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      Treatment of severe dialysis reactions with the AN69-ST membrane: biocompatibility does matter

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          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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          Most cited references 9

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          New insights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding.

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            Activation of complement by hemodialysis membranes: polyacrylonitrile binds more C3a than cuprophan.

            Conventionally, complement activation by hemodialysis membranes has been determined by measuring fluid phase C3a. Based on such measurements, polyacrylonitrile (PAN) membranes have been classified as weak activators compared to cuprophan. Previous studies have demonstrated, however, that PAN adsorb fluid phase C3a. Based on that observation, we hypothesized that complement activation by PAN might be artifactually underestimated if relatively large amounts of C3a remained membrane bound. In the present study, a method that allows the simultaneous quantification of both fluid phase and membrane bound C3a was used to assess complement activation by PAN and cuprophan. Pieces of membrane were incubated with C3-depleted serum that had been repleted with radiolabeled C3. Subsequently, the supernates and membranes were subjected to SDS-PAGE, and complement activation was quantified by determining the radioactivity of the C3a bands in the gel. The results showed that while the serum exposed to cuprophan membranes contained almost five times more C3a than that exposed to PAN, approximately 80 times more C3a was bound to the PAN membranes. Consequently, the total amount of C3a generated in the presence of PAN was higher than that generated in the presence of cuprophan. We conclude that assessment of complement activation by hemodialysis membranes using fluid phase C3a measurements alone may be misleading.
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              First-use reactions during hemodialysis: a definition of subtypes.

              We believe that it is worthwhile to separate out two distinct types of first-use reactions: a hypersensitivity type (type A) characterized by anaphylactic signs and symptoms and a non-specific type (type B) characterized primarily by chest pain and back pain. Further research is needed to better define the etiology, the epidemiology, and the pathogenesis of these two subgroups of the first-use syndrome.
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                Author and article information

                Journal
                NDT Plus
                NDT Plus
                ckj
                ndtplus
                NDT Plus
                Oxford University Press
                1753-0784
                1753-0792
                June 2010
                28 February 2010
                28 February 2010
                : 3
                : 3
                : 298-299
                Affiliations
                [1 ]Nephrology Research and Development Unit, Faculty of Medicine, University of Porto , Hospital de S. João EPE, Porto, Portugal
                [2 ]Institute of Pharmacology and Therapeutics , Faculty of Medicine, University of Porto , Porto, Portugal
                [3 ]Imunoalergology Department, Hospital S. João EPE , Porto, Portugal
                Author notes
                Luís Coentrão; E-mail: coentrao@ 123456med.up.pt
                Article
                sfq005
                10.1093/ndtplus/sfq005
                5477941
                © The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Categories
                Case Report

                Nephrology

                biocompatibility, dialysis reactions, surface-treated an69

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