Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Reactions to the hemodialysis membrane

Alessandro Bellucci, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Dialyzer reactions refer to all of the abnormal sequelae resulting from the interaction between blood constituents and the hemodialysis membrane. There are two types of reactions: type A and type B [1]. In the past, these reactions were grouped under the term "first-use syndrome" because they primarily occurred with new dialyzers. Before discussing the characteristics of these disorders, it is helpful to review the different types of dialyzers since they can affect the frequency and type of reaction seen. The longer-term clinical consequences of exposure to dialysis membranes are discussed separately. (See "Clinical consequences of hemodialysis membrane biocompatibility".)


There are four types of membranes currently used to manufacture dialyzers [2]:

Cellulose, also called cuprophan (or cuprophane), is a polysaccharide-based membrane obtained from pressed cotton. It is composed of chains of glucosan rings with abundant free hydroxyl groups.

Substituted cellulose membranes are obtained by chemical bonding of a material to the free hydroxyl groups at the surface of the cellulose polymer. The most common type is cellulose acetate, in which acetate replaces 80 percent of the hydroxyl groups.

Cellulosynthetic membranes are modified by the addition of a synthetic material (such as diethylaminoethyl in the production of Hemophane) to liquefied cellulose during its formation.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Daugirdas JT, Ing TS. First-use reactions during hemodialysis: a definition of subtypes. Kidney Int Suppl 1988; 24:S37.
  2. Bouré T, Vanholder R. Which dialyser membrane to choose? Nephrol Dial Transplant 2004; 19:293.
  3. Lemke HD, Heidland A, Schaefer RM. Hypersensitivity reactions during haemodialysis: role of complement fragments and ethylene oxide antibodies. Nephrol Dial Transplant 1990; 5:264.
  4. Röckel A, Klinke B, Hertel J, et al. Allergy to dialysis materials. Nephrol Dial Transplant 1989; 4:646.
  5. Hertel J, Kimmel PL, Phillips TM, Bosch JP. Eosinophilia and cellular cytokine responsiveness in hemodialysis patients. J Am Soc Nephrol 1992; 3:1244.
  6. Parnes EL, Shapiro WB. Anaphylactoid reactions in hemodialysis patients treated with the AN69 dialyzer. Kidney Int 1991; 40:1148.
  7. Brunet P, Jaber K, Berland Y, Baz M. Anaphylactoid reactions during hemodialysis and hemofiltration: role of associating AN69 membrane and angiotensin I-converting enzyme inhibitors. Am J Kidney Dis 1992; 19:444.
  8. Simon P, Potier J, Thebaud HE. [Risk factors for acute hypersensitivity reactions in hemodialysis]. Nephrologie 1996; 17:163.
  9. Schulman G, Hakim R, Arias R, et al. Bradykinin generation by dialysis membranes: possible role in anaphylactic reaction. J Am Soc Nephrol 1993; 3:1563.
  10. Verresen L, Fink E, Lemke HD, Vanrenterghem Y. Bradykinin is a mediator of anaphylactoid reactions during hemodialysis with AN69 membranes. Kidney Int 1994; 45:1497.
  11. Kuwahara T, Markert M, Wauters JP. Biocompatibility aspects of dialyzer reprocessing: a comparison of 3 re-use methods and 3 membranes. Clin Nephrol 1989; 32:139.
  12. Brophy PD, Mottes TA, Kudelka TL, et al. AN-69 membrane reactions are pH-dependent and preventable. Am J Kidney Dis 2001; 38:173.
  13. Lacour F, Maheut H. [AN 69 membrane and conversion enzyme inhibitors: prevention of anaphylactic shock by alkaline rinsing?]. Nephrologie 1992; 13:135.
  14. Thomas M, Valette P, Mausset AL, Déjardin P. High molecular weight kininogen adsorption on hemodialysis membranes: influence of pH and relationship with contact phase activation of blood plasma. influence of pre-treatment with poly(ethyleneimine). Int J Artif Organs 2000; 23:20.
  15. Maheut H, Lacour F. Using AN69 ST membrane: a dialysis centre experience. Nephrol Dial Transplant 2001; 16:1519.
  16. Pegues DA, Beck-Sague CM, Woollen SW, et al. Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. Kidney Int 1992; 42:1232.
  17. John B, Anijeet HK, Ahmad R. Anaphylactic reaction during haemodialysis on AN69 membrane in a patient receiving angiotensin II receptor antagonist. Nephrol Dial Transplant 2001; 16:1955.
  18. Krieter DH, Canaud B. Anaphylactic reaction during haemodialysis on AN69 membrane in a patient receiving angiotensin II receptor antagonist. Nephrol Dial Transplant 2002; 17:943.
  19. Centers for Disease Control (CDC). Update: acute allergic reactions associated with reprocessed hemodialyzers--United States, 1989-1990. MMWR Morb Mortal Wkly Rep 1991; 40:147, 153.
  20. Maurice F, Rivory JP, Larsson PH, et al. Anaphylactic shock caused by formaldehyde in a patient undergoing long-term hemodialysis. J Allergy Clin Immunol 1986; 77:594.
  21. Spartà G, Kemper MJ, Gerber AC, et al. Latex allergy in children with urological malformation and chronic renal failure. J Urol 2004; 171:1647.
  22. Heegard KD, Tilley MA, Stewart IJ, et al. Anaphylactoid reaction during first hemofiltration
with a PUREMA polysulfone membrane. Int J Artif Organs 2013; 36:363.
  23. Craddock PR, Fehr J, Dalmasso AP, et al. Hemodialysis leukopenia. Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 1977; 59:879.
  24. Hakim RM, Breillatt J, Lazarus JM, Port FK. Complement activation and hypersensitivity reactions to dialysis membranes. N Engl J Med 1984; 311:878.
  25. Chenoweth DE. Complement activation during hemodialysis: clinical observations, proposed mechanisms, and theoretical implications. Artif Organs 1984; 8:281.
  26. Chenoweth DE, Cheung AK, Henderson LW. Anaphylatoxin formation during hemodialysis: effects of different dialyzer membranes. Kidney Int 1983; 24:764.
  27. Tabor B, Geissler B, Odell R, et al. Dialysis neutropenia: the role of the cytoskeleton. Kidney Int 1998; 53:783.
  28. Chenoweth DE, Henderson LW. Complement activation during hemodialysis: laboratory evaluation of hemodialyzers. Artif Organs 1987; 11:155.
  29. Bell JL, Henderson LW. Anaphylatoxin mass generated by cuprophane membranes is not influenced by blood flow rate. Kidney Int 1989; 35:240.
  30. Deppish R, Eberhard R, et al. Biocompatibility — Perspectives in 1993. Kidney Int 1994; 45:77.
  31. Dinarello CA. Cytokines: agents provocateurs in hemodialysis? Kidney Int 1992; 41:683.
  32. Hutter JC, Kuehnert MJ, Wallis RR, et al. Acute onset of decreased vision and hearing traced to hemodialysis treatment with aged dialyzers. JAMA 2000; 283:2128.
  33. Bellucci A. Shortness of breath and abdominal pain within minutes of starting hemodialysis. Semin Dial 2004; 17:417.