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Hypersensitivity reactions to bicarbonate dialysate containing acetate: a case report with literature review

2020; Springer Science+Business Media; Volume: 9; Issue: 3 Linguagem: Inglês

10.1007/s13730-020-00466-w

2192-4449

Yoko Nishiuchi, Hisato Shima, Yoshio Fukata, Tomohiro Tao, Takuya Okamoto, Norimichi Takamatsu, Kazuyoshi Okada, Jun Minakuchi,

Food Allergy and Anaphylaxis Research

Although hemodialysis-hypersensitivity reactions have various causes, only a few cases of hypersensitivity to acetate dialysate accompanied by fever have been reported. We present the case of a 69-year-old hemodialysis patient who was admitted due to fever after dialysis. He had undergone online hemodiafiltration using acetate-free citrate-containing dialysate. After admission, we switched to acetate-containing bicarbonate dialysate. He was diagnosed with pneumonia and treated with ceftriaxone. However, fever that occurred post dialysis persisted, displaying a gradual elevation in CRP level and eosinophils (up to 9.7 mg/dL and 3774 cells/μL, respectively). After a series of negative workups for infection and dialysis membrane allergy, we suspected that acetate-containing bicarbonate dialysate to be the cause of the allergic reaction and switched to acetate-free bicarbonate dialysate. Consequently, eosinophil count decreased and the fever abated. The drug-induced lymphocyte stimulation test finding (for acetate dialysate) was positive, and he was diagnosed with acetate dialysate-induced hypersensitivity reactions. The condition was not detected earlier due to the complications associated with pneumonia.