Abstract: FR-PO1007
Severe Hyperbilirubinemia Causing Recurrent False Blood Leak Alarms and Complete Hemodialysis Failure
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Moumen, Jad, Albany Med Health System, Albany, New York, United States
- Beers, Kelly, Albany Med Health System, Albany, New York, United States
- Salman, Loay H., Albany Med Health System, Albany, New York, United States
- Faddoul, Giovanni, Albany Med Health System, Albany, New York, United States
- Sterling, Maarika, Albany Med Health System, Albany, New York, United States
- Luce, Ashley, Albany Med Health System, Albany, New York, United States
Introduction
Yellow dialyzer discoloration is a rare phenomenon attributed to hyperbilirubinemia or medications including rifampin and propofol. False blood leak alarms from dialysate discoloration have been reported with vitamin B12. We present the first case of hyperbilirubinemia causing recurrent false blood leak alarms and complete HD failure across multiple machines and sessions.
Case Description
A 51-year-old woman with ESKD on HD and failed liver transplant from immunosuppression nonadherence presented after two missed sessions. On 4/7/26, HD via right tunneled catheter on a B. Braun/Optiflux F160NRe triggered a blood leak alarm within 10 minutes. Two dipstick tests were negative for blood, confirming a false alarm. Circuit and machine replacement each triggered identical alarms, with ~30 minutes across two machines yielding no treatment. The patient declined ED transfer. On 4/9/26, a false blood leak alarm recurred within 5 minutes, and she again declined ED transfer. On 4/14/26 bilirubin was 47 mg/dL, and she was transferred to a transplant center and passed away.
Discussion
B. Braun machines use visible-spectrum optical sensors to detect blood leaks. Serial labs showed bilirubin rising from 13.1 mg/dL (February) to 38.1 mg/dL (late March), placing estimated levels in the high 30s to low 40s during the failed attempts, confirmed at 47 mg/dL one week later. Dialysate discoloration repeatedly mimicked a blood leak, rendering HD impossible. Unlike prior reports where dialysis continued despite yellow discoloration, this represents complete outpatient treatment failure. Infrared-based platforms such as PrismaFlexand NxStage are unaffected by visible-spectrum chromophores and may be the only viable RRT option. Clinicians managing patients with hepatic and kidney failure should anticipate this and transition early to infrared-based platforms.