Letter to the Editor
Sustained severe intestinal edema after nafamostat mesilate-associated anaphylactic reaction during hemodialysis
Edema intestinal grave y prolongado después de reacción anafiláctica relacionada con nafamostat mesilato durante la hemodiálisis
Mitsutoshi Shindo, Susumu Ookawara
, Taisuke Kitano, Hiroki Ishii, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, Yoshiyuki Morishita
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Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Remarkable mucosal edema was confirmed in the circumference of the sigmoid colon. (b) Abdominal and pelvic computed tomography scan (coronal view) showing severe whole-intestine edema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Anticoagulant use is essential to safe hemodialysis (HD) therapy because it prevents thrombosis in the extracorporeal circuit. For HD therapy in Japan, nafamostat mesilate (NM) is usually used during HD in patients with a tendency to bleed because of its short half-life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> However, NM use is reportedly associated with adverse effects, including hyperkalemia,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> agranulocytosis,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and anaphylactic reaction.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> A recent report indicated the development of anaphylactic shock in HD patients who received NM.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Here, we report a case of NM-associated anaphylactic reaction in a patient on HD, followed by severe intestinal edema.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old man with diabetes mellitus and a 5-year history of HD was admitted to our hospital for body-fluid status evaluation because of a recent episode of intradialytic hypotension at his dialysis facility. The intradialytic hypotension was suspected to be associated with ultrafiltration-induced hypovolemia during HD before admission. NM was used several times instead of heparin sodium for retinal bleeding complicated by diabetes mellitus in his dialysis facility. At our dialysis center, HD was performed in the same manner using NM. We carefully monitored for the occurrence of ultrafiltration-induced intradialytic hypotension. His blood pressure (BP) was 195/90<span class="elsevierStyleHsp" style=""></span>mmHg before HD but rapidly decreased to 114/56<span class="elsevierStyleHsp" style=""></span>mmHg. The arterial oxygen saturation measured by pulse oximetry (SpO<span class="elsevierStyleInf">2</span>) was 88% with dyspnea and deterioration of consciousness shortly after the HD initiation. Based on the clinical course from before admission to this episode, intradialytic hypotension with NM-associated anaphylactic reaction was diagnosed. At a later date, specific immunoglobulin E (IgE) antibodies to NM were detected in his blood. The HD therapy was discontinued to avoid further worsening of his systemic circulation. Although his BP recovered and his symptoms disappeared after HD was discontinued, he suffered from mild abdominal tenderness after the anaphylactic reaction; therefore, contrast computed tomography of the abdomen and pelvis was performed, which revealed remarkable mucosal edema at a circumference of the sigmoid colon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) and along the entire intestine on a coronal view (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). During the next HD session using low-molecular-weight heparin, the intradialytic hypotension completely disappeared; thereafter, HD was safely performed. However, because the intestinal edema persisted on lower gastrointestinal endoscopy 2 weeks after the reaction, total parenteral nutrition instead of solid and liquid foods was necessary for approximately 3 weeks. Thereafter, he ate normally without worsening of the intestinal edema and fully recovered after 1 month of treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An anaphylactic reaction usually occurs by an IgE-dependent immunologic mechanism and is commonly triggered by foods, stinging insect venom, and medications through acute onset within minutes to several hours. Furthermore, its reaction frequently increases vascular permeability, which increases the risk of death due to fluid extravasation with resultant sequential decreases in circulating blood volume, venous return, and BP.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Interestingly, the increase in vascular permeability induced by the anaphylactic reaction differs among systemic organs, and the extent of vascular permeability changes vary considerably among tissues: vascular permeability increases markedly in the trachea, moderately in the mesentery and intestines, and slightly in the other organs.