Clinical and microbiological effects of dialyzers reuse in hemodialysis patients

Abstract

Introduction: Chronic kidney disease (CKD) has a high prevalence and is a worldwide public health problem. Reuse of dialyzers is a cost reduction strategy used in many countries. There is controversy over its effects on clinical parameters and microbiological safety. Methods: In this clinical crossover study, 10 patients performed consecutive hemodialysis (HD) sessions divided in two phases: "single use" sessions (N = 10 HD sessions) followed by "dialyzer reuse" sessions (N = 30 HD sessions). Clinical, laboratory, and microbiological parameters were collected in the following time points: "single use", 1st, 6th, and 12th sessions with reuse of dialyzers, including bacterial cultures, endotoxins quantification in serum and dialyzer blood chamber, and detection of hemoglobin and protein residues in dialyzers. Results: Mean age of the sample was 37 ± 16 years, 6 (60%) were men, and 5 (50%) were white. CKD and HD vintage were 169 ± 108 and 47 (23-111) months, respectively. Serum C-reactive protein (CRP) [4.9 (2.1) mg/mL], ferritin (454 ± 223 ng/mL), and endotoxin levels [0.76 (0.61-0.91) EU/mL] were high at baseline. Comparison of pre- and post-HD variations of serum levels of CRP and endotoxins in the "single use" versus "reuse" phases did not result in differences (p = 0.8 and 0.4, respectively). Samples of liquid in the dialyzer inner chamber were negative for the growth of bacteria or endotoxins. There was no significant clinical manifestation within and between the phases. Conclusion: Dialyzers reuse was safe from a clinical, microbiological, and inflammatory point of view. The dialyzer performance remained adequate until the 12th reuse.

Reprocessing and reuse of dialyzers: A technological solution for balancing cost and quality in lower and middle-income countries

“…In a small cross-over study of 10 patients from Brazil, comparing pre- and post-HD measurements, variations of serum CRP and endotoxins within dialyzer chambers were not significantly different between “single-use” versus “reuse” phases using polysulfide high flux dialyzers. 16 In another comparative study of 70 patients in Pakistan, there was a 14% total cost saving with dialyzer reuse compared to single-use. 17 In a detailed analysis of the single HD session economics from India, the cost of a dialyzer per session with six reuses was 76% less than that with single-use.…”

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

“…However, multiple dialyzer reuse may contribute to negative outcomes [ 69 ] such as infection risks, biochemical and immunologic reactions, improper sterilization, increased membrane permeability [ 49 ], and loss of performance leading to inadequate dialysis adequacy. These issues are believed to arise from the reprocessing procedure involving sanitizing agents [ 67 , 70 ]. However, two studies have indicated that single, minimal (>6 times), or multiple dialyzer reuse carries no impact on dialysis adequacy, body weight, and serum albumin level [ 71 , 72 ].…”

Dialyzer reuse: is it safe and worth it?

“…In this backdrop, Dr. Ribeiro and colleagues report the findings of their small cross-over study examining the differences in clinical and microbiological parameters with single-use and reuse practices 17. Ten patients were selected to undergo one hemodialysis treatment using the single-use practice and twelve hemodialysis treatments using the reuse-practice.…”