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Dialyzer Reuse — Techniques And Controversy

  • Anne Marie V. Miles
  • Eli A. Friedman

Abstract

Hemodialyzer reuse refers to the processing of a used dialyzer cartridge with or without connecting tubing, for repeated hemodialysis in the same patient. Dialyzer reuse was first described in 1964 by Shaldon (1), who refrigerated coil dialyzers containing the patient’s heparinized blood until the next dialysis. Reuse of dialyzers then underwent a series of refinements and became progressively widespread, initially for reasons of convenience in home hemodialysis programs to reduce the need for rebuilding of Kiil dialyzers, and later for cost containment and improved dialyzer biocompatibility. Dialyzer reuse today is largely limited to hollow fiber capillary dialyzers because of their near universal use, and because of difficulty in assessing the efficacy of reprocessing in parallel plate dialyzers. Automated reprocessing machines were introduced in 1980–1981 and contributed to the increasing trend to reuse dialyzers. In an effort to contain the burgeoning cost of health care in the United States, in 1983, the Federal Government discontinued the previous Medicare system of reimbursing 80% of the actual cost of each dialysis session and instituted a composite rate of reimbursement for each hemodialysis treatment, i.e.: a limited, fixed amount was paid for each dialysis

Keywords

Peracetic Acid Blood Compartment Dialysis Center Formaldehyde Level Dialyzer Clearance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Shaldon S, Silva H, Rosen M: Technique of refrigerated coil preservation hemodialysis with femoral vein catheterization. Br Med J 2: 411, 1964PubMedGoogle Scholar
  2. 2.
    Tokars JI, Alter MJ, Favero MS, Moyer LS, Moyer LA, Bland LA National surveillance of dialysis-associated diseases in the United States, 1991. Am Soc Artif Int Org J 39: 966, 1993Google Scholar
  3. 3.
    Lore G: Industry leaders respond to FDA proposed guidelines on dialyzer reuse labelling. Contemp Dial Nephrol 15: 14, 1994Google Scholar
  4. 4.
    Shaldon S: Unanswered questions pertaining to dialysis adequacy in 1992. Kidney Int 43(Suppl 41): 274, 1993Google Scholar
  5. 5.
    US Department of Health and Human Services: Food and Drug Administration. Talk paper T92-46. October 13, 1992Google Scholar
  6. 6.
    Held PJ, Levin NW, Bovbjerg RR, Pauly MV, Diamond LH: Mortality and duration of hemodialysis treatment. J Am Med Ass 265: 871, 1991CrossRefGoogle Scholar
  7. 7.
    Shaldon S: Dialyzer reuse: a practice that should be abandoned. Sem Dial 6: 11, 1993Google Scholar
  8. 8.
    Alter MJ, Favero MS, Moyer LS, Bland LA: National surveillance of dialysis-associated diseases in the United States, 1989. Trans Am Soc Artiflnt Organs 37: 97, 1991Google Scholar
  9. 9. Thirteenth report of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA): Reuse of Hemodialyzers, 1990, p 111Google Scholar
  10. 10.
    Fassbinder W, Brunner FP, Brynger H, Ehrich JHH et al.: Combined report on regular dialysis and transplantation in Europe, XX, 1989. Nephrol Dial Transplant 6(Suppl 1): 5, 1991Google Scholar
  11. 11.
    Challah S, Wing AJ, Brunner FP, Brynger HOA, Oules R, Seiwood NH: Use and reuse of dialyzers in Europe, in Guide to Reprocessing of Hemodialyzers, edited by Deane W, Wineman RJ, Bemis JA, Massachusetts, Martinus Nijhoff, 1986, p 99Google Scholar
  12. 12.
    Favero MS, Deane N, Leger RT, Sosin AE: Effect of multiple use of dialyzers on hepatitis B incidence in patients and staff. J Am Med Ass 245: 166, 1981CrossRefGoogle Scholar
  13. 13.
    Association for the Advancement of Medical Instrumentation: Recommended Practice for Reuse of Hemodialyzers. Arlington, VA, 1986Google Scholar
  14. 14.
