1
|
Optimal Time for Recirculation with Ultrafiltration to Remove Disinfectant in Reused Dialyzer. ASAIO J 2022; 68:1414-1418. [PMID: 36326706 DOI: 10.1097/mat.0000000000001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The practice of dialyzer reuse is common in developing countries. One essential technique for safe dialyzer reprocessing is to remove disinfectants properly to the recommended standards before treatment initiation, using dialysis machine recirculation with ultrafiltration. This study was conducted to identify the most effective time for carrying out this procedure, and the factors affecting it. We studied 420 high-flux dialyzers with three different membrane types: FB210U (cellulose triacetate), F80S (polysulfone), and Elisio-210HR (polyethersulfone) at four reused cycles (5th, 10th, 15th, and 19th). Peracetic acid was used as the disinfectant at a concentration of 0.16%. The total cell volume (TCV) and clot inspection grade of the reused dialyzer were recorded before the procedure. The optimal time for disinfectant removal was independently determined by two observers using the residual peroxide strip test of the ultrafiltrate. We observed that disinfectant removal was dependent on the recirculation time and became undetectable at 5 minutes. The type of dialyzer had a significant effect on the effective recirculation time (shortest for FB210U followed by Elisio-210HR and F80S; p < 0.001), but the reused number, TCV, and clot inspection grade did not. It is conceivable that the dialyzer membrane type might affect peracetic acid removal. In conclusion, the interval for carrying out dialysis machine recirculation with ultrafiltration depends on the dialyzer type, and 5 minutes is the optimal time for the operation. This result can be implemented to improve further practice in dialyzer reprocessing.
Collapse
|
2
|
Lopes LG, Csonka LA, Castellane JAS, Oliveira AW, de Almeida-Júnior S, Furtado RA, Tararam C, Levy LO, Crivellenti LZ, Moretti ML, Giannini MJSM, Pires RH. Disinfectants in a Hemodialysis Setting: Antifungal Activity Against Aspergillus and Fusarium Planktonic and Biofilm Cells and the Effect of Commercial Peracetic Acid Residual in Mice. Front Cell Infect Microbiol 2021; 11:663741. [PMID: 33996634 PMCID: PMC8116949 DOI: 10.3389/fcimb.2021.663741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aspergillus and Fusarium cause a broad spectrum of infections in humans, mainly in immunocompromised patients. Among these, patients undergoing hemodialysis are highly susceptible to infections, requiring a constant and adequate environmental disinfection program. Nevertheless, monitoring the residual disinfectants can contribute to the morbidity and mortality reduction in these patients. Here, we evaluated the susceptibility of Aspergillus spp. (n=19) and Fusarium spp. (n=13) environmental isolates against disinfectants (acetic acid, citric acid, peracetic acid, sodium hypochlorite, and sodium metabisulphite) at different concentrations and time exposures. Also, we investigated the in vivo toxicity of the peracetic acid residual concentration in mice. Fusarium isolates were identified by F. equiseti, F. oxysporum and F. solani while Aspergillus presented clinically relevant species (A. fumigatus, A. niger and A. terreus) and environmental ones. Against planktonic cells, only two disinfectants (acetic acid and sodium hypochlorite) showed a fungicidal effect on Fusarium spp., while only one (sodium hypochlorite) was effective against Aspergillus spp. Both fungi formed robust in vitro biofilms with large amounts of the extracellular matrix, as evidenced by electron micrographs. Exposure of fungal biofilms to disinfectants showed sensitivity to three (acetic, citric, and peracetic acids), although the concentrations and times of exposure varied according to the fungal genus. Mice exposure to the residual dose of peracetic acid during 60 weeks showed anatomopathological, hematological, and biochemical changes. The implementation of news control measures and those that already exist can help reduce infections, the second cause of death and morbidity in these patients, besides providing safety and well-being to them, a priority of any quality health program.
