Dialyzer Reuse and Mortality Risk in Patients with End-Stage Renal Disease: A Systematic Review

Abstract

Background and Aim: Robust evidence about dialyzer reuse effects on mortality is not available. Our aim was to summarize the evidence for the effectiveness of dialyzer reuse compared to single use in patients with end-stage renal disease. Methods: We searched MEDLINE, Embase, CINAHL, SciELO, LILACS, USRDS ADR, universities’ theses databases and annals of congress from major nephrology societies. Reviewers performed the study selection and data extraction independently. We used the GRADE approach to assess the quality of the evidence. Mortality was the primary outcome. Results: A total of 1,190 studies were retrieved, and 14 were included in the review (n = 956,807 patients). The disinfectants used on dialyzer reprocessing were hypochlorite, formaldehyde, glutaraldehyde, and peracetic acid. The evidence available from the studies was of very low quality. Most studies found no differences between groups. In studies with statistically significant differences, these differences were not observed in all groups and they varied by the type of disinfectant, time of observation and treatment unit. Conclusions: No significant differences were identified for the superiority or inferiority of dialyzer reuse versus single use when assessing the mortality of patients with end-stage renal disease. Studies of higher quality, including randomized clinical trials, are required to provide conclusive evidence regarding the effectiveness and safety of dialyzer reuse.

Dialyzer Reuse and Outcomes of High Flux Dialysis

“…Our analysis of the HEMO data does find an association between reuse and dialyzer flux, but in the opposite direction: rather than negatively affecting the survival of patients dialyzing with reused HF membranes, reuse improved the outcomes of LF dialysis. To our knowledge this is the first analysis to highlight the importance of the extent of reuse and membrane flux in addition to membrane material and reprocessing technique [ 51 ] on outcomes The existing literature includes harmful [ 51 – 54 ], protective [ 55 ] or null associations [ 13 , 56 ] and an overall neutral effect on mortality across the various studies [ 57 ]. The conflicting nature of the literature seems hardly surprising given the numerous factors that could confound the relation between reuse and outcomes.…”

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…The issue of the reuse of dialysers has not been developed in this discussion, because the practice has been banned in Italy, as well as in most European countries, for over 20 years. Notwithstanding the increased risk of infection that is often reported, reuse is a highly complex issue, probably also because most of the measures of "biocompatibility" are indirect (like pre-dialysis beta2 microglobulin level) and, as it is common in the field of dialysis, it is very difficult to disentangle the effect on mortality from that of the overall patient care, of which reuse may be a reflection [94,95]. The low quality of the evidence in the available studies, acknowledged in the only systematic review we were able to retrieve, and the heterogeneity of the reuse modalities suggest that the time may be ripe for re-thinking this practice in the different context of ecological sustainability.…”

“…The low quality of the evidence in the available studies, acknowledged in the only systematic review we were able to retrieve, and the heterogeneity of the reuse modalities suggest that the time may be ripe for re-thinking this practice in the different context of ecological sustainability. In this regard, future studies should balance the advantages in reducing plastic waste with the need for using potentially toxic chemicals for membrane sterilization [94][95][96][97].…”

Riscos ocupacionais para profissionais de enfermagem relacionados ao reúso e uso único do dialisador

“…Seeing that there is no conclusive opinion on the best use of the dialyzer, its reuse still occurs in many countries (3) . If, on the one hand, speculation regarding cost containment seems to be what supports its reuse (4) , on the other, proponents of the single use rely on evidence related to greater security and better survival of patients (2) .…”