Abandoning peracetic acid-based dialyzer reuse is associated with improved survival.
OBJECTIVE
Higher mortality risk reported with reuse versus single use of dialyzers is potentially related to reuse reagents that modify membrane surface characteristics and the blood-membrane interface. A key mechanism may involve stimulation of an inflammatory response.


METHODS
In a prospective crossover design, laboratory markers and mortality from 23 hemodialysis facilities abandoning reuse with peracetic acid mixture were tracked. C-reactive protein (CRP), white blood cell (WBC) count, albumin, and prealbumin were measured for 2 consecutive months before abandoning reuse and subsequently within 3 and 6 months on single use. Survival models were utilized to compare the 6-month period before abandoning reuse (baseline) and the 6-month period on single use of dialyzers after a 3-month "washout period."


RESULTS
Patients from baseline and single-use periods had a mean age of approximately 63 years; 44% were female, 54% were diabetic, 60% were white, and the mean vintage was approximately 3.2 years. The unadjusted hazard ratio for death was 0.70 and after case-mix adjustment was 0.74 for single use compared with reuse. Patients with CRP≥5 mg/L during reuse (mean CRP=26.6 mg/ml in April) declined on single use to 20.2 mg/L by August and 20.4 mg/L by November. WBC count declined slightly during single use, but nutritional markers were unchanged.


CONCLUSIONS
Abandonment of peracetic-acid-based reuse was associated with improved survival and lower levels of inflammatory but not nutritional markers. Further study is needed to evaluate a potential link between dialyzer reuse, inflammation, and mortality.
Clinical Sciences, Epidemiology, and Research, Fresenius Medical Care, North America, 920 Winter Street, Waltham, MA 02451-1457, USA. elacsonj@fmc-na.com
Eduardo
E
Lacson
Weiling
W
Wang
Ann
A
Mooney
Norma
N
Ofsthun
J Michael
JM
Lazarus
Raymond M
RM
Hakim
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D004202:Disinfectants; D004209:Disposable Equipment; D004866:Equipment Contamination / Q000517:prevention & control*; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008422:Materials Testing; D008567:Membranes, Artificial; D008875:Middle Aged; D009656:North America; D009752:Nutritional Status; D010463:Peracetic Acid; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D004202:Disinfectants; D018836:Inflammation Mediators; D008567:Membranes, Artificial; D011228:Prealbumin; D002097:C-Reactive Protein; D010463:Peracetic Acid