title: Eluted substances from hemodialysis membranes elicit positive skin prick tests in bioincompatible patients.
abstract: Recently, hypotension and malaise during hemodialysis using polysulfone (PS) membranes have been reported. This study aimed to evaluate the bioincompatibility of eluted substances from PS hemodialysis membranes that can induce hypotension, malaise, and anaphylactic shock. Polyvinylpyrrolidone (PVP) elution from five hemodialysis membranes was measured in an in vitro experimental circulation. Skin prick tests (SPTs) with PVP or the priming fluid of hemodialysis membranes were carried out for seven PS membrane-incompatible patients and seven healthy volunteers. Skin reactivity for histamine was compared in patients and healthy volunteers. The symptoms of PS membrane-incompatible cases were hypotension, dyspnea, nausea, or vomiting. One patient had gone into shock. PVP was eluted from hemodialysis membranes, but the SPT for PVP was negative in all patients. SPTs with priming fluid (or priming fluid effluxed during priming) were positive in four out of six patients. However, the SPT with bisphenol A was positive in one patient. The area of the flare reaction against histamine in patients was smaller than that of healthy subjects. In conclusion, eluted substances apart from PVP from hemodialysis membranes could cause bioincompatibility with PS membranes.
authors.affiliation: Division of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Clinical Engineering, Hattori Hospital, Miki, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Konishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukunaga
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamashita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miyata
authors.forename: Makoto
authors.initials: M
authors.lastname: Usami
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced; D001559:Benzhydryl Compounds / Q000009:adverse effects* / Q000032:analysis; D001672:Biocompatible Materials; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007428:Intradermal Tests; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010636:Phenols / Q000009:adverse effects* / Q000032:analysis; D011108:Polymers; D011205:Povidone / Q000009:adverse effects* / Q000032:analysis; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D012307:Risk Factors; D012769:Shock / Q000139:chemically induced; D012995:Solubility; D013450:Sulfones; D013997:Time Factors; D055815:Young Adult; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D001672:Biocompatible Materials; D008567:Membranes, Artificial; D010636:Phenols; D011108:Polymers; D011205:Povidone; D013450:Sulfones; C017662:polysulfone P 1700; C006780:bisphenol A; D000098826:Bisphenol A Compounds
keywords: Hemodialysis; Hemodialysis membrane; Polymethyl methacrylate; Polysulfone; Polyvinylpyrrolidone; Priming fluid; Skin prick test