Single-Use versus Reusable Dialyzers

Abstract

The practice of reusing dialyzers has been widespread in the United States for decades, with single use showing signs of resurgence in recent years. Reprocessing of dialyzers has traditionally been acknowledged to improve blood-membrane biocompatibility and prevent first-use syndromes. These proposed advantages of reuse have been offset by the introduction of more biocompatible membranes and favorable sterilization techniques. Moreover, reuse is associated with increased health hazard from germicide exposure and disposal. Some observational studies have also pointed to an increased mortality risk with dialyzer reuse, and the potential for legal liability is another concern. The desire to save cost is the major driving force behind the continued practice of dialyzer reuse in the United States. It is imperative that future research focus on the environmental consequences of dialysis, including the need for more optimal management of disinfectant-related waste with reuse, and solid waste with single use. The dialysis community has a responsibility to explore ways to mitigate environmental consequences before single-use and a more frequent dialysis regimen becomes a standard practice in the United States.

Clinical Transformation: The Key to Green Nephrology

“…Dialyser reuse produces less waste than the practice of single-use, which has been estimated to contribute over 4,000 tonnes of polymer waste annually in the USA [9]. Such clinical waste must undergo incineration, a form of waste management that is preferable only to landfill in terms of its environmental impact.…”

In vitro Clearance and Hemocompatibility Assessment of Ultrathin Nanoporous Silicon Membranes for Hemodialysis Applications Using Human Whole Blood

“…Polymer membranes have tortuous pores with pore size varying well over a factor of 10 over membrane surface [1,2,3]. Polymer-based blood dialyzers have not yet been miniaturizable and they also have short service life time [4], limiting their application for a wearable or implantable artificial kidney. Wide pore size distribution in such membranes results in low molecule selectivity and reduced filtration resolution [5].…”

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

“…According to reports, the practice of dialyzer reuse in the USA is decreasing [2,3]. The largest US dialysis provider, Fresenius Medical Care discontinued reuse in the 2000s, in a combined own product manufacturing and renal care chain [4,5]. 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].…”