Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors

Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. From July 18 through November 27, 1989, 12 anaphylactoid reactions (ARs) occurred in 10 patients at a hemodialysis center in Virginia. One patient required hospitalization; no patients died. ARs occurred...

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Bibliographic Details
Published in:Kidney international 1992-11, Vol.42 (5), p.1232-1237
Main Authors: Pegues, David A., Beck-Sague, Consuelo M., Woollen, Stan W., Greenspan, Bonnie, Burns, Susan M., Bland, Lee A., Arduino, Matthew J., Favero, Martin S., Mackow, Robert C., Jarvis, William R.
Format: Article
Language:English
Subjects:
Ambulatory Care Facilities
Anaphylaxis - epidemiology
Anaphylaxis - etiology
Anaphylaxis - physiopathology
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Biological and medical sciences
Disease Outbreaks
Emergency and intensive care: renal failure. Dialysis management
Epidemiologic Factors
Humans
Intensive care medicine
Kidneys, Artificial - adverse effects
Life Sciences & Biomedicine
Medical sciences
Middle Aged
Risk Factors
Science & Technology
Urology & Nephrology
Virginia - epidemiology
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Summary:Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. From July 18 through November 27, 1989, 12 anaphylactoid reactions (ARs) occurred in 10 patients at a hemodialysis center in Virginia. One patient required hospitalization; no patients died. ARs occurred within minutes of initiating dialysis and were characterized by peripheral numbness and tingling, laryngeal edema or angioedema, facial or generalized sensation of warmth, and/or nausea or vomiting. All 12 ARs occurred with dialyzers that had been reprocessed with an automated reprocessing system. A cohort study, including all patients undergoing dialysis sessions on the six days when an AR occurred, showed that the patients who experienced ARs were significantly more likely than patients who did not to be treated with angiotensin-converting enzyme (ACE) inhibitors (7/10 vs. 3/33; relative risk = 7.9; 95% confidence interval = 2.5 to 25.2) and to have been exposed to reused dialyzers rather than to new dialyzers (12/70 sessions vs. 0/31; P = 0.016). In those sessions using a reused dialyzer, the mean number of dialyzer uses in case-sessions was significantly higher than for noncase-sessions (10.3 vs. 6.2; P = 0.016). After reuse of dialyzers was discontinued at the center, no further ARs occurred, despite the continued administration of ACE inhibitors. This is the first report of an outbreak of ARs associated exclusively with reused dialyzers. We hypothesize that interactions between a dialyzer that has been repeatedly reprocessed and reused, blood, and additional factors, such as ACE inhibitors, increased the risk of developing ARs.
ISSN:0085-2538
1523-1755
DOI:10.1038/ki.1992.409