Dialyzer Reuse with Peracetic Acid Does Not Impact Patient Mortality

Abstract

SummaryBackground and objectives Numerous studies have shown the overall benefits of dialysis filter reuse, including superior biocompatibility and decreased nonbiodegradable medical waste generation, without increased risk of mortality. A recent study reported that dialyzer reprocessing was associated with decreased patient survival; however, it did not control for sources of potential confounding. We sought to determine the effect of dialyzer reprocessing with peracetic acid on patient mortality using contemporary outcomes data and rigorous analytical techniques. Design, setting, participants, & measurementsWe conducted a series of analyses of hemodialysis patients examining the effects of reuse on mortality using three techniques to control for potential confounding: instrumental variables, propensity-score matching, and time-dependent survival analysis. ResultsIn the instrumental variables analysis, patients at high reuse centers had 16.2 versus 15.9 deaths/100 patient-years in nonreuse centers. In the propensity-score matched analysis, patients with reuse had a lower death rate per 100 patient-years than those without reuse (15.2 versus 15.5). The risk ratios for the time-dependent survival analyses were 0.993 (per percent of sessions with reuse) and 0.995 (per unit of last reuse), respectively. Over the study period, 13.8 million dialyzers were saved, representing 10,000 metric tons of medical waste. ConclusionsDespite the large sample size, powered to detect miniscule effects, neither the instrumental variables nor propensity-matched analyses were statistically significant. The time-dependent survival analysis showed a protective effect of reuse. These data are consistent with the preponderance of evidence showing reuse limits medical waste generation without negatively affecting clinical outcomes.

Does Hemodialyzer Reuse Have a Place in Current ESRD Care: “To Be or Not To Be?”

“…Facilities pay for waste disposal by volume, thus numbers of dialyzers and the way lines and dialyzers are packaged as bulk waste play roles in this expense. Bond et al argue that limiting medical waste favors reuse (4). We suspect that most medical directors and administrators are not paying attention to these details.…”

“…Bond et al. argue that limiting medical waste favors reuse . We suspect that most medical directors and administrators are not paying attention to these details.…”

“…It utilized this single-use philosophy as a marketing strategy aimed at recruiting patients and nephrologists to Fresenius facilities, which would have implications to insurers and other payers. Very shortly after this (in part, we believe to counter Fresenius' promotion of LDO wide single-use), DaVita reported its successful survival outcomes practicing reuse (4). By December 2013, about 40% of DaVita treatments were with reprocessed dialyzers in a decision made jointly between the medical director of each facility and DaVita (personal correspondence, Robert Provenzano).…”

Choosing a dialyzer: What clinicians need to know

“…[59][60][61][62] The outcomes of dialyzer reuse in terms of hospitalization risk and mortality is inconclusive. [63][64][65] Given the lower costs of dialyzers, single use dialyzers have now become the standard of care in developed countries.…”

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

“…This trend is likely due to the availability of less expensive high-flux, single-use dialyzers, greater compatibility of the synthetic membranes, and alternative sterilization methods that avoid first-use syndrome [5]. However, other large providers – like DaVita and smaller ones – still reuse dialyzers [6]. In lower resource settings, dialyzer reuse is predominant [7,8].…”