Hemodialysis Hypersensitivity and Patient Reactions
Summary
Hypersensitivity reactions during haemodialysis encompass a spectrum of immune-mediated events triggered by contact between blood and extracorporeal materials or sterilants. Although relatively uncommon, these reactions can range from mild cutaneous flushing and pruritus to life-threatening anaphylaxis, intradialytic hypotension, bronchospasm and chest pain. Key causative agents include residual ethylene oxide used in sterilisation, eluted membrane additives such as polyvinylpyrrolidone, and complement activation by synthetic polymers. Underlying mechanisms involve IgE-mediated responses, mast cell degranulation and complement activation-related pseudo-allergy. Pre-existing eosinophilia or sensitisation can predispose individuals to severe reactions at first use or upon re-exposure. Recognition and timely management are essential to prevent morbidity and ensure continuity of renal replacement therapy. Advances in membrane biocompatibility, sterilisation methods and pre-treatment protocols have reduced but not eliminated the risk. A global appraisal of recent clinical observations underscores the need for vigilance, standardised reporting and tailored interventions to mitigate these potentially fatal events.
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Hemodialysis Hypersensitivity and Patient Reactions publication trend
The graph below shows the total number of articles in hemodialysis hypersensitivity and patient reactions across all publications each year (not limited to Nature Index journals).
Technical terms
Haemodialysis: Renal replacement technique in which blood is cleansed extracorporeally through a semipermeable membrane.
Hypersensitivity: Exaggerated immune reaction to an otherwise harmless antigen, often involving specific antibodies or complement.
Anaphylaxis: Rapid onset, severe systemic allergic reaction characterised by hypotension, bronchospasm and urticaria.
IgE-mediated reaction: Immune response driven by immunoglobulin E antibodies binding to allergens and triggering mast cell degranulation.
CARPA: Complement activation-related pseudo-allergy, a non-IgE hypersensitivity resulting from direct complement activation by foreign surfaces.
Polysulfone: Synthetic polymer commonly used in dialyser membranes for its mechanical strength and solute permeability.
Polyvinylpyrrolidone (PVP): Hydrophilic polymer coating on dialyser membranes that may elute under certain sterilisation processes.
Extracorporeal circuit (ECC): The complete assembly of tubing, dialyser and pumps through which blood circulates outside the patient during haemodialysis.
References
- Anaphylaxis From Ethylene Oxide–Sterilized Dialysis Tubing and Needles: A Case Report. American Journal of Kidney Diseases (2023).
- Problems in the evaluation of polyvinylpyrrolidone (PVP) elution from polysulfone membrane dialyzers sterilized by gamma-ray irradiation. Renal Replacement Therapy (2016).
- Complement-mediated dialysis reaction during regular hemodialysis treatment: a case report. Journal of Medical Case Reports (2024).
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