This may result from the elevated bradykinin levels which may predispose some individuals to hypotension and shock. These AN69 dialyzers tend to be associated with higher bradykinin levels in those patients on ACE inhibitors, compared with other membranes, particulary cellulosic. T he management of patients suspected to have anaphylaxis includes immediate termination of dialysis without return of the patients extracorporeal blood. Saline should be infused. In addition one may administer benadryl 25 - 50 mgm intravenously as well as intravenous sterolds.
Supportive care is critical.
All patients should be observed for several hours or hospitalized if a life threatening reaction has occurred. One must then look for the cause of anaphylaxis and consider serveral options. These include changing to a different artifical membrane, cleaning the artifical kidney with a reuse procedure prior to the initial use, using gamma irradiated dialyzers, stopping ACE inhibitors if present and reviewing the patients medications for other potential allergens. Rinsing and priming procedures may need to be reviewed and the same applies for reuse procedures. C hronic sequelae of dialyzer use have also been described.