Abstract
The practice of reprocessing and reusing hemodialyzers can be traced to the very origins of chronic hemodialysis. The basic process associated with the reuse of hemodialyzers remains the same after over 50 years of practice: upon completion of a dialysis treatment the used dialyzer is cleaned, tested for efficacy and integrity, high-level disinfected or sterilized, and stored in a controlled environment for subsequent use. Reprocessing can be performed manually or by automated reprocessing systems. Automated systems provide control and consistency to the process. Chemical cleaning agents associated with dialyzer reprocessing include bleach, hydrogen peroxide and peracetic acid. Commonly used chemical disinfectants and sterilants include formaldehyde, and peracetic acid. A processing substituting heated citric acid for chemical germicides has been used on a limited basis. Advantages associated with dialyzer reuse include economic, efficacy and environmental returns while disadvantages include possible increased infections, exposure to chemical agents, development of antibodies and changes in dialyzer performance. Current controversies associated with dialyzer reuse are linked to studies documenting switching from reusing dialyzers to using disposable dialyzers by a single provider in the United States. The future of dialyzer reprocessing is linked to the same economic factors that initially promoted the practice.
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References
AAMI: Recommended Practice for Reuse of Hemodialyzers. Association for Advancement of Medical Instrumentation, Arlington (2008)
Arduino, M., McAllister, S., Bland, L.: Assuring Proper Germicide Concentrations in Reprocessed Hemodialyzers. Dial. Transplant. 22(11), 652–656 (1993)
Beck-Sague, C., Jarvis, W., Bland, L., et al.: Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am. J. Nephrol. 10(5), 397–403 (1990)
Berkseth, R., Luehmann, D., McMichael, C., et al.: Peracetic acid for reuse of hemodialyzers, clinical studies. Trans. Am. Soc. Artif. Intern. Organs 30, 270–274 (1984)
Bland, L., Arduino, M., Aguero, et al.: Recovery of bacteria from reprocessed high flux dialyzers after bacterial contamination of the header spaces and o-rings. ASAIO Trans. 35(3), 314–316 (1989)
Block, S.S.: Disinfection, Sterilization and Preservation, 5th edn., p. 192. Lippincott, Williams and Wilkins, Philadelphia (2001)
Bond, T.C., Nissesnson, A.R., Krishnan, M., et al.: Dialyzer Reuse and Peracetic Acid and Patient Mortality. CJASN ePress (2011) (published on May 12, 2011), doi:10.2215/cjn.10391110
Carlson, W.G.: Reuse: what does the industry think? Nephrol. News Issues 18(11), 95, 97 (2004)
CDC: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. MMWR Recomm Rep. 50(RR-5), 1–43 (2001), http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.html (accessed January 06, 2011)
Clorox Company: Clorox Regular-Bleach, Material Safety Data Sheet (2010), http://www.thecloroxcompany.com/products/msds/bleach/cloroxregularbleach0505_.pdf (accessed January 31, 2011)
Collins, A.J., Ma, J.Z., Constantini, E.G., Everson, S.E.: Dialysis Unit and Patient Characteristics Associates with Reuse Practices and Mortality: 1989 - 1993. J. Am. Soc. Nephrol. 9(11), 2108–2117 (1998)
Deane, N., Wineman, R.R.: Replacement of Renal Function by Dialysis: a textbook of Dialysis, 3rd edn., pp. 400–405. Kluwer, Dordrecht (1989)
Dennis Jr., M.B., Vizzo, J., Cole, J., et al.: Comparison of four methods of cleaning hollow-fiber dialyzers for reuse. Artif. Organs 10(6), 448–451 (1986)
Fan, Q., Liu, J., Ebben, J.P., et al.: Reuse-Associated Mortality in Incident Hemodialysis Patients in the United States, 2000 to 2001. Am. J. Kidney Dis. 46(4), 661–668 (2005)
Fleming, S., Foreman, K., Shanley, K., et al.: Dialyzer reprocessing with Renalin. Am. J. Nephrol. 11, 27–31 (1991)
Fresenius Medical Care, Annual Report (2009), http://www.fmc.com/portals/corp/sec/2009_FMC_Annual_Report.pdf (accessed January 31, 2011)
Gordon, S., Tipple, M., Bland, L., et al.: Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers. JAMA 260(14), 2077–2081 (1988)
Gotch, F.A.: Mass Transport in Reused Dialyzers. Proc. Clin. Dial. Transplant. Forum 10, 81–85 (1980)
Graeber, C.W., Halley, S., Lapkin, R., et al.: Protein losses with reused dialyzers. J. Amer. Soc. Nephrol. 4(3), 349 (1993)
Held, P., Wolfe, R., Gaylin, D., et al.: Analysis of the association of dialyzer reuse practices and patient outcomes. American Journal of Kidney Diseases 23(5), 692–708 (1994)
Howell, E.D., Perkins, H.A.: Anti-N-like antibodies in the sera of patients undergoing haemodialysis. Vox Sang 23, 291–299 (1972)
