Hypersensitivity to acetate dialysate: report of a case

Acetate dialysate is currently the most widely used in hemodialysis. The adverse effect of acetate during hemodialysis is well known upon the cardiovascular system. However, hypersensitivity reactions related to acetate during dialysis therapy are rare. We report a patient who developed hypersensitivity reactions such as generalized skin itching, flushing, hypotension and shortness of breath within a few minutes of beginning hemodialysis with acetate dialysate. Changing dialyzer membranes failed to alleviate these symptoms. Using the same dialyzer and tubing, these reactions disappeared immediately when bicarbonate dialysate was substituted for acetate dialysate. The patient's serum IgE and total eosinophile counts were normal. We conclude that acetate may initiate hypersensitivity reactions during hemodialysis. The exact mechanism is still unclear.