engleski

Sudden death in chronic hemodialysis patients caused by dialyzer

Sudden death in chronic hemodialysis patients (HD pts) is most often caused by cardiovascular events. Mortality rate in HD pts is ca 10%. In 2000 almost equal mortality was observed in Croatia. Five sudden deaths in 1 week only at our dialysis center (95 pts) in October 2001, are reported. Three pts died during HD: 2 men (66 ; 24 yrs.) and a woman (63). Other 2 pts died 7 and 1.3 hrs. after HD. Two pts died on October 8, 2 on Oct 9 and 1 pt on Oct 11. Clinical presentation in the 2 pts who died during HD was almost the same: sudden refractory hypotension, bradycardia and cardiac arrest refractory to all resuscitation measures. Patient 3 complained of chest pain and vomiting. He suddenly lost consciousness and developed EPI. Patient 4 died at home. It looked like a cardiac death. Patient 5 died after HD, in the ambulance, on his way home. He was a diabetic, with the left coronary a. occlusion found at autopsy. Foaming blood in the pulmonary a. and int. carotid a. was found at autopsy of a young man. All these pts were dialyzed on the same dialyzer - P15 (cellulose diacetate membrane) (Baxter, USA, distributed by Pliva, Croatia). Two pts were on Hospal Integra monitor, 2 on Althin Tina and 1 on Braun Dialog. No filter reuse was done. Water quality was good. All pts had Braun Solcard. On Friday, 5 pts on P15 died in another dialysis unit. That week, a total of 23 HD pts suddenly died in 6 Croatian HD units - during HD or some hours later. They were all dialyzed on Baxter dialyzers P15 or P18. The manufacturer found perfluorohydrocarbon as the causative toxic agent. It remained after fiber preparation and stabilization. No further deaths were recorded after the withdrawal of Baxter dialyzers. Baxter recalled all series A dialyzers from the market.

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