title: Dialyzer reuse and mortality risk in patients with end-stage renal disease: a systematic review.
abstract: OBJECTIVE
  Robust evidence about dialyzer reuse effects on mortality is not available. Our aim was to summarize the evidence for the effectiveness of dialyzer reuse compared to single use in patients with end-stage renal disease.
  
  
  METHODS
  We searched MEDLINE, Embase, CINAHL, SciELO, LILACS, USRDS ADR, universities' theses databases and annals of congress from major nephrology societies. Reviewers performed the study selection and data extraction independently. We used the GRADE approach to assess the quality of the evidence. Mortality was the primary outcome.
  
  
  RESULTS
  A total of 1,190 studies were retrieved, and 14 were included in the review (n = 956,807 patients). The disinfectants used on dialyzer reprocessing were hypochlorite, formaldehyde, glutaraldehyde, and peracetic acid. The evidence available from the studies was of very low quality. Most studies found no differences between groups. In studies with statistically significant differences, these differences were not observed in all groups and they varied by the type of disinfectant, time of observation and treatment unit.
  
  
  CONCLUSIONS
  No significant differences were identified for the superiority or inferiority of dialyzer reuse versus single use when assessing the mortality of patients with end-stage renal disease. Studies of higher quality, including randomized clinical trials, are required to provide conclusive evidence regarding the effectiveness and safety of dialyzer reuse.
authors.affiliation: Faculty of Medicine, University of Brasilia, Brazil. taisgalvao@gmail.com
authors.forename: Tais Freire
authors.initials: TF
authors.lastname: Galvao
authors.forename: Marcus Tolentino
authors.initials: MT
authors.lastname: Silva
authors.forename: Maria Elizete de Almeida
authors.initials: ME
authors.lastname: Araujo
authors.forename: Wilson Seffair
authors.initials: WS
authors.lastname: Bulbol
authors.forename: Angela Libia de Melo Pereira
authors.initials: AL
authors.lastname: Cardoso
mesh_terms: D004203:Disinfection / Q000379:methods*; D017743:Equipment Reuse; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D006435:Renal Dialysis / Q000295:instrumentation*