Dialyzer Reactions

Dialyzer Reactions

Reactions attributed to the hemodialyzer are generally divided into two types:

Type A – anaphylactoid reaction

  • Increased risk in patients with a history of atopy, high IgE levels, eosinophilia and allergic reactions during dialysis1

Type B – mild reaction


Type A reaction

  • Severe and rapid in onset
  • Rare (7.0 per 1000 patient year2)
  • Established by three major criteria or two major and one minor criterion
    • Major criteria3
      • Onset within 20 minutes of starting dialysis
      • Dyspnea
      • Burning/heat sensation at the access site or throughout the body
      • Angioedema
    • Minor criteria
      • Reproducible during subsequent dialysis when using the same type or brand of dialyzer
      • Urticaria
      • Rhinorrhea or lacrimation
      • Abdominal cramping
      • Itching
  • Etiology- Use of ethylene oxide (ETO) for sterilization of dialyzer and polyacrylonitrile membranes (PAN) membranes, especially AN69 in patients on ACE-inhibitors

Type B reaction

  • Primary symptoms are chest and back pain
  • Occurs 20-40 minutes into the dialysis treatment
  • Disappears or lessens dramatically during the subsequent hours of dialysis4
  • Pathogenesis of type B reaction is not clear
    • May be related to complement activation
  • Current data do not support the role of membrane biocompatibility in development of type B reactions5


  • Symptomatic and supportive
  • Discontinue HD and discard the blood, oxygen, anti-histamines, epinephrine and corticosteroids
  • HD can be initiated after stabilization with a more biocompatible membrane and a hemodialyzer not sterilized with ETO (ethylene oxide)6


  • Avoid combination of PAN membrane and angiotensin converting enzyme inhibitor (ACEI) use
  • Use of ARBs (angiotensin receptor blockers) and dialysate with 3.5 mEq/L calcium may lower the risk7


  1. Kraske GK, Shinaberger JH, Klaustermeyer WB. Severe hypersensitivity reaction during hemodialysis. Ann Allergy Asthma Immunol  78: 217-220, 1997
  2. Bright RA, Torrence ME, McMlellan WM. Preliminary survey of the occurrence of anaphylactoid reactions during haemodilaysis. Nephrol Dial Transplant  14:799-800, 1999
  3. Daugirdas JT, Ing TS. First-use reactions during hemodialysis: A definition of subtypes. Kidney Int  33(suppl 24) S37-S43, 1988
  4. Jaber BL, Pereira BJG. Dialysis reactions. Semin Dial  10:158-165, 1997
  5. Locatelli F, Manzoni C. Biocompatibility in haemodialysis: Fact and fiction. Curr Opin Nephrol Hyperten 6:528-532, 1997
  6. Dumler F, Zasuwa G, Levin NW. Effect of dialyzer reprocessing methods on complement activation and hemodialyzer-related symptoms. Artif Organs  11:128-31, 1987
  7. Van der Niepen P, Sennesael JS, Verbeelen DL. Prevention of anaphylactoid reactions to high flux membrane dialysis and ACE inhibitors by calcium. Nephrol Dial Transplant 9:87-89, 1994