    AAMI: Recommended Practice for Reuse of Hemodialyzers, Arlington, VA, Association for the Advancement of Medical Instrumentation, 1993Google Scholar
  15. 15. NKF revised standards for reuse of hemodialyzers: Am J Kid Dis 3:466, 1984Google Scholar
  16. 16.
    Deane M, Bemis JA: Multiple Use of Hemodialyzers, New York, Manhattan Kidney Center, National Nephrology Foundation, 1982, p 64Google Scholar
  17. 17.
    Veys N, Vanholder R, De Cuyper K, Ringoir S: Influence of erythropoietin on dialyzer reuse, heparin need and urea kinetics in maintenance hemodialysis patients. Am J Kid Dis 23: 52, 1994PubMedGoogle Scholar
  18. 18.
    Billiouw JM, Vanholder R, Piron M, Veirman R, Ringoir S: Automated reuse of capillary hemodialyzers. Int J Artif Organs 8: 83, 1985PubMedGoogle Scholar
  19. 19.
    Deane M, Beamis J: Multiple Use of Hemodialyzers. Final report to the National Institutes of Arthritis, Diabetes and Digestive and Kidney Disease. Contract NO1-AM-9-2214. 1981, p 53Google Scholar
  20. 20.
    Stein G, Lines W, Volksch G et al.: Changes of the capillary surface in reused dialyzers — electron microscopic investigations. Int J Artif Organs 2: 27, 1979PubMedGoogle Scholar
  21. 21.
    Gagnon RF, Kaye M: Hemodialysis neutropenia and dialyzer reuse: role of the cleaning agent. Uremia Invest 8: 17, 1984PubMedGoogle Scholar
  22. 22.
    Kuwahara T, Marken M, Wauters JP: Biocompatibility aspects of dialyzer reprocessing: a comparison of 3 reuse methods and 3 membranes. Clin Nephrol 32: 139, 1989PubMedGoogle Scholar
  23. 23.
    Graeber CW, Halley SE, Lapkin RA, Graeber CA, Kaplan AA: Protein losses with reused dialyzers (abstract). J Am Soc Nephrol 4: 349, 1993Google Scholar
  24. 24.
    Gotch FA: Quality control tests for validation of dialyzer performance, in Hemodialyzer Reuse; Issues and Solutions. AAMI Technology Assessment Report 10-85, Arlington, VA, Association for the Advancement of Medical Instrumentations, 1985, p 37Google Scholar
  25. 25.
    Farrell P, Eschbach J, Vizzo J, Babb L: Hemodialyzer reuse: estimation of area loss from clearance data. Kidney Int 5: 466, 1974CrossRefGoogle Scholar
  26. 26.
    Gotch F: Mass transport in reused dialyzers. Proc Clin Dial Transplant Forum 10: 81, 1980PubMedGoogle Scholar
  27. 27.
    Garred LJ, Canaud B, Flavier JL et al.: Effect of reuse on dialyzer efficacy. Artif Organs 14: 80, 1990PubMedCrossRefGoogle Scholar
  28. 28.
    Schmidt R, Zasuwa G, Schell D, Dumler F: Proper dialyzer reprocessing does not impair urea mass transfer. J Am Soc Nephrol 2: 349, 1991Google Scholar
  29. 29.
    Gagnon RF, Kaye M: Dialyzer performance over prolonged reuse. Clin Nephrol 24: 21, 1985PubMedGoogle Scholar
  30. 30.
    Kaye M, Gagnon R, Mulheam B, Spergel D: Prolonged dialyzer reuse. Trans Am Soc Artif Int Organs 30: 491, 1984Google Scholar
  31. 31.
    Deane N, Bemis J: Multiple Use of Hemodialyzers. Final report to the National Institute of Arthritis, Diabetes and Digestive and Kidney Disease, Contract NO1-AM-9-2214, 1981, p 53Google Scholar
  32. 32.
    Delmez JA, Weerts CA, Hasamear PD, Windus DW: Severe dialyzer dysfunction undetectable by standard reprocessing validation tests. Kidney Int 36: 478, 1989PubMedCrossRefGoogle Scholar
  33. 33.