Kaehny, W.D., Miller, G.E., White, W.L.: Relationship between dialyzer reuse and the presence od anti-N-like antibodies in chronic hemodialysis patients. Kidney Int. 12, 59–65 (1997)
Lacson Jr, E., Wang, W., Monney, A., et al.: Abandoning Peracetic Acid-Based Dialyzer Reuse Is Associated with Improved Survival. Clin. J. Am. Soc. Nephrol. 6(2), 297–302 (2011)
Levin, N.W., Parnell, S.L., Prince, H.N., et al.: The use of heated citric acid for dialyzer reprocessing. J. Am. Soc. Nephrol. 6(6), 1578–1585 (1995)
Leypoldt, J.K., Cheung, A.K., Deeter, R.B.: Effect of Hemodialyzer Reuse: Dissociation Between Clearances and Small and Large Solutes. Am. J. Kidney Dis. 32(2), 295–301 (1998)
Lowrie, E.G., Zhensheng, L., Ofsthun, N., et al.: Reprocessing dialyzers for multiple uses: recent analysis of death risks for patients. Nephrol. Dial. Transplant. 19(11), 2823–2830 (2004)
Luehmann, D., Hirsch, D., Carlson, G., et al.: Dialyzer reuse in a large dialysis program. Trans. Am. Soc. Artif. Intern. Organs 28, 76–82 (1982)
Luehmann, D., Carlson, G., Keshaviah, P., et al.: Reuse of the model 4 Cordis Dow artificial kidney (CDAK-4). Proc. Clin. Dial. Transplant. Forum 4, 220–223 (1974)
Luehmann, D.A., Cosintino, L.C.: Safety of Dialyzer Reuse with Renalin: The Untold Story. Dial. Transplant. 23(5), 248–258 (1994)
Luehmann, D.: Dialyzer Reprocessing. Minntech Corporation, Minneapolis (1990)
Marshall, C., Shimizu, A., Smith, E.K., et al.: Ethylene oxide allergy in a dialysis center: prevalence in hemodialysis and peritoneal dialysis populations. Clin. Nephrol. 21(6), 346–349 (1984)
Mason, R.G., Zucker, W.H., Bilinsky, R.T., et al.: Blood Components Deposited On Used and Reused Dialysis Membranes. Biomat. Med. Dev., Art. Org. 4(3 & 4), 333–358 (1976)
Miach, P., Evans, S., Wilcox, A., et al.: Reuse of a disposable dialyzer for home dialysis. Med. J. 1(6), 146–147 (1976)
Minntech Corp., Renalin Directions for Use, p. 16 (2004)
Murthy, B.V., Sundaram, S., Jaber, B.L., et al.: Effect of formalde-hyde/bleach reprocessing on in vivo performances of high-efficiency cellulose and high-flux polysulfone dialyzers. J. Am. Soc. Nephrol. 9(3), 464–472 (1998)
Nissenson, A.R., Fine, R.N.: Clinical Dialysis, 4th edn. Mcgraw-Hill, New York (2005)
Ogden, D.A.: New-dialyzer syndrome. N. Engl. J. Med. 302(22), 1262–1263 (1980)
Renalin® 100 Cold Sterilant Concentrate Instructions for Use, p. 11
Shaldon, S., Silva, H., Rosen, M.: Technique of refrigerated coil preservation haemidialysis with femoral venous catheritization. Br. Med. J. 2(5406), 411–413 (1964)
Sharon, R.: Relationship between formaldehyde-related antibodies and cross-reacting anti-N-like antibodies in patients undergoing chronic haemodialysis. J. Clin. Pathol. 34(1), 41–43 (1981)
Siemsen, A., Lumeng, J., Wong, E., et al.: Clinical and laboratory evaluation of coil reuse. Trans. Am. Soc. Artif. Organs 20, 589–594 (1974)
United States Environmental Protection Agency (USEPA), Integrated Risk Information system (IRIS) on Formaldehyde. National Center for Environmental Assessment, Office of research and Development, Washington, DC (1999)
US Renal Data System Annual Report (USRDS). National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md (2006)
Vanholder, R., Vanhaecke, E., Ringoir, S.: Waterborne pseudomonas septicemia. ASAIO Trans. 36(3), M215–M216 (1990)
Varughese, P.M., Andrysiak, P.: Dialyzer Reuse. In: Curtis, J., Varrughese, P. (eds.) Dialysis Technology: A Manual for Dialysis Technicians, 2nd edn. National Association of Nephrology Technicians/Technologists, Dayton, OH (2000)
Vercellone, A., Piccolo, G., Aloatti, S., et al.: Reuse of hemodialyzers. Dial. and Transplant. 7, 350–359 (1978)
Walker, F.J.: Commercial Formaldehyde Soultions. In: Formaldehyde, 3rd edn. Kreiger, New York (1975)
Ward, R.A., Ouseph, R.: Impact of bleach cleaning on the performance of dialyzers with polysulfone membranes processed for reuse using peracetic acid. Artif. Organs 27(11), 1029–1034 (2003)
William, A.R., Weber, D.J.: Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities (2008), http://www.premierinc.com/safety/topics/guidelines/downloads/Disinfection_Nov_2008.pdf (accessed January 6, 2011)
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Carlson, W. (2013). Dialyzer Reprocessing. In: Azar, A. (eds) Modelling and Control of Dialysis Systems. Studies in Computational Intelligence, vol 404. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27458-9_10
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DOI: https://doi.org/10.1007/978-3-642-27458-9_10
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