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Effect of dialyzer reuse on survival of patients treated with hemodialysis. 1996

H I Feldman, and M Kinosian, and W B Bilker, and C Simmons, and J H Holmes, and M V Pauly, and J J Escarce
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia 19104-6021, USA.

OBJECTIVE To evaluate the impact of dialyzer reuse on the survival of US hemodialysis patients. METHODS Nonconcurrent cohort study of 27938 patients beginning hemodialysis in the United States in 1986 and 1987. METHODS Patient survival. RESULTS Dialysis in freestanding facilities reprocessing dialyzers with the combination of peracetic and acetic acids was associated with greater mortality than treatment in facilities not reprocessing dialyzers (rate ratio [RR],1.10, 95% confidence interval [CI], 1.02-1.18; P=.02) In contrast, there was no significant difference between survival in freestanding facilities reprocessing dialyzers with either formaldehyde (RR,1.03, 95% CI, 0.96-1.10; P=.45) or glutaraldehyde (RR, 1.13, 95% CI, 0.95-1.35, P=.18) and survival in freestanding facilities not reprocessing dialyzers. Among freestanding facilities reprocessing dialyzers, use of peracetic/acetic acid was associated with a higher rate of death than use of formaldehyde (RR = 1.08, 95% CI, 1.01-1.14; P=.02). There was no statistical difference between survival in hospital-based facilities reprocessing dialyzers with either peracetic/acetic acid (RR=0.95, 95% CI, 0.85-1.06; P=.40), formaldehyde (RR=1.06, 95% CI, 0.98-1.15; P=.12), or glutaraldehyde (RR=1.09, 95% CI, 0.71-1.67; P=.70) and survival in hospital-based facilities not reprocessing dialyzers. In addition, choice of sterilant was not associated with a statistically significant difference in survival among hospital-based facilities reprocessing dialyzers. CONCLUSIONS Dialysis in freestanding facilities reprocessing dialyzers with peracetic/acetic acid may be associated with worse survival than dialysis in free-standing facilities not reprocessing dialyzers or in those reprocessing with formaldehyde. We were unable to determine whether these relationships arose from greater comorbidity among patients treated in facilities using peracetic/acetic acid, poor quality of dialysis procedures in these facilities, or direct toxicity of peracetic/acetic acid. These findings raise important concerns about potentially avoidable mortality among US hemodialysis patients treated in dialysis facilities reprocessing hemodialyzers.

UI MeSH Term Description Entries
D007676 Kidney Failure, Chronic The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION. ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D007688 Kidneys, Artificial Devices which can substitute for normally functioning KIDNEYS in removing components from the blood by DIALYSIS that are normally eliminated in the URINE. Artificial Kidney,Kidney, Artificial,Artificial Kidneys,Blood Dialyser,Blood Dialyzers,Hemodialyser,Hemodialyzers,Renal Dialysis Machine,Blood Dialysers,Blood Dialyzer,Dialyser, Blood,Dialysers, Blood,Dialysis Machine, Renal,Dialysis Machines, Renal,Dialyzer, Blood,Dialyzers, Blood,Hemodialysers,Hemodialyzer,Machine, Renal Dialysis,Machines, Renal Dialysis,Renal Dialysis Machines
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010463 Peracetic Acid A liquid that functions as a strong oxidizing agent. It has an acrid odor and is used as a disinfectant. Acetyl Hydroperoxide,Peroxyacetic Acid,Desoxone-1,Dialax,Peracetic Acid, Sodium Salt,Peroxyethanoic Acid,Sodium Peracetate,Zinc Peracetate,Acid, Peracetic,Acid, Peroxyacetic,Acid, Peroxyethanoic,Desoxone 1,Desoxone1,Peracetate, Sodium,Peracetate, Zinc
D004202 Disinfectants Substances used on inanimate objects that destroy harmful microorganisms or inhibit their activity. Disinfectants are classed as complete, destroying SPORES as well as vegetative forms of microorganisms, or incomplete, destroying only vegetative forms of the organisms. They are distinguished from ANTISEPTICS, which are local anti-infective agents used on humans and other animals. (From Hawley's Condensed Chemical Dictionary, 11th ed) Biocide,Disinfectant,Biocides
D005260 Female Females
D005557 Formaldehyde A highly reactive aldehyde gas formed by oxidation or incomplete combustion of hydrocarbons. In solution, it has a wide range of uses: in the manufacture of resins and textiles, as a disinfectant, and as a laboratory fixative or preservative. Formaldehyde solution (formalin) is considered a hazardous compound, and its vapor toxic. (From Reynolds, Martindale The Extra Pharmacopoeia, 30th ed, p717) Formalin,Formol,Methanal,Oxomethane
D005976 Glutaral One of the protein CROSS-LINKING REAGENTS that is used as a disinfectant for sterilization of heat-sensitive equipment and as a laboratory reagent, especially as a fixative. Glutaraldehyde,Cidex,Diswart,Gludesin,Glutardialdehyde,Glutarol,Korsolex,Novaruca,Sekumatic,Sonacide,Sporicidin
D006435 Renal Dialysis Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION. Dialysis, Extracorporeal,Dialysis, Renal,Extracorporeal Dialysis,Hemodialysis,Dialyses, Extracorporeal,Dialyses, Renal,Extracorporeal Dialyses,Hemodialyses,Renal Dialyses

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