    Centers for Disease Control: Bacteremia associated with reuse of hollow fiber dialyzers. MMWR 35: 417, 1986Google Scholar
  34. 34.
    Bland LA, Favero MS, Oxborrow GS et al.: Effect of chemical germicides on the integrity of hemodialyzer membranes. Trans Am Soc Artif Int Organs 34: 172, 1988Google Scholar
  35. 35.
    Bolan GA, Reingold AL, Carson LA et al.: Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis 152: 1013, 1985PubMedGoogle Scholar
  36. 36.
    Lowry PW, Beck-Sague CM, Bland LA et al.: Mycobacterium chelonae infection among patients receiving high flux dialysis in a hemodialysis clinic in California. J Infect Dis 161:85, 1990PubMedGoogle Scholar
  37. 37.
    Hakim RM, Friedrich RA, Lowrie EG: Formaldehyde kinetics and bacteriology in dialyzers. Kidney Int 28: 936, 1985PubMedCrossRefGoogle Scholar
  38. 38. Occupational Safety and Health Administration Code of Federal Regulations (Chapter 29, Part 1910.20) Federal Register, May 27, 1992Google Scholar
  39. 39.
    Hendrick DJ, Lane DJ: Formalin asthma in hospital staff. Br Med J 1: 607, 1975PubMedCrossRefGoogle Scholar
  40. 40. Formaldehyde: evidence of carcinogenicity. NIOSH Current Intelligence Bulletin 34, DHEW (NIOSH) Publication no81-111, 1981Google Scholar
  41. 41.
    Gotch F, Keene M: Formaldehyde kinetics in reused dialyzers. Trans Am Soc Artif Int Organs 29: 396, 1983Google Scholar
  42. 42.
    Gotch FA: Dialyzer transport properties and germicide elution. in Proceedings, Seminar on Reuse of Hemodialyzers and Automated and Manual Methods, New York, National Nephrology Foundation, 1984Google Scholar
  43. 43.
    Heck H: Formaldehyde (CH2O) concentrations in the blood of humans and Fischer-344 rats exposed to CH2O under controlled conditions. J Am Ind Hyg Ass 46: 1, 1985Google Scholar
  44. 44. Formaldehyde: evidence of carcinogenicity: NIOSH Current Intelligence Bulletin 34, DHEW (NIOSH) Publication no 81-111, 1981Google Scholar
  45. 45.
    Beizer FO, Kountz SL, Perkins HA: Red cell cold autoagglutinins as a cause of failure of renal allotransplantation. Transplantation 11: 422, 1971Google Scholar
  46. 46.
    White W, Miller G, Kaehny WD: Formaldehyde in the pathogenesis of hemodialysis-related anti-N antibodies. Transfusion 17: 443, 1977PubMedCrossRefGoogle Scholar
  47. 47.
    Orringer EP, Mattern WD: Formaldehyde-induced hemolysis during chronic hemolysis. N Engl J Med 294: 1416, 1976PubMedCrossRefGoogle Scholar
  48. 48.
    Kline LB, Hull RD: The virucidal properties of peracetic acid. Am J Clin Pathol 33: 30, 1960PubMedGoogle Scholar
  49. 49.
    Berkseth R, Luehman D, McMichael C, Keshavian P, Kjellstrand C Peracetic acid for reuse of hemodialyzers. Clinical studies. Trans Am Soc Artif Int Organs 30: 270, 1984Google Scholar
  50. 50.
    Fleming SJ, Foreman K, Schanley K, Mihrshahi A, Siskind V: Dialyzer reprocessing with Renalin. Am J Nephrol 11: 27, 1991PubMedGoogle Scholar
  51. 51.
    Husni L, Kale E, Climer C, Bostwick B, Parker TF: Evaluation of a new disinfectant for dialyzer reuse. Am J Kid Dis 14: 110, 1989PubMedGoogle Scholar
  52. 52.
    Kaufman AM, Frinak S, Godmere RO, Levin NW: Clinical experience with heat sterilization for reprocessing dialyzers. Am Soc Artif Int Organs J 38: M338, 1992Google Scholar
  53. 53.
