A case of a type 2 diabetic patient with end-stage renal disease who experienced repeated pyrexia after hemodialysis due to acetate intolerance

Abstract

We report a case of a type 2 diabetic patient with end-stage renal disease (ESRD) who experienced repeated pyrexia after each hemodialysis session due to acetate intolerance. A 62-year-old man with type 2 diabetic kidney disease was admitted to our hospital for dialysis initiation. Since the first dialysis session, he had experienced general malaise and fever with temperatures of 37～39℃ after dialysis. On the basis of intensive laboratory examinations, no evidence suggestive of the presence of infection, cancer or collagen diseases was demonstrated. The endotoxin concentration in the dialysate was within the acceptable range. Changes of the dialyzer membrane and anticoagulant agent were unsuccessful. Finally, we changed from bicarbonate dialysate containing a small amount of acetate to completely acetate-free dialysate, which effectively led to disappearance of the pyrexia. Given the clinical course, the cause of the pyrexia was considered to be acetate intolerance. We need to add acetate intolerance to the list of differential diagnoses of pyrexia associated with hemodialysis.