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RETRACTED ARTICLE: Anaphylaxis secondary to citric acid allergy in End Stage Renal Disease patient

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This article was retracted on 09 April 2024

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Abstract

Dialysis reactions are not uncommon in End Stage Renal Disease (ESRD) patients who are undergoing in-center hemodialysis. Here we report the first case of anaphylaxis related to citric acid solutions used for dialysis machine disinfection and descaling. The patient developed repeated episodes of anaphylactic reactions during hemodialysis only in the inpatient setting leading to respiratory failure needing intubation and anaphylactic shock. This had failed to resolve despite using various combinations of different dialysis machines and dialyzer membranes and only resolved after the elimination of citric acid from the dialysis circuit. This case highlights the importance of different allergens in dialysis circuits and emphasizes the importance of looking for alternative reasons for dialyzer reactions.

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References

  1. Daugirdas JT, Ing TS. First-use reactions during hemodialysis: a definition of subtypes. Kidney Int Suppl. 1988;24:S37–43.

    CAS  PubMed  Google Scholar 

  2. Hutter JC, Kuehnert MJ, Wallis RR, Lucas AD, Sen S, Jarvis WR. Acute onset of decreased vision and hearing traced to hemodialysis treatment with aged dialyzers. JAMA. 2000;283(16):2128–34. https://doi.org/10.1001/jama.283.16.2128.

    Article  CAS  PubMed  Google Scholar 

  3. Iftikhar H, Jarad G. Anaphylaxis secondary to citric acid allergy in in end stage kidney disease patients. Kidney Int Suppl. 2022;7:S269.

    Article  Google Scholar 

  4. Butani L, Calogiuri G. Hypersensitivity reactions in patients receiving hemodialysis. Ann Allergy Asthma Immunol. 2017;118(6):680–4. https://doi.org/10.1016/j.anai.2017.04.006.

    Article  PubMed  Google Scholar 

  5. Ebo DG, Bosmans JL, Couttenye MM, Stevens WJ. Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy. 2006;61(2):211–20. https://doi.org/10.1111/j.1398-9995.2006.00982.x.

    Article  CAS  PubMed  Google Scholar 

  6. Yang RC, Lindsay RM. Dialyzer reactions in a patient switching from peritoneal dialysis to hemodialysis. Hemodial Int. 2005;9(2):120–6. https://doi.org/10.1111/j.1492-7535.2005.01123.x.

    Article  CAS  PubMed  Google Scholar 

  7. Lemke HD, Heidland A, Schaefer RM. Hypersensitivity reactions during haemodialysis: role of complement fragments and ethylene oxide antibodies. Nephrol Dial Transplant. 1990;5(4):264–9. https://doi.org/10.1093/ndt/5.4.264.

    Article  CAS  PubMed  Google Scholar 

  8. Crane C, Cunard RA, Sweiss N, Scanlon N, Doherty TA, Potok OA. Anaphylaxis from ethylene oxide-sterilized dialysis tubing and needles: a case report. Am J Kidney Dis. 2023. https://doi.org/10.1053/j.ajkd.2022.12.004. (published online ahead of print, 2023 Jan 21).

    Article  PubMed  Google Scholar 

  9. Hertel J, Kimmel PL, Phillips TM, Bosch JP. Eosinophilia and cellular cytokine responsiveness in hemodialysis patients. J Am Soc Nephrol. 1992;3(6):1244–52. https://doi.org/10.1681/ASN.V361244.

    Article  CAS  PubMed  Google Scholar 

  10. Röckel A, Klinke B, Hertel J, et al. Allergy to dialysis materials. Nephrol Dial Transplant. 1989;4(7):646–52.

    PubMed  Google Scholar 

  11. Mukaya JE, Jacobson MS, Esprit D, Ajayi T. Allergic reaction to polysulphone membrane dialyser masquerading as infection. BMJ Case Rep. 2015;2015:bcr2014208591. https://doi.org/10.1136/bcr-2014-208591. (Published 2015 Feb 18).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Craddock PR, Fehr J, Dalmasso AP, Brighan KL, Jacob HS. Hemodialysis leukopenia. Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest. 1977;59(5):879–88. https://doi.org/10.1172/JCI108710.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sakuma K, Uchiumi N, Sato S, et al. Experience of using heat citric acid disinfection method in central dialysis fluid delivery system. J Artif Organs. 2010;13(3):145–50. https://doi.org/10.1007/s10047-010-0505-0.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA

    Hassaan Iftikhar, Maryam Saleem & Frank O’Brien

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  1. Hassaan Iftikhar
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  2. Maryam Saleem
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  3. Frank O’Brien
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Correspondence to Hassaan Iftikhar.

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This article has been retracted. Please see the retraction notice for more detail:https://doi.org/10.1007/s13730-024-00877-z

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Iftikhar, H., Saleem, M. & O’Brien, F. RETRACTED ARTICLE: Anaphylaxis secondary to citric acid allergy in End Stage Renal Disease patient. CEN Case Rep 13, 125–127 (2024). https://doi.org/10.1007/s13730-023-00812-8

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  • DOI: https://doi.org/10.1007/s13730-023-00812-8

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