    Wineman RJ: Automated reprocessing, in Guide to Reprocessing of Hemodialyzers, edited by Deane N, Wineman RJ, Bemis JA, Massachusetts, Martinus Nijhoff, 1986, p 163Google Scholar
  54. 54.
    Bok DV, Pascual L, Herberger C, Sawyer R, Levin NW: Effect of multiple use of dialyzers on intradialytic symptoms. Proc Clin Dial Transpl Proc 92, 1980Google Scholar
  55. 55.
    Robson MD, Charoenpanich R, Kant KS et al.: Effect of first and subsequent use of hemodialyzers on patient well being. Am J Nephrol 6: 101, 1986PubMedGoogle Scholar
  56. 56.
    Kant KS, Pollak VE, Cathey M et al.: Multiple use of dialyzers: safety and efficacy. Kidney Int 19: 728, 1981PubMedCrossRefGoogle Scholar
  57. 57.
    Dumler F, Zasuwa G, Levin NW: Effect of dialyzer reprocessing on complement activation and hemodialyzerrelated symptoms. Artif Organs 11: 128, 1987PubMedGoogle Scholar
  58. 58.
    Cheung AK: A prospective study on intradialytic symptoms associated with reuse of hemodialyzers. Am J Nephrol 11:397, 1991PubMedGoogle Scholar
  59. 59.
    Hakim RM, Breillat J, Lazarus JM, Port FK: Complement activation and hypersensitivity reactions to dialysis membranes. N Engl J Med 311:878, 1984PubMedCrossRefGoogle Scholar
  60. 60.
    Hakim RM, Lowrie EG: Effect of dialyzer reuse on leukopenia and the total hemolytic system. Trans Am Soc Artif Int Organs 26: 159, 1980Google Scholar
  61. 61.
    Craddock PR, Fehr J, Dalmasso AP, Brigham KL, Jacob HS: Hemodialysis leukopenia; pulmonary leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 59: 879, 1977PubMedGoogle Scholar
  62. 62.
    Davenport A, Williams AJ: The effect of dialyzer reuse on peak expiratory flow rate. Res Med 84: 17, 1996Google Scholar
  63. 63.
    Zaoui P, Green W, Hakim RM: Hemodialysis with cuprophane membrane modulates interleukin 2 receptor expression. Kidney Int 39: 1020, 1991PubMedCrossRefGoogle Scholar
  64. 64.
    Pegues DA, Beck-Sague CM, Woollen SW et al.: Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. Kidney Int 42: 1232, 1992PubMedCrossRefGoogle Scholar
  65. 65.
    Di Raimondo CR, Pollak VE: Beta-2-microglobulin kinetics in maintenance hemodialysis: a comparison of conventional and high flux dialyzers and the effects of dialyzer reuse. Am J Kid Dis 13: 390, 1989Google Scholar
  66. 66.
    Diaz RJ, Washburn S, Cauble L, Siskind MS, Van Wyck D: The effect of dialyzer reprocessing on performance and β2-microglobulin removal using polysulfone membranes. Am J Kid Dis 21: 405, 1993PubMedGoogle Scholar
  67. 67.
    Easterling RE: Invited Commentary. National Workshop on Reuse of Consumables in Hemodialysis. Kidney Disease Coalition. Washington, DC, 1982, p 257Google Scholar
  68. 68.
    Hoffstein PA: Reuse of Consumables in Hemodialysis. National Workshop on Reuse of Consumables in Hemodialysis. Kidney Disease Coalition. Washington, DC, 1982, p 228Google Scholar
  69. 69.
    Ogden DA: Clinical responses to new and reprocessed hemodialyzers. in Guide to Reprocessing of Hemodialyzers, edited by Deane W, Wineman RJ, Bemis JA, Massachusetts, Martinus Nijhoff, 1986, p 87Google Scholar
  70. 70.
    Petersen NJ, Carson JA, Favero MS: Bacterial endotoxin in new and reused hemodialyzers: a potential cause of endotoxemia. Trans Am Soc Artif Int Organs 27: 155, 1981Google Scholar
  71. 71.
