A case of anaphylactoid reaction to acetate in acetate-containing bicarbonate dialysate

CEN Case Reports
Taro MisakiTaisuke Isozaki

Abstract

A 35-year-old man with end-stage kidney disease due to chronic glomerulonephritis was admitted to our hospital to start maintenance hemodialysis (HD). One hour after starting the first session of HD, he experienced general pruritus, urticaria, and dyspnea. Signs and symptoms were resolved by discontinuing HD and administrating an antihistamine drug; HD-associated anaphylactoid reactions were therefore suspected. Over the next few HD sessions, we changed the dialysis membrane, anticoagulant, HD circuit and needle, in that order, but general pruritus and urticaria again appeared within 3 h after starting each session of HD. Finally, when we changed the dialysate from acetate-containing bicarbonate dialysate to acetate-free bicarbonate dialysate, urticaria was clearly less than that seen in previous HD sessions, and subsided after discontinuation of HD. Subsequently, 20 mg of oral prednisolone (PSL) was administered 1 h before starting HD, and the patient did not experience general pruritus, urticaria, or dyspnea after starting the session. When administered acetate-containing bicarbonate dialysate after oral PSL pretreatment, the patient again experienced general pruritus, urticaria and dyspnea. Few reports have been published on...Continue Reading

References

Jan 1, 1987·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·S M Diamond, W L Henrich
Oct 4, 1984·The New England Journal of Medicine·R M HakimF K Port
Feb 12, 1998·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·U ThollM Anlauf
Feb 22, 2011·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Kazuhiro MatsuyamaJun-ichi Kadota
Oct 7, 2011·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Ken HanadaKenjiro Kimura

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