pH of the washing solutions for dialysis filters and generation of vasodilatory mediators (bradykinin and nitric oxide): Role in first use syndrome
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:231A 1997
Anaphylactoid reaction with first use of a dialyzer is termed the "first use syndrome." This syndrome may result from hypersensitivity to ethylene oxide used for dialyzer sterilization or may result from generation of vasodilatory factors produced by the blood dialyzer interaction.
The authors of the present study evaluated the effect of the pH of the solution used to wash the filters on subsequent generation of bradykinin and nitric oxide when these dialyzers came in contact with blood from nine patients with end-stage disease. Polysulfone, tri-acetate, and AN-69 membranes were studied after they had been flushed with phosphate buffer at pH 7 or pH 8 for 10 minutes at 5 ml/min. AN-69 membranes flushed with phosphate buffer at ph 7 lead to significant activation of bradykinin (3768 ± 5159 versus 26 ± 0.05 pg/ml for pH 8 solution). Nitric oxide generation was not influenced by dialyzer type, but was higher with buffer at pH 7 versus pH 8.
Comment: Use of ACE inhibitors have been associated with severe reactions in patients exposed to AN-69 membranes. The data presented in this study show convincingly higher bradykinin generation with a flushing solution of a lower pH. However, whether this would have necessarily translate to a clinical syndrome is difficult to judge. Individual host factors, such as the ability to catabolize bradykinin and to mount compensatory adaptations such as increase in heart rate and effective venoconstriction, must account for the relative heterogeneity and rarity of the full blown syndrome in the dialysis population at large. Nevertheless, this study should lead to a closer look at the pH of solutions used for flushing dialyzers. (Shahab Arfeen, M.D., Valparaiso, IN)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Complications (acute)