Collapse
Affiliation(s)
- Leonardo G. Lopes
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | - Larissa A. Csonka
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | | | | | | | | | - Cibele Tararam
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | - Regina H. Pires
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| |
Collapse
|
3
|
Ribeiro IC, Roza NAV, Duarte DA, Guadagnini D, Elias RM, Oliveira RBD. Clinical and microbiological effects of dialyzers reuse in hemodialysis patients. J Bras Nefrol 2019; 41:384-392. [PMID: 30720850 PMCID: PMC6788851 DOI: 10.1590/2175-8239-jbn-2018-0151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/09/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: Chronic kidney disease (CKD) has a high prevalence and is a worldwide public
health problem. Reuse of dialyzers is a cost reduction strategy used in many
countries. There is controversy over its effects on clinical parameters and
microbiological safety. Methods: In this clinical crossover study, 10 patients performed consecutive
hemodialysis (HD) sessions divided in two phases: "single use" sessions (N =
10 HD sessions) followed by "dialyzer reuse" sessions (N = 30 HD sessions).
Clinical, laboratory, and microbiological parameters were collected in the
following time points: "single use", 1st, 6th, and
12th sessions with reuse of dialyzers, including bacterial
cultures, endotoxins quantification in serum and dialyzer blood chamber, and
detection of hemoglobin and protein residues in dialyzers. Results: Mean age of the sample was 37 ± 16 years, 6 (60%) were men, and 5
(50%) were white. CKD and HD vintage were 169 ± 108 and 47 (23-111)
months, respectively. Serum C-reactive protein (CRP) [4.9 (2.1) mg/mL],
ferritin (454 ± 223 ng/mL), and endotoxin levels [0.76 (0.61-0.91)
EU/mL] were high at baseline. Comparison of pre- and post-HD variations of
serum levels of CRP and endotoxins in the "single use" versus "reuse" phases
did not result in differences (p = 0.8 and 0.4,
respectively). Samples of liquid in the dialyzer inner chamber were negative
for the growth of bacteria or endotoxins. There was no significant clinical
manifestation within and between the phases. Conclusion: Dialyzers reuse was safe from a clinical, microbiological, and inflammatory
point of view. The dialyzer performance remained adequate until the
12th reuse.
Collapse
Affiliation(s)
- Isabella Carvalho Ribeiro
- Universidade Estadual de Campinas, Serviço de Nefrologia do Hospital de Clínicas, Campinas, SP, Brasil.,Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Noemí Angelica Vieira Roza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Diego Andreazzi Duarte
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Dioze Guadagnini
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Rosilene Motta Elias
- Universidade de São Paulo, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Serviço de Nefrologia do Hospital de Clínicas, Campinas, SP, Brasil.,Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| |
Collapse
|
4
|
Silva OMD, Proença MCDC, Vicari AR, Fengler KPM, Karohl C, Rabelo-Silva ER. Occupational hazards for nursing professionals related to the reuse and single use of the dialyzer. Rev Esc Enferm USP 2018; 52:e03389. [PMID: 30570080 DOI: 10.1590/s1980-220x2017045403389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the reports of occupational events recorded by nursing professionals during the periods of reuse and single use of the dialyzer. METHOD Retrospective longitudinal study with electronic medical records from nursing technicians of a hemodialysis service. Data were analyzed descriptively and Rate ratio. RESULTS During the reuse of the dialyzer, there were seven events from five professionals reporting musculoskeletal disorders, ocular allergies and dermatosis. During single use, two professionals reported low back pain. The rate ratio of medication use was 6.7 days for every 1000 professionals during the reuse period and 1.52 days in the single use period (RR=4.4; 95% CI 2.182-9.805). Anti-inflammatory drugs were the most prescribed, and sick leaves were similar in both periods. CONCLUSION Dialyzer reuse was associated with musculoskeletal disorders, ocular irritation, dermatosis and increased use of medications by professionals. Sick leaves were similar on the periods of dialyzer reuse and single use.
