Reuse of dialyzers
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
Hemodialyzer reuse refers to the practice of using the dialyzer multiple times for a single patient. Dialyzer reuse appears to be a safe and cost-effective procedure for high-flux and high-urea removal dialyzers.
Reuse was commonly practiced in the United States during the 1980s through 1990s, largely for cost containment but also to reduce the incidence of inflammatory reactions due to blood-membrane interactions with bioincompatible cellulosic membranes [1-3]. The practice has markedly decreased since that time in the US, as has the use of bioincompatible membranes . In 2005, approximately 40 percent of dialysis units in the United States were thought to reuse dialyzers [2,3]. More recent data are not available, as the United States Renal Data System (USRDS) and the Centers for Disease Control (CDC) have stopped collecting information on re-use. Reuse is still commonly used in other parts of the world, particularly in countries with limited resources to dedicate to renal replacement therapies [4-6].
Only hollow-fiber dialyzers that are labeled by the manufacturer for multiple use are reprocessed . The methods used to ensure optimal performance of the reused dialyzer are best suited to hollow-fiber dialyzers (See 'Performance testing' below.)
This topic reviews methods of reprocessing hemodialyzers for reuse. Standards for hemodialysis, including water processing, are discussed elsewhere. (See "Water purification systems in hemodialysis" and "Contaminants in water used for hemodialysis" and "Maintaining water quality for hemodialysis".)
The basic procedure for dialyzer reprocessing involves four steps: rinsing, cleaning, performance testing, and disinfection and sterilization. Dialyzer processing may be performed manually or with the use of automated equipment. Most reprocessing in the United States is done using automated methods, which may be more reliable and predictable, though few good studies have compared methods. One study showed no significant difference in mortality between processing techniques when identical germicides were used . (See 'Clinical outcomes with reuse' below.)
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jun 20, 2016.References
- Tokars JI, Alter MJ, Favero MS, et al. National surveillance of dialysis associated diseases in the United States, 1992. ASAIO J 1994; 40:1020.
- Lacson E Jr, Lazarus JM. Dialyzer best practice: single use or reuse? Semin Dial 2006; 19:120.
- Upadhyay A, Sosa MA, Jaber BL. Single-use versus reusable dialyzers: the known unknowns. Clin J Am Soc Nephrol 2007; 2:1079.
- Duong CM, Olszyna DP, Nguyen PD, McLaws ML. Challenges of hemodialysis in Vietnam: experience from the first standardized district dialysis unit in Ho Chi Minh City. BMC Nephrol 2015; 16:122.
- Galvao TF, Silva MT, Araujo ME, et al. Dialyzer reuse and mortality risk in patients with end-stage renal disease: a systematic review. Am J Nephrol 2012; 35:249.
- Dhrolia MF, Nasir K, Imtiaz S, Ahmad A. Dialyzer reuse: justified cost saving for south Asian region. J Coll Physicians Surg Pak 2014; 24:591.
- Peter B. DeOreo. Dialyzer Reuse. In: Handbook of DIalysis, 5th, John T. Daugirdas, Peter G, Blake, Todd S. Ing (Eds), Wolters Kluwer, Philadelphia 2015. p.237-251.
- Held PJ, Wolfe RA, Gaylin DS, et al. Analysis of the association of dialyzer reuse practices and patient outcomes. Am J Kidney Dis 1994; 23:692.
- Recommended practice for reuse of hemodialyzers. Arlington, VA, AAMI 1993.
- Reprocessing of hemodialyzers. Association for the Advancement of Medical Instrumentation, American National Standards Institute, Arlington, VA, 2008. http://my.aami.org/aamiresources/previewfiles/RD47_1310_preview.pdf (Accessed on June 14, 2016).
- Denny GB, Golper TA. Does hemodialyzer reuse have a place in current ESRD care: "to be or not to be?". Semin Dial 2014; 27:256.
- DeOreo PB. Dialyzer Reuse. In: Handbook of Dialysis, 5th, Daugirdas JT, Blake PG, Ing TS (Eds), Wolter Kluwer, Philadelphia, Baltimore, New York, London, Beuonos Aires, Hong Kong, Sydney, Tokyo 2015. p.237-251.
- Pizziconi VB. Performance and integrity testing in reprocessed dialyzers: A QC update. AAMI, Standards and Recommended Practices, Vol 3, Dialysis, Association for the Advancement of Medical Instrumentation, Arlington, 1990.
- Kaplan AA, Halley SE, Lapkin RA, Graeber CW. Dialysate protein losses with bleach processed polysulphone dialyzers. Kidney Int 1995; 47:573.
- Kaufman AM, Godmere RO, et al. Dialyzer reuse. In: Handbook of dialysis, 2nd ed., Daugirdas JT, Ing TS (Eds), Little, Brown, Boston 1994.
- Gotch FA. Mass transport in reused dialyzers. Proc Clin Dial Transplant Forum 1980; 10:81.
- Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.
- Krivitski NM, Kislukhin VV, Snyder JW, et al. In vivo measurement of hemodialyzer fiber bundle volume: theory and validation. Kidney Int 1998; 54:1751.
- Finelli L, Miller JT, Tokars JI, et al. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005; 18:52.
- Bland L, Alter M, Favero M, et al. Hemodialyzer reuse: practices in the United States and implication for infection control. Trans Am Soc Artif Intern Organs 1985; 31:556.
