[Hypersensitivity reactions during hemodialysis. Role of high permeability, retrofiltration and bacterial contamination of the dialysate].

Since the more frequent use of highly permeable membranes and bicarbonate dialysate, hypersensitivity reactions are more often described during hemodialysis and raise the question of the entry of pyrogens from dialysate towards blood due to high permeability of membranes and to possible backfiltration. During dialysis sessions with such membranes, authors observed a severe collapse in a patient on bicarbonate fluid and a repeated Quincke's edema in another on acetate fluid. After exclusion of other causes of such hypersensitivity accidents, they discuss the role of bacterial contamination of dialysis fluid. They analyse the phenomenons of bidirectional high permeability and of backfiltration linked to these new membranes. They recall the different causes of dialysate contamination and give some means of avoiding these inconveniences which expose on one hand to acute severe reactions and on the other are prejudicial in the long term for the patients because of interleukin 1 production.