as 5 minutes after initiation 4
• May persist for 15-20 minutes 4
• Important note: Reactions can occur even after multiple uneventful dialysis sessions with the same dialyzer (documented case after 9 successful sessions) 5

Risk Factors and Associated Conditions

• Previous allergic reactions to medications or substances 4
• Use of polyarylsulfone family membranes (polysulfone/polyethersulfone) 1
• Cross-reactivity between different dialyzers containing similar membrane materials (approximately 85% cross-reactivity) 1
• Possible interaction between AN69 membrane and angiotensin-converting enzyme inhibitors 2
• Possible sensitization to ethylene oxide sterilization 2
• Dialysate contamination 2

Laboratory Findings

• Leukopenia 2
• Thrombocytopenia 2
• Oxygen desaturation on pulse oximetry 2

Progression and Severity

• Reactions may increase in severity with repeated exposures 4
• Can progress from mild symptoms to life-threatening anaphylaxis 4
• In severe cases, can lead to cardiorespiratory arrest and death 3, 4

Clinical Pitfalls and Caveats

1. Reactions can be misdiagnosed as other conditions (heart failure exacerbation, respiratory infection)
2. Symptoms may occur even after multiple uneventful dialysis sessions with the same dialyzer 5
3. Trial-and-error testing with similar membrane types is potentially dangerous due to high cross-reactivity 1
4. Patients with a history of dialyzer reactions should not be rechallenged with similar membrane materials 1
5. Reactions can occur with both continuous renal replacement therapy and intermittent hemodialysis 3

Management Considerations

For patients who experience dialyzer reactions:

• Switch to a non-polyarylsulfone dialyzer (substituted cellulose, polymethylmethacrylate, or polyacrylonitrile) 1
• Avoid trial-and-error testing with similar membrane materials 1
• Document the reaction in the patient's medical record to prevent reexposure 3
• Consider reporting the reaction to appropriate authorities 3

By recognizing the signs and symptoms of dialyzer reactions promptly, healthcare providers can intervene quickly to prevent progression to severe, life-threatening reactions and adjust dialysis prescriptions appropriately to prevent recurrence.