Collapse
Affiliation(s)
| | | | | | | | - Cristina Karohl
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brasil
| | | |
Collapse
|
5
|
Gabbay E, Meyer KB. Amazing and Fantastic Infection Control: The Case of Dialyzer Reuse. Am J Kidney Dis 2018; 69:717-719. [PMID: 28532633 DOI: 10.1053/j.ajkd.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ezra Gabbay
- Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
6
|
Edens C, Wong J, Lyman M, Rizzo K, Nguyen D, Blain M, Horwich-Scholefield S, Moulton-Meissner H, Epson E, Rosenberg J, Patel PR. Hemodialyzer Reuse and Gram-Negative Bloodstream Infections. Am J Kidney Dis 2016; 69:726-733. [PMID: 27940061 DOI: 10.1053/j.ajkd.2016.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/19/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization. STUDY DESIGN Outbreak investigation, including matched case-control study. SETTING & PARTICIPANTS Hemodialysis patients treated in multiple outpatient clinics owned by a dialysis organization. PREDICTORS Main predictors were dialyzer reuse, dialyzer model, and dialyzer reprocessing practice. OUTCOMES Case patients had a bloodstream infection caused by B cepacia or S maltophilia; controls were patients without infection dialyzed at the same clinic on the same day as a case; results of environmental cultures and organism typing. RESULTS 17 cases (9 B cepacia and 8 S maltophilia bloodstream infections) occurred in 5 clinics owned by the same dialysis organization. Case patients were more likely to have received hemodialysis with a dialyzer that had been used more than 6 times (matched OR, 7.03; 95% CI, 1.38-69.76) and to have been dialyzed with a specific reusable dialyzer (Model R) with sealed ends (OR, 22.87; 95% CI, 4.49-∞). No major lapses during dialyzer reprocessing were identified that could explain the outbreak. B cepacia was isolated from samples collected from a dialyzer header-cleaning machine from a clinic with cases and was indistinguishable from a patient isolate collected from the same clinic, by pulsed-field gel electrophoresis. Gram-negative bacteria were isolated from 2 reused Model R dialyzers that had undergone the facility's reprocessing procedure. LIMITATIONS Limited statistical power and overmatching; few patient isolates and dialyzers available for testing. CONCLUSIONS This outbreak was likely caused by contamination during reprocessing of reused dialyzers. Results of this and previous investigations demonstrate that exposing patients to reused dialyzers increases the risk for bloodstream infections. To reduce infection risk, providers should consider implementing single dialyzer use whenever possible.
Collapse
Affiliation(s)
- Chris Edens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Jacklyn Wong
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; California Department of Public Health, Richmond, CA
| | - Meghan Lyman
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kyle Rizzo
- California Department of Public Health, Richmond, CA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michela Blain
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin Epson
- California Department of Public Health, Richmond, CA
| | - Jon Rosenberg
- California Department of Public Health, Richmond, CA
| | - Priti R Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
7
|
Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transplant 2015; 31:1251-61. [PMID: 26109485 DOI: 10.1093/ndt/gfv233] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.
Collapse
Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, University Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
8
|
Argyropoulos C, Roumelioti ME, Sattar A, Kellum JA, Weissfeld L, Unruh ML. Dialyzer Reuse and Outcomes of High Flux Dialysis. PLoS One 2015; 10:e0129575. [PMID: 26057383 PMCID: PMC4461247 DOI: 10.1371/journal.pone.0129575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 05/11/2015] [Indexed: 11/23/2022] Open
Abstract
Background The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Methods Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. Findings In HEMO, minimally reused (< 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48–0.92, p = 0.015), 0.64 (95%CI: 0.44 – 0.95, p = 0.03), 0.61 (95%CI: 0.41 – 0.90, p = 0.012), 0.53 (95%CI: 0.28 – 1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51–0.78) for non-reused HF dialyzers compared with non-reused LF membranes. Conclusions This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.
