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      Reactions to Synthetic Membranes Dialyzers: Is there an Increase in Incidence?


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          Background: Reactions to dialyzers used in dialysis have been reported more frequently in recent years. Evidence, however, shows that the reaction rate has remained stable for years. Summary: One explanation for the apparent increase in publication frequency could be the lack of knowledge that dialyzer reactions may well occur with biocompatible membranes. Studies showed that the cause of these reactions is very diverse and varied, involving multiple materials. However, polyvinylpyrrolidone continues to be the main suspect, but without conclusive results. There are no differences between the different fibers, and although polysulfone is the most described, it is also the most used. Key Messages: The change to cellulose triacetate continues to be the most appropriate form of treatment. The classification of these reactions into type A and B complicates the diagnosis, and its true usefulness is in doubt.

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          Most cited references28

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          Haemodialysis-associated anaphylactic and anaphylactoid reactions.

          Anaphylactic and anaphylactoid reactions related to haemodialysis have been increasingly described for almost 3 decades. The majority of these cases used to occur with ethylene oxide sterilized, and complement-activating cellulose membranes. However, a considerable number of publications have focused on polyacrylonitrile AN69 high flux membranes, angiotensin converting enzyme inhibitors and iron as other important causes of potentially severe haemodialysis-related anaphylactoid reactions. Clinical manifestations vary considerably and generally do not allow differentiation between IgE-mediated anaphylaxis and anaphylactoid reactions (e.g. from nonspecific mediator release). Successful management of these patients requires multidisciplinary approach and involves prompt recognition and treatment by the attending physician, and identification of the offending agent(s) with subsequent avoidance of the incriminated compound(s). This review focuses on some major causes of anaphylactoid and anaphylactic reactions during haemodialysis. Special consideration is given to the therapeutic and diagnostic approach.
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            Anaphylactoid reactions during hemodialysis on AN69 membranes in patients receiving ACE inhibitors.

            We report five life-threatening anaphylactoid reactions occurring within the very first minutes of hemodialysis on polyacrylonitrile (AN69) capillary dialyzers in three patients receiving ACE inhibitors. Such reactions were not observed either in patients treated with ACE inhibitors but dialyzed on other membranes (N = 9), nor in patients on AN69 who did not receive ACE inhibitors (N = 19). These anaphylactoid reactions could be due to bradykinin accumulation, as a result of both increased synthesis--by interaction of blood with the AN69 polymer--and catabolism blockade by ACE inhibitors.
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              Anaphylactic reaction induced by a polysulfone/polyvinylpyrrolidone membrane in the 10th session of hemodialysis with the same dialyzer


                Author and article information

                Kidney Blood Press Res
                Kidney and Blood Pressure Research
                S. Karger AG
                November 2019
                10 September 2019
                : 44
                : 5
                : 907-914
                [_a] aDepartment of Nephrology, Hospital Infanta Leonor, Madrid, Spain
                [_b] bDepartment of Nephrology, IIS-Fundación Jiménez Díaz, UAM/FJD, Madrid, Spain
                [_c] cCIBERDEM, Madrid, Spain
                [_d] dREDINREN, Madrid, Spain
                Author notes
                *Sebastian Mas Fontao, Department of Vascular, Renal and Diabetes Research Laboratory, Instituto de Investigación Sanitaria Fundacion Jimenez Diaz, University/Hospital Universidad Autonoma de Madrid, Av. Reyes Católicos 2, ES–28040 Madrid (Spain), E-Mail smas@fjd.es
                501035 Kidney Blood Press Res 2019;44:907–914
                © 2019 The Author(s) Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 18 March 2019
                : 18 May 2019
                Page count
                Figures: 2, Tables: 3, Pages: 8
                Review Article

                Cardiovascular Medicine,Nephrology
                Allergy,Hemodialysis,Synthetic membranes,Hypersensibility
                Cardiovascular Medicine, Nephrology
                Allergy, Hemodialysis, Synthetic membranes, Hypersensibility


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