Dialyzer Reuse—Part II: Advantages and Disadvantages

Abstract

Although single dialyzer use and reuse by chemical reprocessing are both associated with some complications, there is no definitive advantage to either in this respect. Some complications occur mainly at the first use of a dialyzer: a new cellophane or cuprophane membrane may activate the complement system, or a noxious agent may be introduced to the dialyzer during production or generated during storage. These agents may not be completely removed during the routine rinsing procedure. The reuse of dialyzers is associated with environmental contamination, allergic reactions, residual chemical infusion (rebound release), inadequate concentration of disinfectants, and pyrogen reactions. Bleach used during reprocessing causes a progressive increase in dialyzer permeability to larger molecules, including albumin. Reprocessing methods without the use of bleach are associated with progressive decreases in membrane permeability, particularly to larger molecules. Most comparative studies have not shown differences in mortality between centers reusing and those not reusing dialyzers, however, the largest cluster of dialysis-related deaths occurred with single-use dialyzers due to the presence of perfluorohydrocarbon introduced during the manufacturing process and not completely removed during preparation of the dialyzers before the dialysis procedure. The cost savings associated with reuse is substantial, especially with more expensive, high-flux synthetic membrane dialyzers. With reuse, some dialysis centers can afford to utilize more efficient dialyzers that are more expensive; consequently they provide a higher dose of dialysis and reduce mortality. Some studies have shown minimally higher morbidity with chemical reuse, depending on the method. Waste disposal is definitely decreased with the reuse of dialyzers, thus environmental impacts are lessened, particularly if reprocessing is done by heat disinfection. It is safe to predict that dialyzer reuse in dialysis centers will continue because it also saves money for the providers. Saving both time for the patient and money for the provider were the main motivations to design a new machine for daily home hemodialysis. The machine, developed in the 1990s, cleans and heat disinfects the dialyzer and lines in situ so they do not need to be changed for a month. In contrast, reuse of dialyzers in home hemodialysis patients treated with other hemodialysis machines is becoming less popular and is almost extinct.

Renal replacement therapy review

“…154 The membrane serves both structural and protective functions as humoral and cellular immune components are excluded from the cultured nor is there any concomitant increase in mortality. [129][130][131][132] A recent study suggests reuse of dialyzers may convey a reduced mortality risk; however, this was a short study in a single center and caution is warranted regarding generalization of results. 133 Dialyzer reuse continues worldwide using predominantly chemical processing, most commonly peracetic acid and formaldehyde.…”

Dialyzer Reuse with Peracetic Acid Does Not Impact Patient Mortality

“…The earliest studies reported increased mortality associated with reuse, but suggested that mortality was associated with the specific reprocessing agent and not reuse per se. Use of high-flux dialyzers became much more common in the late 1980s and early 1990s (1). Research from this period did not find an association between reuse and mortality risk ( Table 1).…”

Single-Use versus Reusable Dialyzers

“…Ethylene oxide has traditionally been implicated in this reaction, and the emergence of nonethylene oxide sterilization techniques has significantly reduced its occurrence (23). However, other chemical contaminants during the manufacturing process might pose some potential hazards if dialyzers are not preprocessed before first use, a common practice in dialysis centers that reuse.…”

“…A number of potentially serious disadvantages of reusing dialyzers have previously been highlighted (6,23). Residual germicide infusion as a result of the rebound release of disinfectants during dialysis may have theoretical long-term adverse consequences on the patient's health.…”

“…However, this risk benefit was demonstrable only after a minimum lag time of 60 days, suggesting that this benefit might lag behind the change in practice. This study has been criticized because it is based on the experience of a single large dialysis provider chain, where only one type of reuse machine was used and 75% of facilities used formaldehyde as the germicide and bleach as the cleaning agent (23,42). Concerns with conflict of interest have also been raised because this study was funded by a large dialysis provider chain that manufactures and supplies dialyzers (22).…”