(1) Tokyo Kyosai Hospital, Tokyo, Japan
(2) Tokyo Medical and Dental University, Tokyo, Japan
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There are various types of fevers of unknown origin (FUO) among dialysis patients. Physicians should determine the causes of fever and start providing patients with appropriate treatment as early as possible. The aim of this review was to discuss the causes, diagnosis and treatments of FUO in dialysis patients.
FUO is classified into four types depending on the patients’ background: classical, nosocominal, neutropenic, and human immunodeficiency virus (HIV)-associated FUO. Haemodialysis patients may develop a fever as an allergic reaction to a dialysis circuit. Therefore, various items including dialysis membranes, dialysis circuits, puncture needles, anticoagulants, and endotoxin should be examined. The main pathogenic mechanism underlying the development of FUO in dialysis patients is based on allergic reactions to the materials used in dialysis devices and the contaminants (endotoxins) in the dialysate. When the cause of fever is unclear, diagnosis should be started on the basis of the urgency of treatment and the classification of FUO to provide appropriate treatment. When an allergic reaction to the materials used in dialysis devices is suspected, such materials and the sterilization method should be examined to determine the causes of fever and be replaced with a device made of other materials or another method as necessary.
There are various causes of fever in dialysis patients. The identification of the causes of fever and its appropriate treatment based on the severity of the symptoms are essential for dialysis patients with FUO.