Vitamin E-coated membrane reversed itchy rash during hemodialysis

Excerpt

A 73-year-old woman on chronic hemodialysis (HD) presented a relapsing itchy rash during her HD sessions (Fig. 1). She had been diagnosed with chronic kidney disease (CKD) 7 years earlier, in 2014, presumably due to oxalate nephropathy in enteric hyperoxaluria. At the time of diagnosis, she presented with radiological signs of chronic nephropathy with kidney stones and high urinary oxalate values. A genetic test ruled out primary hyperoxaluria. She started twice-weekly HD treatment in September 2019. In April 2021, she presented an itchy rash on her right ankle during a dialysis session, that immediately disappeared after discontinuing treatment. Recurrence of the rash was observed in the following HD sessions and it extended to all body areas followed by an intractable itch, unresponsive to antihistamines and intravenous steroids. Hemodynamic parameters were stable and no respiratory symptoms were observed. Biochemical parameters were not remarkably altered (PTH, calcium, phosphorus, urea, B2-microglobulin) and an immunologic panel was negative. All intra-dialytic pharmacological therapy was discontinued (iron carboxymaltose, low-weight molecular heparin and erythropoietin) without any improvement. Hypothesizing a type of urticaria of cholinergic origin the dialysate temperature was reduced from 36.5 to 35 °C, but there was no remission. Not even the use of the Bellco Flexia temperature biofeedback system during treatment prevented the rash.

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