Nephrol Dial Transplant (2000) 15: 1288-1290
© 2000 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Importance of the bradykinin–nitric oxide synthase system in the hypersensitivity reactions of chronic haemodialysis patients
Nephrology, Dialysis and Transplantation Department, Regina Margherita Hospital, Torino, Italy
Keywords: AN69; bioincompatibility; bradykinin; filter rinsing solutions; hypersensitivity reactions; nitric oxide
Incidence of hypersensitivity reactions
The syndrome of hypersensitivity reactions (HSRs) occurs within the first 20 min of the haemodialysis (HD) session, with protean presentation and variable clinical expression ranging from mild to life-threatening symptoms, including nausea, faintness, itching, flushing, swelling of tongue or throat, wheezing or bronchospasm, hypotension and in most severe cases, irreversible shock.
Its impact on patients is likely to be underestimated. The frequency of severe episodes was reported in 1982 to be rather low (0.3/1000 patients/year with flat sheet dialysers) [1] but it has been recently estimated in a US survey to involve 1000 patients/year [2], highlighting this syndrome's unpredictability of appearance and severity.
An analysis of the factors that might increase the risk of HSR is necessary for appropriate prevention.
Enhancing factors and pathophysiology of HSRs
Attention has been focused on several possible enhancing factors, including ethylene oxide (Eto) residues, bacterial lipopolysaccharide fragments and dialysis capillary geometry. The overlap of the clinical
Modulation of enhancing factors
Possible attempts to avoid HSRs
Conclusions
Notes
References
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