Formaldehyde in Dialysis Patients

Abstract

Exposure to formaldehyde is associated with a variety of effects in chromosomal damage. Most notably formaldehyde stimulates antigenic changes in erythrocytes that cause the development of antibodies. With new and reused filters, residual formaldehyde left after sterilization is leached from the filter during dialysis and enters the patient. As formaldehyde contacts the erythrocytes, it apparently forms an active hapten that stimulates the production of antiformaldehyde and anti-N-like antibodies. Anti-N-like antibodies may develop in more than 30% of the patients who are exposed to formaldehyde during dialysis. Antibodies related to formaldehyde exposure have been associated with hemolysis, anemia, and changes in the hematocrit. In a few patients who had received renal transplants, erythrocyte agglutination, caused by the antigen-antibody reactions, probably blocked microcirculation in the kidney and caused its rejection by the host. Perhaps by understanding the ways that patients are exposed to and affected by formaldehyde during dialysis, systems for dialysis and patient protection may be improved. This information may also help elucidate formaldehyde's potential to elicit reactions in healthy people when the exposure occurs by other routes.