Dialyzer Reactions Revisited: A Fresh Perspective

Dialyzer reactions can cause significant morbidity and even mortality. The current convention using time- and symptom-based classification has limited practical utility because of considerable overlap and diverse presentations. Several biomarkers have been described as diagnostic adjuncts, but clinical application remains sparse and inconsistent. There is also little guidance on subsequent management after diagnosis. In this paper, we highlighted the diagnostic complexities and current limitations through 2 clinical cases. We hence proposed a novel, pragmatic clinical and biomarker-guided algorithm using serum tryptase levels to address these. We adopted an acute increase from baseline levels of ≥ 20% + 2 ng/mL (20 + 2 rule) as the diagnostic threshold, demonstrated in one of the cases. Following this, ethylene oxide exposure should first be eradicated, as it remains one of the most common precipitants. If symptoms persist, decisions on dialyzer change should then be guided by clinical severity. In conclusion, there is a dire need for better diagnostic precision and individualized management of dialyzer reactions. Our proposed algorithm can potentially fill this gap but requires validation in larger prospective studies. Future research could further refine the optimal diagnostic threshold and explore risk stratification using a similar clinical-biomarker approach for more precise management.