Collapse
Affiliation(s)
- Christos Argyropoulos
- Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuqurque, New Mexico, United States of America
- * E-mail:
| | - Maria-Eleni Roumelioti
- Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuqurque, New Mexico, United States of America
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - John A. Kellum
- Department of Critical Care Medicine, CRISMA Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lisa Weissfeld
- Department of Critical Care Medicine, CRISMA Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Biostatistics University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mark L. Unruh
- Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuqurque, New Mexico, United States of America
| |
Collapse
|
9
|
Denny GB, Golper TA. Does hemodialyzer reuse have a place in current ESRD care: "to be or not to be?". Semin Dial 2014; 27:256-8. [PMID: 24649806 DOI: 10.1111/sdi.12232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gerald B Denny
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
10
|
Yamamoto T, Nascimento MM, Hayashi SY, Qureshi AR, Waniewski J, Brodin LÅ, Anderstam B, Lind B, Riella MC, Seeberger A, Lindholm B. Changes in circulating biomarkers during a single hemodialysis session. Hemodial Int 2012; 17:59-66. [PMID: 22716238 DOI: 10.1111/j.1542-4758.2012.00720.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The hemodialysis (HD) procedure induces an inflammatory response potentially contributing to cardiovascular disease. Here we investigated the acute impact of HD on circulating biomarkers. Circulating biomarkers (small solutes, middle molecular-sized peptides, and proteins) related to inflammation, oxidative stress, and vascular calcification (VC) were measured before and after a single session of HD in 45 clinically stable patients. Concentrations were corrected for ultrafiltration-induced hemoconcentration. Among vascular calcification-related biomarkers, osteoprotegerin and fetuin-A remained unchanged while fibroblast growth factor-23 (FGF23) decreased by -19%. Changes of FGF23 and changes of phosphate correlated (ρ = 0.61, P < 0.001). While C-reactive protein did not change, interleukin-6 (IL-6) increased by 14% and pentraxin 3 (PTX3) increased by 45%. IL-6 and PTX3 appear to be valid biomarkers of the intradialytic inflammatory response. VC-related markers were in general not affected by the single HD session; however, the observed correlation between acute changes of FGF-23 and phosphate during HD warrants further studies.
Collapse
Affiliation(s)
- Tae Yamamoto
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Spiegel DM. Avoiding harm and achieving optimal dialysis outcomes--the dialysate component. Adv Chronic Kidney Dis 2012; 19:166-70. [PMID: 22578676 DOI: 10.1053/j.ackd.2012.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/20/2012] [Accepted: 03/20/2012] [Indexed: 11/11/2022]
Abstract
Appropriate dialysate composition is critical for effective and safe hemodialysis. Unfortunately, there are few randomized trials to guide practice, and although solute clearance is well understood, there is a limited understanding of balance in dialysis patients. The current practice of simply trying to normalize serum electrolyte and mineral concentrations measured predialysis may not provide optimal care. More thought should be given to normalizing balance with respect to sodium, bicarbonate, magnesium, and potassium and minimizing wide swings in serum concentrations that may have adverse effects. In practice, this would require longer or more frequent dialysis with less steep chemical gradients. With respect to calcium, the goal should be to optimize bone and vascular health. Clinicians should also be mindful that the dialysis procedure itself exposes patients to potential toxins, and efforts to minimize these risks should be stressed.
Collapse
|
12
|
Galvao TF, Silva MT, Araujo MEDA, Bulbol WS, Cardoso ALDMP. Dialyzer reuse and mortality risk in patients with end-stage renal disease: a systematic review. Am J Nephrol 2012; 35:249-58. [PMID: 22353780 DOI: 10.1159/000336532] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/14/2012] [Indexed: 11/19/2022]
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.
Collapse
|
13
|
Sherman RA. Briefly Noted. Semin Dial 2011. [DOI: 10.1111/j.1525-139x.2011.00944.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Bond TC, Nissenson AR, Krishnan M, Wilson SM, Mayne T. Dialyzer reuse with peracetic acid does not impact patient mortality. Clin J Am Soc Nephrol 2011; 6:1368-74. [PMID: 21566107 DOI: 10.2215/cjn.10391110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND 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, & MEASUREMENTS We 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. RESULTS In 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. CONCLUSIONS Despite 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.
Collapse
|