title: Effect of dialyzer reuse on survival of patients treated with hemodialysis.
abstract: 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.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia 19104-6021, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Feldman
authors.forename: M
authors.initials: M
authors.lastname: Kinosian
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: C
authors.initials: C
authors.lastname: Simmons
authors.forename: J H
authors.initials: JH
authors.lastname: Holmes
authors.forename: M V
authors.initials: MV
authors.lastname: Pauly
authors.forename: J J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004202:Disinfectants; D017743:Equipment Reuse / Q000592:standards; D005260:Female; D005557:Formaldehyde; D005976:Glutaral; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D007688:Kidneys, Artificial / Q000592:standards; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010463:Peracetic Acid; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000295:instrumentation* / Q000401:mortality* / Q000592:standards; D013242:Sterilization; D016019:Survival Analysis; D014481:United States
chemical_list: D004202:Disinfectants; D005557:Formaldehyde; D010463:Peracetic Acid; D005976:Glutaral