Reuse-associated mortality in incident hemodialysis patients in the United States, 2000 to 2001.
BACKGROUND
The impact of dialyzer reuse on the mortality of hemodialysis patients is debated. This study assesses reuse-associated mortality across US dialysis provider systems (for-profit, not-for-profit; hospital-based, and freestanding units) in incident patients.


METHODS
Incident Medicare hemodialysis patients who initiated dialysis therapy from January 1, 2000, to December 31, 2001, were included and followed up to December 31, 2002. A 3-month entry period was used to determine comorbidity and disease severity. Applying various analytic approaches, mortality rates for patients treated with reused (or reprocessed) or single-use dialyzers were compared. Because of differences among dialysis units, facility clustering was addressed.


RESULTS
Of 75,831 patients, 61,391 patients (81.0%) were classified as on reuse, and 14,440 patients (19.0%), as on single use, as of the start of follow-up. The overall mortality rate was 25.0/100 patient-years. No difference in mortality risk was found between patients treated with reuse compared with single use in an intent-to-treat approach (hazard ratio, 0.98; 95% confidence interval, 0.94 to 1.02; P = 0.266) after adjusting for chain affiliation, for-profit status, year of dialysis inception, age, sex, race, renal diagnosis, comorbidity, and hospitalization days. Findings were similar in an as-treated approach (hazard ratio, 0.97; 95% confidence interval, 0.93 to 1.01; P = 0.136). No survival advantage associated with single use was found for subgroups.


CONCLUSIONS
No overall survival advantage or disadvantage is associated with dialyzer reuse compared with single use in incident hemodialysis patients in the United States; however, continued monitoring is advised.
Fan
Qiao
Q
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Liu
Jiannong
J
Ebben
James P
JP
Collins
Allan J
AJ
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D017743:Equipment Reuse / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006436:Hemodialysis Units, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D015993:Life Tables; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000295:instrumentation*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology