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Updated: Mar 2, 2026

Direct Detection of the Acetate-forming Activity of the Enzyme Acetate Kinase
Published on: December 19, 2011
Hypersensitivity reactions to acetate in the bicarbonate dialysate in a patient undergoing pre-dilution online
Akihiko Kato1, Takako Takita2, Mitsuyoshi Furuhashi2
1Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. a.kato@hama-med.ac.jp.
Abstract:
A 63-year-old male patient first experienced recurrent hypotensive episode during the dialysis session just after switching the mode from hemodialysis to online hemodiafiltration (OL-HDF) with infusion in pre-dilution of the bicarbonate dialysate containing 9.2 mEq/L of acetate. Peripheral eosinophil count and serum IgE were both elevated to 16,440/μL and 2000 IU/L. The reactions promptly dissolved with substitution of acetate-free solution. This case illustrated that pre-dilution OL-HDF can induce an occult hypersensitivity to acetate in the standard bicarbonate dialysate.
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