RISK-FACTORS FOR ACUTE HYPERSENSITIVITY R EACTIONS IN HEMODIALYSIS - A 6-MONTH PROSPECTIVE MULTICENTRIC STUDY IN THE WEST PART OF FRANCE

The aim of this prospective study was to evaluate the prevalence of an aphylactoid reactions (AR) in patients dialysed with cellulose or synt hetic membranes and the possible link with ACE inhibitors. Survey was conducted for six months (Jan, 1 to July 1 1993). Thirty dialysis unit s treating 1573 patients (899 M and 674 F) were participating to the s tudy. At the end of the period under study, only 1536 patients were in cluded in the analysis, Prevalence of AR was calculated from 122 694 h emodialysis sessions. Thirty-three AR in 21 patients (1.3%) (8 M, 13 F ), of which 8 severe AR in 5 patients (0.25%) were observed. Annual in cidence of AR was 0.17 per 1000 sessions with cellulose membranes and 4.2 per 1000 sessions with synthetic membranes. Relative risk of the o ccurrence of AR was 10 to 20 times higher with synthetic membranes tha n cellulose membranes, and 3 to 4 times higher in patient treated with ACE inhibitors than in those no treated. Prevalence of AR with AN69 m embrane (3.2%) was not significatively different from that with other synthetic membranes (1.6%). However, treat ment with ACE inhibitors in creased strongly the risk of AR in AN69 patients (7.2%) in comparison to patients treated with other synthetic membranes (1.6%) (<0.1). Prev alence of severe AR was 0.25% in total dialysed population, 0.5% in pa tient treated with synthetic membranes, 1.1% in AN69 patient and 4.9% in AN69 patients treated with ACE inhibitors. Relative risk of AR is a t least 20 times higher in dialysed patients with ACE inhibitors (1.7% ) than other dialysed patient without ACE inhibitors (0%). Seventy-two percent oi AR occurred in 2/30 dialysis units, thus demonstrating the role of a ''unit effect''. That suggest the role of a ''third factor' ' in the occurrence of AR.