**2.6 Dialysis reaction**

Interaction between patients' blood and dialyzer can lead to various adverse reactions [16].

The common dialyzer reactions include:

## *2.6.1 Type A dialyzer reaction*

It was attributed to dialyzer sterilant ethylene oxide, which is rarely used now, and now it is recommended that dialyzers that are validated for re-use should be approved for re-use. The sterilization should be as per the manufacturer's guidance by heat sterilization, gamma radiation or chemicals like formaldehyde, sodium hypochlorite or peracetic acid.

Symptoms usually develop early between 5 and 20 minutes after start of dialysis and include burning throughout the body and access site, dyspnea, chest tightness and angioedema.

Other symptoms like rhinorrhea, lacrimation, cough, pruritis, nausea and vomiting could also be seen.

Management includes cessation of dialysis, drugs like hydrocortisone, antihistamine and epinephrine with or without respiratory support.

Preventive measures include substituting ethylene oxide, biocompatible membranes and discontinuing reprocessing procedures.

#### *2.6.2 Type B dialyzer reaction*

It occurs between 20 and 40 minutes after initiation of dialysis.

The cause is attributed to complement activation.

Symptoms include: chest pain and back pain, which subsided with continuation of dialysis.

Preventive measures include automated cleansing of dialyzer and use of noncellulose dialyzer.

#### *2.6.3 Febrile reactions*

It can be due to infection of microbial contamination of the dialysis apparatus. Treatment: first asses the hemodynamic stability of patient, if the patient is

hypotensive administer i.v fluid, cease the UF, discontinue dialysis, give antipyretic and evaluate the potential cause of infection.

Evaluation of dialysate, water source, vascular access. Identify the potential source of infection and treat.
