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Kidney Week

Abstract: PO1196

A Case of a Yellow Dialyzer in a Hemodialysis Patient

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Parikh, Rushang, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Andrade paz, Hugo, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Uppal, Nupur N., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Sachdeva, Mala, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction

Yellowish discoloration of a dialyzer during hemodialysis (HD) can have various diagnostic and therapeutic implications, however its recognition must be made in a timely manner. Here we present a case of a patient whose dialyzer color was noted to be yellow after his HD session.

Case Description

A 65-year-old African American male with ESKD secondary to hypertension and diabetes mellitus, on intermittent hemodialysis for 9 years was noted to have a yellow dialyzer post hemodialysis. His only complaint during dialysis was severe itching for two days. On exam, he had no scleral or palatal icterus. Stat outpatient laboratory testing revealed a total bilirubin of 13.1 mg/dL with a direct bilirubin of > 10.0 mg/dL which led to his hospital admission. Further laboratory testing revealed an AST of 188 U/L, ALT of 188 U/L, alkaline phosphatase of 587 U/L, a normal amylase and lipase, and negative viral testing for hepatitis A, B, C, CMV, and EBV. Autoimmune workup revealed a normal ANA, anti-mitochondrial, and anti-smooth muscle antibody. An abdominal ultrasound showed mildly thickened gallbladder, without stones, sludge or ductal dilatation. Doppler showed no portal or hepatic vein thrombosis. A CT scan of his abdomen showed no discernable liver or gallbladder issues. He denied herbal medications or rifampin use. Although etiology was entirely unclear, there was suspicion for drug induced liver injury caused by hydralazine and high dose statin. Patient had a planned liver biopsy however he decompensated rapidly, and had a cardiac arrest which led to his demise.

Discussion

Although yellow dialyzers have been described they are still quite a rare entity. In this case, the presence of a yellow dialyzer was one of the only two presenting symptoms for this patient, the other being itching. Itching, which occurs in dialysis patients could have easily been disregarded if it were not for the dialyzer discoloration. We highly stress that close attention to dialyzer color is needed in patients who present with itching, in the absence of any other symptoms. Recognition of a yellow dialyzer in a timely manner can assist in discerning if the etiology is medication related or hyperbilirubinemia related where the yellow color is thought to be due to entrapment of unfiltered bilirubin-albumin complexes by the dialysis membrane. Hopefully this recognition can improve outcome.