We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13,1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, ≥37.8°C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment. Pyrogenic reactions to dialysis sessions during the epidemic period (July 1 through 14) were associated with the use of a reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The water used to rinse the dialyzers after use and to dilute the germicide for disinfecting the dialyzers contained high concentrations of endotoxins (>6 ng/mL) and bacteria (>104 colony forming units/mL). After reuse of dialyzers was discontinued at the center, the PR rate fell to pre-epidemic levels. We concluded that PRs were associated with reuse of dialyzers, probably contaminated with endotoxins. Active surveillance for PRs among patients undergoing long-term hemodialysis should be routine at all dialysis centers; an increase in PRs should prompt timely review of water treatment and dialyzer reprocessing systems.
Gordon SM, Tipple M, Bland LA, Jarvis WR. Pyrogenic Reactions Associated With the Reuse of Disposable Hollow-Fiber Hemodialyzers. JAMA. 1988;260(14):2077-2081. doi:10.1001/jama.1988.03410140089029