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In this case, the whole-intestine edema associated with increased vascular permeability was surprisingly remarkable compared to other systemic organs in the NM-associated anaphylactic reaction, although the presence of tracheal edema might be suspected because of his respiratory distress and the SpO<span class="elsevierStyleInf">2</span> decrease at the reaction's onset. In addition to the intestinal edema, it was interesting that improvement of the intestinal edema and dysfunction took several weeks. The reason for the difference between the rapid improvement of the circulating status and respiratory distress and the sustained gastrointestinal symptoms, including intestinal edema, in this case remains unclear. However, reports to date of the association between NM-associated anaphylactic reactions and remarkable intestinal edema are scarce. Therefore, this case report is relevant and showed that we should carefully monitored the systemic vascular permeability increase caused by the anaphylactic reaction, particularly in the intestine, in patients in whom NM is used during HD.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Japan, the use of NM as an anticoagulant during blood purification is recommended in patients with various hemorrhagic complications as it has a lower risk of hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> However, in patients with a history of NM-induced allergic reactions, low-molecular-weight heparin is usually administered instead of NM.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In this case, HD was performed without worsening of the retinal bleeding after switching to low-molecular-weight heparin. Furthermore, rinsing the dialysis circuit with heparin and albumin<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and introducing a regional citrate infusion into the circuit<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> have recently shown good survival of the extra corporeal circuit without increasing the bleeding risk. Therefore, HD may have been better performed using these methods to avoid the occurrence of the NM-associated anaphylactic reaction.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, our experience described here suggests that patients administered NM during HD because of hemorrhagic complications should be carefully observed for anaphylactic reaction including BP reduction, respiratory distress, and intestinal edema via increased vascular permeability.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack416717" "titulo" => "Acknowledgement" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 494 "Ancho" => 1405 "Tamanyo" => 90920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Pelvic computed tomography scan at the level of the sigmoid colon. Remarkable mucosal edema was confirmed in the circumference of the sigmoid colon. (b) Abdominal and pelvic computed tomography scan (coronal view) showing severe whole-intestine edema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Japanese Society for Dialysis therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Hirakata" 1 => "K. Nitta" 2 => "M. Inaba" 3 => "T. Shoji" 4 => "H. Fujii" 5 => "S. Kobayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ther Apher Dial" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "387" "paginaFinal" => "435" "itemHostRev" => array:3 [ "pii" => "S0022399917308486" "estado" => "S300" "issn" => "00223999" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of hyperkalemia caused by nafamostat mesilate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Muto" 1 => "M. Imai" 2 => "Y. Asano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gen Pharmacol" "fecha" => "1995" "volumen" => "26" "paginaInicial" => "1627" "paginaFinal" => "1632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8745149" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Additional mechanisms of nafamostat mesilate-associated hyperkalemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Ookawara" 1 => "K. Tabei" 2 => "T. Sakurai" 3 => "Y. Sakairi" 4 => "H. Furuya" 5 => "Y. Asano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Pharmacol" "fecha" => "1995" "volumen" => "51" "paginaInicial" => "149" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8911880" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Agranulocytosis in a haemodialysed patient induced by a proteinase inhibitor, nafamostat mesilate" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "H. Okada" 1 => "H. Suzuki" 2 => "N. Deguchi" 3 => "T. Saruta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/7.9.980b" "Revista" => array:5 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "1992" "volumen" => "7" "paginaInicial" => "980" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1328952" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anaphylactoid reaction induced by a proteinase inhibitor, nafamostat mesilate, following nine administrations in a hemodialysis patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Higuchi" 1 => "H. Yamazaki" 2 => "H. Kikuchi" 3 => "F. Gejyo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000045822" "Revista" => array:6 [ "tituloSerie" => "Nephron" "fecha" => "2000" "volumen" => "86" "paginaInicial" => "400" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11096324" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac arrest caused by nafamostat mesilate" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.S. Kim" 1 => "K.E. Lee" 2 => "J.H. Oh" 3 => "C.S. Jung" 4 => "D. Choi" 5 => "Y. