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Hypersensitivity reactions in patients receiving hemodialysis
Lavjay Butani1, Gianfranco Calogiuri2
1University of California Davis Medical Center, Sacramento, California.
Summary
Hypersensitivity reactions in hemodialysis patients are often caused by medications like iron and erythropoietin. Identifying the cause is crucial for prevention and managing these potentially severe reactions.
Area of Science:
- Nephrology
- Clinical Immunology
- Pharmacology
Background:
- Hypersensitivity reactions (HSRs) pose a significant risk to patients undergoing maintenance hemodialysis.
- These reactions, though uncommon, can be life-threatening and have substantial implications due to the large end-stage renal disease (ESRD) population.
Purpose of the Study:
- To describe the spectrum and causes of hypersensitivity reactions in patients receiving maintenance hemodialysis.
- To highlight the importance of identifying triggers for preventing recurrence.
Main Methods:
- A comprehensive literature search was conducted using PubMed, focusing on the past 30 years with emphasis on the last decade.
- Included case reports and review articles detailing HSRs in the context of hemodialysis.
Main Results:
- Pharmacologic agents, including iron, erythropoietin, and heparin, are the most common causes of HSRs, leading to anaphylactic or pseudoallergic reactions.
- Topical antibiotics and anesthetics can cause delayed-type hypersensitivity reactions.
- Complement activation and bradykinin formation, particularly with angiotensin-converting enzyme inhibitor use, are implicated in many HSRs.
Conclusions:
- Most hemodialysis-associated HSRs are pseudoallergic, not IgE-mediated.
- Identifying the specific cause of HSRs is challenging due to multiple exposures but essential for preventing recurrence.
- Alternative medications and dialyzer membranes exist to manage HSRs without compromising patient care.
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