The effects of reprocessing high-flux polysulfone dialyzers with peroxyacetic acid on beta 2-microglobulin removal in hemodiafiltration.
The reuse of dialyzers is widely practiced, especially in the United States. Despite this, the effects of reuse on the efficacy of removal of solutes and more recently proteins such as beta 2-microglobulin (beta 2M) are the subject of much debate. There is considerable evidence to suggest that reuse after cleansing and sterilizing with formalin, with or without bleach, maintains dialyzer performance. In this study, we have examined peroxyacetic acid use as the cleansing and sterilizing agent using Renatron machines. We analyzed reuse in 24 patients using polysulfone membranes in a hemodiafiltration (HDF) unit over a 2-year period. The mean maximum number of uses achieved was 20.1 +/- 0.5. Several factors considered clinically to influence the number of reuses achievable (hemoglobin, white blood cell, and platelet levels, erythrocyte sedimentation rate [ESR], and fibrinogen and total protein levels) were found not to influence the maximum number of uses obtainable. We then assessed prospectively the performance of 26 polysulfone dialyzers after peroxyacetic acid reprocessing up to 20 times, particularly with regard to their ability to remove beta 2M. We report that this combination of polysulfone membranes reprocessed with peroxyacetic acid used for HDF up to 20 times exhibits a maintained high level removal of compounds beyond a molecular weight (MW) of 12,000. Any secondary membrane formation that occurs appears not to influence the subsequent removal of beta 2M. Thus, we would recommend the use of peroxyacetic acid for reprocessing dialyzers in a safe and efficacious manner.
Kerr
P G
PG
A.I.D.E.R., Montpellier, France.
Argiles
A
A
Canaud
B
B
Flavier
J L
JL
Mion
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015312:Hemodialysis Solutions; D006440:Hemofiltration / Q000295:instrumentation*; D006801:Humans; D008567:Membranes, Artificial; D008875:Middle Aged; D010463:Peracetic Acid; D011108:Polymers; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D013242:Sterilization / Q000379:methods; D013450:Sulfones; D001613:beta 2-Microglobulin
D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; D001613:beta 2-Microglobulin; C017662:polysulfone P 1700; D010463:Peracetic Acid