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.krcp.2015.10.003" "Revista" => array:6 [ "tituloSerie" => "Kidney Res Clin Pract" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "187" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668164" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to manage anaphylaxis in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Alvarez-Perea" 1 => "L.K. Tanno" 2 => "M.L. Baeza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Trans Allergy" "fecha" => "2017" "volumen" => "7" "paginaInicial" => "45" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "β<span class="elsevierStyleInf">2</span>-Adrenoceptor blockade deteriorates systemic anaphylaxis by enhancing hyperpermeability in anesthetized mice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Yang" 1 => "T. Shibamoto" 2 => "Y. kuda" 3 => "T. Zhang" 4 => "M. Tanida" 5 => "Y. Kurata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4168/aair.2018.10.1.52" "Revista" => array:6 [ "tituloSerie" => "Allergy Asthma Immunol Res" "fecha" => "2018" "volumen" => "10" "paginaInicial" => "52" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29178678" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heparin and albumin as part of the priming solution limits exposure to anticoagulation during hemodialysis: in vitro studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Kyrk" 1 => "A. Bechara" 2 => "M. Skagerlind" 3 => "B. Stegmayr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5301/ijao.5000358" "Revista" => array:6 [ "tituloSerie" => "Int J Artif Organs" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "734" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25361181" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regional citrate anticoagulation in hemodialysis: an observational study of safety, efficacy, and effect on calcium balance during routine care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.F. Singer" 1 => "O. Williams" 2 => "C. Mercado" 3 => "B. Chen" 4 => "G. Talaulikar" 5 => "G. Walters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40697-016-0113-x" "Revista" => array:5 [ "tituloSerie" => "Can J Kidney Health Dis" "fecha" => "2016" "volumen" => "3" "paginaInicial" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27099775" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack416717" "titulo" => "Acknowledgement" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">We thank our hospital's dialysis staff members.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02116995/0000003900000002/v2_201907130624/S0211699518301206/v2_201907130624/en/main.assets" "Apartado" => array:4 [ "identificador" => "48186" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003900000002/v2_201907130624/S0211699518301206/v2_201907130624/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518301206?idApp=UINPBA000064" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 5 | 9 |
| 2024 Octubre | 45 | 51 | 96 |
| 2024 Septiembre | 64 | 32 | 96 |
| 2024 Agosto | 72 | 70 | 142 |
| 2024 Julio | 44 | 27 | 71 |
| 2024 Junio | 78 | 53 | 131 |
| 2024 Mayo | 75 | 38 | 113 |
| 2024 Abril | 96 | 47 | 143 |
| 2024 Marzo | 89 | 32 | 121 |
| 2024 Febrero | 70 | 43 | 113 |
| 2024 Enero | 84 | 30 | 114 |
| 2023 Diciembre | 58 | 28 | 86 |
| 2023 Noviembre | 81 | 53 | 134 |
| 2023 Octubre | 82 | 30 | 112 |
| 2023 Septiembre | 63 | 30 | 93 |
| 2023 Agosto | 51 | 28 | 79 |
| 2023 Julio | 71 | 32 | 103 |
| 2023 Junio | 83 | 27 | 110 |
| 2023 Mayo | 76 | 38 | 114 |
| 2023 Abril | 73 | 30 | 103 |
| 2023 Marzo | 75 | 33 | 108 |
| 2023 Febrero | 54 | 28 | 82 |
| 2023 Enero | 59 | 33 | 92 |
| 2022 Diciembre | 98 | 43 | 141 |
| 2022 Noviembre | 77 | 45 | 122 |
| 2022 Octubre | 88 | 53 | 141 |
| 2022 Septiembre | 58 | 47 | 105 |
| 2022 Agosto | 71 | 50 | 121 |
| 2022 Julio | 75 | 61 | 136 |
| 2022 Junio | 94 | 44 | 138 |
| 2022 Mayo | 104 | 48 | 152 |
| 2022 Abril | 128 | 51 | 179 |
| 2022 Marzo | 134 | 50 | 184 |
| 2022 Febrero | 109 | 42 | 151 |
| 2022 Enero | 84 | 54 | 138 |
| 2021 Diciembre | 67 | 49 | 116 |
| 2021 Noviembre | 84 | 48 | 132 |
| 2021 Octubre | 75 | 56 | 131 |
| 2021 Septiembre | 64 | 50 | 114 |
| 2021 Agosto | 54 | 53 | 107 |
| 2021 Julio | 50 | 40 | 90 |
| 2021 Junio | 62 | 49 | 111 |
| 2021 Mayo | 68 | 57 | 125 |
| 2021 Abril | 118 | 104 | 222 |
| 2021 Marzo | 62 | 58 | 120 |
| 2021 Febrero | 76 | 44 | 120 |
| 2021 Enero | 46 | 26 | 72 |
| 2020 Diciembre | 41 | 25 | 66 |
| 2020 Noviembre | 55 | 34 | 89 |
| 2020 Octubre | 38 | 40 | 78 |
| 2020 Septiembre | 49 | 39 | 88 |
| 2020 Agosto | 55 | 23 | 78 |
| 2020 Julio | 58 | 25 | 83 |
| 2020 Junio | 70 | 29 | 99 |
| 2020 Mayo | 74 | 25 | 99 |
| 2020 Abril | 95 | 52 | 147 |
| 2020 Marzo | 60 | 27 | 87 |
| 2020 Febrero | 31 | 31 | 62 |
| 2020 Enero | 49 | 34 | 83 |
| 2019 Diciembre | 47 | 39 | 86 |
| 2019 Noviembre | 43 | 27 | 70 |
| 2019 Octubre | 30 | 22 | 52 |
| 2019 Septiembre | 39 | 23 | 62 |
| 2019 Agosto | 28 | 26 | 54 |
| 2019 Julio | 41 | 25 | 66 |
| 2019 Junio | 99 | 34 | 133 |
| 2019 Mayo | 49 | 27 | 76 |
| 2019 Abril | 128 | 59 | 187 |
| 2019 Marzo | 60 | 36 | 96 |
| 2019 Febrero | 34 | 26 | 60 |
| 2019 Enero | 38 | 28 | 66 |
| 2018 Diciembre | 96 | 45 | 141 |
| 2018 Noviembre | 102 | 29 | 131 |
| 2018 Octubre | 60 | 22 | 82 |
| 2018 Septiembre | 28 | 8 | 36 |
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