The technology of dialyzer reuse.

Dialyzer reuse has become an integral part of chronic hemodialysis in the United States of America because it has large economic benefits which allow the use of expensive, biocompatible membranes, and the delivery of adequate dialysis therapy in the face of continued inflation of costs and fixed reimbursement. The conflict between patient safety and provider economic benefit has been resolved by the development of recommended practice guidelines by the Association for the Advancement of Medical Instrumentation. When followed carefully, disinfection of dialyzers for multiple reuse by the same patient is relatively safe and effective in eliminating infection, pyrogen reactions, and other potential complications associated with germicide use. However, despite all precautions, there appears to be consequences of certain germicides, such as formaldehyde, that are difficult to eliminate, such as anti-N antibody. The development of heat or heat and 1.5% citric acid would appear to eliminate all these problems, and offers a safe, effective, and cost saving method for reuse of polysulfone dialyzers. Allegations of increased mortality with certain germicides, reuse techniques, and treatment settings, as well as the contribution of reuse to inadequate dialysis remain unproven and require further investigation.