[Risk factors for acute hypersensitivity reactions in hemodialysis]

The aim of this prospective study was to evaluate the prevalence of anaphylactoid reactions (AR) in patients dialysed with cellulose or synthetic membranes and the possible link with ACE inhibitors. Survey was conducted for six months (Jan, 1 to July, 1 1993). Thirty dialysis units treating 1573 patients (899 M and 674 F) were participating to the study. At the end of the period under study, only 1536 patients were included in the analysis. Prevalence of AR was calculated from 122 694 hemodialysis sessions. Thirty-three AR in 21 patients (1.3%) (8 M, 13 F), of which 8 severe AR in 5 patients (0.25%) were observed. Annual incidence of AR was 0.17 per 1000 sessions with cellulose membranes and 4.2 per 1000 sessions with synthetic membranes. Relative risk of the occurrence of AR was 10 to 20 times higher with synthetic membranes than cellulose membranes, and 3 to 4 times higher in patient treated with ACE inhibitors than in those no treated. Prevalence of AR with AN69 membrane (3.2%) was not significatively different from that with other synthetic membranes (1.6%). However, treatment with ACE inhibitors increased strongly the risk of AR in AN69 patients (7.2%) in comparison to patients treated with other synthetic membranes (1.6%) ( < 0.1). Prevalence of severe AR was 0.25% in total dialysed population, 0.5% in patient treated with synthetic membranes, 1.1% in AN69 patient and 4.9% in AN69 patients treated with ACE inhibitors. Relative risk of AR is at least 20 times higher in dialysed patients with ACE inhibitors (1.7%) than other dialysed patients without ACE inhibitors (0%). Seventy-two percent of AR occurred in 2/30 dialysis units, thus demonstrating the role of a "un effect". That suggest the role of a "third factor" in the occurrence of AR.