BACKGROUND AND OBJECTIVES: Higher mortality risk reported with reuse versus single use of dialyzers is potentially related to reuse reagents that modify membrane surface characteristics and the blood-membrane interface. A key mechanism may involve stimulation of an inflammatory response. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a prospective crossover design, laboratory markers and mortality from 23 hemodialysis facilities abandoning reuse with peracetic acid mixture were tracked. C-reactive protein (CRP), white blood cell (WBC) count, albumin, and prealbumin were measured for 2 consecutive months before abandoning reuse and subsequently within 3 and 6 months on single use. Survival models were utilized to compare the 6-month period before abandoning reuse (baseline) and the 6-month period on single use of dialyzers after a 3-month "washout period." RESULTS: Patients from baseline and single-use periods had a mean age of approximately 63 years; 44% were female, 54% were diabetic, 60% were white, and the mean vintage was approximately 3.2 years. The unadjusted hazard ratio for death was 0.70 and after case-mix adjustment was 0.74 for single use compared with reuse. Patients with CRP≥5 mg/L during reuse (mean CRP=26.6 mg/ml in April) declined on single use to 20.2 mg/L by August and 20.4 mg/L by November. WBC count declined slightly during single use, but nutritional markers were unchanged. CONCLUSIONS: Abandonment of peracetic-acid-based reuse was associated with improved survival and lower levels of inflammatory but not nutritional markers. Further study is needed to evaluate a potential link between dialyzer reuse, inflammation, and mortality.
BACKGROUND AND OBJECTIVES: Higher mortality risk reported with reuse versus single use of dialyzers is potentially related to reuse reagents that modify membrane surface characteristics and the blood-membrane interface. A key mechanism may involve stimulation of an inflammatory response. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a prospective crossover design, laboratory markers and mortality from 23 hemodialysis facilities abandoning reuse with peracetic acid mixture were tracked. C-reactive protein (CRP), white blood cell (WBC) count, albumin, and prealbumin were measured for 2 consecutive months before abandoning reuse and subsequently within 3 and 6 months on single use. Survival models were utilized to compare the 6-month period before abandoning reuse (baseline) and the 6-month period on single use of dialyzers after a 3-month "washout period." RESULTS:Patients from baseline and single-use periods had a mean age of approximately 63 years; 44% were female, 54% were diabetic, 60% were white, and the mean vintage was approximately 3.2 years. The unadjusted hazard ratio for death was 0.70 and after case-mix adjustment was 0.74 for single use compared with reuse. Patients with CRP≥5 mg/L during reuse (mean CRP=26.6 mg/ml in April) declined on single use to 20.2 mg/L by August and 20.4 mg/L by November. WBC count declined slightly during single use, but nutritional markers were unchanged. CONCLUSIONS: Abandonment of peracetic-acid-based reuse was associated with improved survival and lower levels of inflammatory but not nutritional markers. Further study is needed to evaluate a potential link between dialyzer reuse, inflammation, and mortality.
Authors: T Christopher Bond; Allen R Nissenson; Mahesh Krishnan; Steven M Wilson; Tracy Mayne Journal: Clin J Am Soc Nephrol Date: 2011-05-12 Impact factor: 8.237
Authors: Leonardo G Lopes; Larissa A Csonka; Jessica A Souza Castellane; Alef Winter Oliveira; Sílvio de Almeida-Júnior; Ricardo Andrade Furtado; Cibele Tararam; Larissa Ortolan Levy; Leandro Zuccolotto Crivellenti; Maria Luiza Moretti; Maria José S Mendes Giannini; Regina H Pires Journal: Front Cell Infect Microbiol Date: 2021-04-29 Impact factor: 5.293
Authors: Christos Argyropoulos; Maria-Eleni Roumelioti; Abdus Sattar; John A Kellum; Lisa Weissfeld; Mark L Unruh Journal: PLoS One Date: 2015-06-09 Impact factor: 3.240