title: Dialyzer reuse with peracetic acid does not impact patient mortality.
abstract: OBJECTIVE
  Numerous studies have shown the overall benefits of dialysis filter reuse, including superior biocompatibility and decreased nonbiodegradable medical waste generation, without increased risk of mortality. A recent study reported that dialyzer reprocessing was associated with decreased patient survival; however, it did not control for sources of potential confounding. We sought to determine the effect of dialyzer reprocessing with peracetic acid on patient mortality using contemporary outcomes data and rigorous analytical techniques.
  
  
  METHODS
  We conducted a series of analyses of hemodialysis patients examining the effects of reuse on mortality using three techniques to control for potential confounding: instrumental variables, propensity-score matching, and time-dependent survival analysis.
  
  
  RESULTS
  In the instrumental variables analysis, patients at high reuse centers had 16.2 versus 15.9 deaths/100 patient-years in nonreuse centers. In the propensity-score matched analysis, patients with reuse had a lower death rate per 100 patient-years than those without reuse (15.2 versus 15.5). The risk ratios for the time-dependent survival analyses were 0.993 (per percent of sessions with reuse) and 0.995 (per unit of last reuse), respectively. Over the study period, 13.8 million dialyzers were saved, representing 10,000 metric tons of medical waste.
  
  
  CONCLUSIONS
  Despite the large sample size, powered to detect miniscule effects, neither the instrumental variables nor propensity-matched analyses were statistically significant. The time-dependent survival analysis showed a protective effect of reuse. These data are consistent with the preponderance of evidence showing reuse limits medical waste generation without negatively affecting clinical outcomes.
authors.affiliation: DaVita Inc., El Segundo, CA 90245, USA.
authors.forename: T Christopher
authors.initials: TC
authors.lastname: Bond
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wilson
authors.forename: Tracy
authors.initials: T
authors.lastname: Mayne
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D004202:Disinfectants; D004866:Equipment Contamination / Q000517:prevention & control*; D017743:Equipment Reuse; D004869:Equipment Safety; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008506:Medical Waste / Q000517:prevention & control; D008567:Membranes, Artificial; D008875:Middle Aged; D010463:Peracetic Acid; D057216:Propensity Score; D006435:Renal Dialysis / Q000295:instrumentation* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004202:Disinfectants; D008506:Medical Waste; D008567:Membranes, Artificial; D010463:Peracetic Acid