    Pizzaconi VB, Dorson WJ, Breillat J et al: Factors affecting complement activation and neutropenia during dialysis using cuprophane membranes. Am Soc Artif Int Organs J 7: 64, 1984Google Scholar
  72. 72.
    Ogden DA, Myers LE, Eskelson CD, Zeigler EJ: Iatrogenic administration of formaldehyde to hemodialysis patients. Proc Dial Transplant Forum 3: 141, 1973Google Scholar
  73. 73.
    Lufft V, Schindler R, Lonneman G, Shaldon S, Koch KM: Adsorption of exogenous pyrogen (EP) onto new and reused high flux dialyzers (abstract). Nephrol Dial Transplant 7:129, 1992Google Scholar
  74. 74.
    Oliver JC, Bland LA, Oettinger CW et al.: Bacteria and endotoxin removal from bicarbonate dialysate fluids for use in conventional, high-efficiency and high flux hemodialysis. Artif Organs 16: 141, 1992PubMedCrossRefGoogle Scholar
  75. 75.
    Lonnemann G, Bingel M, Floege J, Koch KM, Shaldon S, Dinarello CA: Detection of endotoxin-like interleukin-1 inducing activity during in vitro dialysis. Kidney Int 33: 29, 1988PubMedCrossRefGoogle Scholar
  76. 76.
    Vanholder R, Vanhaecke E, Ringoir S: Waterborne Pseudomonas septicemia. Am Soc Artif Int Org Trans 36: 215, 1990Google Scholar
  77. 77.
    Bland LA, Arduino MJ, Aguero SM, Favero MS: Recovery of bacteria from reprocessed high flux dialyzers after bacterial contamination of the header spaces and O-rings. Trans Am Soc Artiflnt Organs 35: 314, 1989Google Scholar
  78. 78.
    Nolph KD, Ahearn DJ, Esterly JA, Maher JF: Irreversible, morphological and functional changes in hollow fiber kidneys with a single dialysis. Trans Am Soc Artif Int Organs 20: 604, 1974Google Scholar
  79. 79.
    Lazarus JM, Friedlich RA, Merrill JP: Hollow fiber kidney reuse. Dial Transplant 2: 14, 1973Google Scholar
  80. 80.
    Sherman RA, Cody RP, Rogers ME, Solanchick JC: The effect of dialyzer reuse on dialysis delivery. Am J Kid Dis. In pressGoogle Scholar
  81. 81.
    Jacobs C, Brunner FP, Chantier C et al.: Combined reports on regular dialysis and transplantation in Europe. VII. Proc Eur Dial Transplant Assoc 14: 3, 1977Google Scholar
  82. 82.
    Pollak V, Kant K, Parnell S et al.: Repeated use of dialyzers is safe: long term observations on morbidity and mortality in patients with end stage renal disease. Nephron 42: 217, 1986PubMedGoogle Scholar
  83. 83.
    Held PJ, Pauly MV, Diamond L: Survival analysis of patients undergoing dialysis. J Am Med Assoc 257: 645, 1987CrossRefGoogle Scholar
  84. 84.
    Luehmann DA, Cosentino LC: Safety of dialyzer reuse with Renalin: the untold story. Dial Transplant 23: 248, 1994Google Scholar
  85. 85.
    Held PJ, Wolfe RA, Gaylin DS et al.: Analysis of the association of dialyzer reuse practices and patient outcomes. Am J Kid Dis 23: 692, 1994PubMedGoogle Scholar
  86. 86.
    Kjellstrand CJ: The search for scientific truth versus corporate interests (editorial). Sem Dial 6: 281, 1993CrossRefGoogle Scholar
  87. 87.
    US Department of Health and Human Services: Food and Drug Administration. Quality Assurance Guidelines for Hemodialysis Devices, 1991Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Anne Marie V. Miles
    • 1
  • Eli A. Friedman
    • 2
  1. 1.SUNY-Health Science Center at BrooklynBrooklynUSA
  2. 2.SUNY Health Science CenterBrooklynUSA

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