National surveillance of dialysis associated diseases in the United States, 1992.
To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, completed a mail survey of chronic hemodialysis centers in the United States in 1992. Of 2,321 centers surveyed, 2,170 (93%) representing 170,028 patients and 43,535 staff members responded. In 1992, 2,049 (94%) centers used bicarbonate dialysate as the primary method of dialysis, 765 (35)% used high flux dialysis, and 1,569 (72%) reused dialyzers, continuing the trends toward increased use of these methods. Central (subclavian or jugular) venous catheters were used in > or = 1 patient as permanent vascular access for hemodialysis at 69% of dialysis centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence - 0.03%, prevalence = 0.3%). Among centers that had > or = 1 hepatitis B surface antigen positive patient, the incidence of hepatitis B virus infection was lower in those centers that used a separate room for dialysis of patients positive for hepatitis B surface antigen. From 1991 to 1992, reported hepatitis B vaccine coverage increased from 17% to 24% among patients and from 56% to 69% among staff members; in absolute terms, these were the largest single year increases since introduction of hepatitis B vaccine. The prevalence of antibody to hepatitis C virus was 8.1% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 19% of centers and associated with use of high flux dialysis. New dialyzer syndrome was reported by 24% of centers, most frequently by centers using regenerated cellulose or cuprophan membranes. Human immunodeficiency virus was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more patients infected with HIV.
Investigation and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333.
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Tokars
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Alter
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Favero
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Moyer
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Miller
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Bland
D000914:Antibodies, Viral / Q000032:analysis; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D015314:Dialysis Solutions; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006526:Hepatitis C / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008403:Mass Screening; D009784:Occupational Diseases / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D000914:Antibodies, Viral; D015314:Dialysis Solutions; D017325:Hepatitis B Vaccines