title: Association of dialyzer reuse and hospitalization rates among hemodialysis patients in the US.
abstract: OBJECTIVE
  To determine if reuse of hemodialyzers is associated with higher rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients.
  
  
  METHODS
  Noncurrent cohort study of hospitalization rates among 27,264 ESRD patients beginning hemodialysis in the United States in 1986 and 1987.
  
  
  RESULTS
  Dialysis in free-standing facilities reprocessing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02-1.14). This higher rate of hospitalization was observed with dialyzer reuse using peracetic/acetic acids (RR = 1.11, CI 1. 04-1.18) and formaldehyde (RR = 1.07, CI 1.00-1.14), but not glutaraldehyde (p = 0.97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reprocessing. Hospitalization for causes other than vascular access morbidity in free-standing facilities reusing dialyzers with formaldehyde was not different from hospitalization in facilities not reusing. However, reuse with peracetic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03-1.15).
  
  
  CONCLUSIONS
  Dialysis in free-standing facilities reprocessing dialyzers with peracetic/acetic acids or formaldehyde was associated with greater hospitalization than dialysis without dialyzer reprocessing. This greater hospitalization accounts for a large increment in inpatient stays in the USA. These findings raise important concerns about potentially avoidable morbidity among hemodialysis patients.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Feldman
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: M
authors.initials: M
authors.lastname: Hackett
authors.forename: C W
authors.initials: CW
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: D015331:Cohort Studies; D017743:Equipment Reuse; D005260:Female; D006436:Hemodialysis Units, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D014481:United States
chemical_list: D008567:Membranes, Artificial