acetylcellulose and Anaphylaxis

The effect of different dialysis modes on kinin kinetics was studied in seven stable haemodialysis patients treated with AN69 dialysers and ACE inhibitors (ACEI). AN69 haemodiafiltration with calcium-enriched substitution (HDF), AN69 haemodialysis with 1.75 (HD 1.75) and 1.50 (HD 1.50) mmol/l dialysate calcium, AN69 haemodialysis with 1.25 mmol/l dialysate calcium and substitution of 2.25 mmol/h calcium (HD+Ca), and cellulose acetate haemodiafiltration (CA HDF) were compared. Dialysis was uneventful in all patients. During dialysis, serum calcium, sodium, pH, albumin, and bradykinin were measured at the start and after 5 min at arterial, venous, and postinfusion side of the extracorporeal circuit. Serum predialysis bradykinin was 107 +/- 18fmol/ml (mean +/- SEM) in patients on HDF, 61 +/- 9 fmol/ml in patients on HD 1.50, 49 +/- 13 fmol/ml in patients on HD 1.75, 35 +/- 3 fmol/l in patients on HD+Ca, and 75 +/- 27 fmol/ml in CA HDF. No significant change of mean bradykinin levels occurred after 5 min at the arterial and venous side of the dialyser or postinfusion. Individual high bradykinin levels, up to 2672 fmol/ml, were observed but without clinical consequences, suggesting that the threshold value is difficult to determine. No significant correlations were evidenced between bradykinin levels and any of the biochemical measurements. The present data show an intraindividual variability of the bradykinin levels with variation coefficients ranging from 0.386 to 2.783. The present study illustrates that haemodialysis and haemodiafiltration with AN69 in ACEI-treated patients, under the present conditions, does not result in anaphylactoid reactions or in a clinically significant release of bradykinin.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acrylic Resins; Acrylonitrile; Adult; Aged; Anaphylaxis; Angiotensin-Converting Enzyme Inhibitors; Bradykinin; Calcium; Cellulose; Female; Hemodiafiltration; Hemodialysis Solutions; Humans; Kidneys, Artificial; Kinetics; Male; Membranes, Artificial; Middle Aged; Renal Dialysis

To evaluate membrane biocompatibility, an open loop ex vivo model was designed simulating the hemodialysis procedure. Blood was withdrawn continuously from healthy nonuremic donors, heparinized, and pumped through a module containing the membrane to be studied. C3a generation in the module was determined at various time points comparing the cuprammonium cellulose (CC) membrane and four types of modified cellulose (MC) membrane, each with a different degree of hydroxyl (OH-) group substitution. In other studies, C3a generation in the ex vivo mode was compared with that during in vivo dialysis. In the ex vivo model, C3a generation with MC membranes was reduced by 70% compared with CC. However, within the MC group, the degree of C3a generation did not correlate with the degree of OH-group substitution. In vivo studies confirmed the reduced degree of C3a generation with the MC membrane compared with CC. Additionally, validation studies using the CC membrane showed excellent agreement between C3a generation during ex vivo perfusion and in vivo dialysis. The results suggest that a group of new MC membranes causes substantially less complement activation than the CC membrane but that the degree of complement activation with various subtypes of MC membranes is not related to the degree of OH-group substitution.

Topics: Anaphylaxis; Biocompatible Materials; Cellulose; Complement Activation; Complement C3; Complement C3a; Humans; Kidneys, Artificial; Membranes, Artificial; Models, Structural; Renal Dialysis

A laboratory method that facilitates delineation of the complement-activating characteristics of various dialyzers under defined conditions has been developed. Results obtained by circulating reconstituted human serum through these devices and measuring time-dependent production of both C3a and C5a antigens are entirely consistent with previous clinical observations. For example, the complement-activating potential of dialyzer membranes could be described as high (cuprammonium cellulose), moderate (cellulose acetate), or low (polycarbonate or polyacrylonitrile). Furthermore, these techniques provided the opportunity to identify membrane characteristics that are not readily defined by clinical studies alone. Specifically, membranes that transported and absorbed C5a antigen were readily identified by these methods. Additionally, laboratory evaluation provided the unique ability to define the efficiency of complement activation taking place on the membrane surface. Results of these investigations are compatible with a hypothetical model that not only describes the properties of a typical dialyzer membrane but may be generally applicable to other biomaterials as well.

Topics: Acrylic Resins; Anaphylaxis; Antigens; Cellulose; Complement Activation; Complement C3; Complement C3a; Complement C5; Complement C5a; Humans; Kidneys, Artificial; Membranes, Artificial; Models, Structural; Polycarboxylate Cement; Renal Dialysis; Zymosan

Topics: Acetates; Adult; Anaphylaxis; Cellulose; Female; Humans; Kidney Failure, Chronic; Membranes, Artificial; Renal Dialysis

Iterative hemodialysis causes only exceptionally anaphylactic reactions. In those cases it has been possible to incriminate sterilizing agents (ethylene oxide, formaldehyde) and in a few cases the membrane. We report the case of one patient suffering from a chronic renal failure who had been undergoing hemodialysis treatment for more than six years in whom we noticed anaphylactic reactions at the beginning of each dialysis session carried on with cuprophan. We were able to use three different types of dialysis membranes: cuprophan, polyacrylonitrile and cellulose acetate, and two means of sterilization: ethylene oxide and gamma rays. The disorders we observed do not seem to be related to the phenomena usually observed during hemodialysis. The clinical signs linked with hypereosinophilia (13,000/mm3), hyperbasophilia (140/mm3) and an increase in total serum IgE disappeared when cuprophan membrane was replaced by cellulose acetate. One year later, hypereosinophilia had disappeared, hyperbasophilia had subsided, total IgE remained high. We conclude that IgE dependent anaphylaxis might be due to one component of the cuprophan membrane.

Topics: Adult; Anaphylaxis; Basophils; Cellulose; Eosinophilia; Eosinophils; Humans; Immunoglobulin E; Leukocyte Count; Male; Membranes, Artificial; Renal Dialysis