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Dialyser-Related Pruritus ETO Allergy — ESENeph MCQ

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ModerateHaemodialysisDialyser-Related Pruritus ETO AllergyESENeph

A 55-year-old man on haemodialysis develops pruritus that worsens during dialysis sessions. He notices it is worse with a new batch of dialysers. What dialysis-specific cause should be investigated?

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Correct answer: E — Consider dialyser biocompatibility reaction or allergy to sterilant (ethylene oxide) used in dialyser manufacturing – switching to a steam-sterilised or gamma-irradiated dialyser may resolve the symptoms

Session-related pruritus that worsens with a new batch of dialysers suggests a biocompatibility issue. Common causes include: (1) allergy to ethylene oxide (ETO) residue from sterilisation – switching to ETO-free (steam or gamma-irradiated) dialysers resolves this; (2) complement activation from the dialyser membrane (cellulose membranes worse than synthetic); (3) contamination of dialysate. This is distinct from chronic uraemic pruritus which is persistent between sessions. Investigation includes: trying a different dialyser brand/membrane, ensuring adequate rinse volume before connecting, and checking dialysate quality.

Reference: ERA-EDTA 2019 – HD Biocompatibility; KDOQI 2015