- Schoenfeld P, McLaughlin MD, Mendelson M. Heat disinfection of polysulfone hemodialyzers. Kidney Int 1995; 47:638.
- Kaufman AM, Frinak S, Godmere RO, Levin NW. Clinical experience with heat sterilization for reprocessing dialyzers. ASAIO J 1992; 38:M338.
- Bolan G, Reingold AL, Carson LA, et al. Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis 1985; 152:1013.
- Kant KS, Pollak VE, Cathey M, et al. Multiple use of dialyzers: safety and efficacy. Kidney Int 1981; 19:728.
- Bok DV, Pascual L, Herberger C, et al. Effect of multiple use of dialyzers on intradialytic symptoms. Proc Clin Dial Transplant Forum 1980; 10:92.
- Fleming SJ, Foreman K, Shanley K, et al. Dialyser reprocessing with Renalin. Am J Nephrol 1991; 11:27.
- Churchill DN, Taylor DW, Shimizu AG, et al. Dialyzer re-use--a multiple crossover study with random allocation to order of treatment. Nephron 1988; 50:325.
- Sherman RA, Cody RP, Rogers ME, Solanchick JC. The effect of dialyzer reuse on dialysis delivery. Am J Kidney Dis 1994; 24:924.
- Petersen J, Moore RM Jr, Kaczmarek RG, et al. The effects of reprocessing cuprophane and polysulfone dialyzers on beta 2-microglobulin removal from hemodialysis patients. Am J Kidney Dis 1991; 17:174.
- Westhuyzen J, Foreman K, Battistutta D, et al. Effect of dialyzer reprocessing with Renalin on serum beta-2-microglobulin and complement activation in hemodialysis patients. Am J Nephrol 1992; 12:29.
- Cheung AK, Agodoa LY, Daugirdas JT, et al. Effects of hemodialyzer reuse on clearances of urea and beta2-microglobulin. The Hemodialysis (HEMO) Study Group. J Am Soc Nephrol 1999; 10:117.
- Labib ME, Murawski J, Tabani Y, et al. Water permeability of high-flux dialyzer membranes after Renalin reprocessing. Kidney Int 2007; 71:1177.
- Scott MK, Mueller BA, Sowinski KM, Clark WR. Dialyzer-dependent changes in solute and water permeability with bleach reprocessing. Am J Kidney Dis 1999; 33:87.
- Ouseph R, Brier ME, Ward RA. Improved dialyzer reuse after use of a population pharmacodynamic model to determine heparin doses. Am J Kidney Dis 2000; 35:89.
- Howell ED, Perkins HA. Anti-N-like antibodies in the sera of patients undergoing chronic hemodialysis. Vox Sang 1972; 23:291.
- Kaehny WD, Miller GE, White WL. Relationship between dialyzer reuse and the presence of anti-N-like antibodies in chronic hemodialysis patients. Kidney Int 1977; 12:59.
- Pegues DA, Beck-Sague CM, Woollen SW, et al. Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. Kidney Int 1992; 42:1232.
- Chenoweth DE, Cheung AK, Ward DM, Henderson LW. Anaphylatoxin formation during hemodialysis: comparison of new and re-used dialyzers. Kidney Int 1983; 24:770.
- Stroncek DF, Keshaviah P, Craddock PR, Hammerschmidt DE. Effect of dialyzer reuse on complement activation and neutropenia in hemodialysis. J Lab Clin Med 1984; 104:304.
- Shusterman NH, Feldman HI, Wasserstein A, Strom BL. Reprocessing of hemodialyzers: a critical appraisal. Am J Kidney Dis 1989; 14:81.
- Dumler F. Reuse of hemodialyzers. Semin Dial 1994; 7:257.
- Davenport A, Williams AJ. The effect of dialyzer reuse on peak expiratory flow rate. Respir Med 1990; 84:17.
- Bommer J, Ritz E. Ethylene oxide (ETO) as a major cause of anaphylactoid reactions in dialysis (a review). Artif Organs 1987; 11:111.
- Rao M, Guo D, Jaber BL, et al. Dialyzer membrane type and reuse practice influence polymorphonuclear leukocyte function in hemodialysis patients. Kidney Int 2004; 65:682.
- Twardowski ZJ. Dialyzer reuse--part II: advantages and disadvantages. Semin Dial 2006; 19:217.
- Pollak VE, Kant KS, Parnell SL, Levin NW. Repeated use of dialyzers is safe: long-term observations on morbidity and mortality in patients with end-stage renal disease. Nephron 1986; 42:217.
- Held PJ, Pauly MV, Diamond L. Survival analysis of patients undergoing dialysis. JAMA 1987; 257:645.
- Wing AJ, Brunner FP, Brynger HO, et al. Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association. Br Med J 1978; 2:853.
- Feldman HI, Kinosian M, Bilker WB, et al. Effect of dialyzer reuse on survival of patients treated with hemodialysis. JAMA 1996; 276:620.
- Collins AJ, Ma JZ, Constantini EG, Everson SE. Dialysis unit and patient characteristics associated with reuse practices and mortality: 1989-1993. J Am Soc Nephrol 1998; 9:2108.
- Kimmel PL, Mishkin GJ. Dialyzer reuse and the treatment of patients with end-stage renal disease by hemodialysis. J Am Soc Nephrol 1998; 9:2153.
- Ebben JP, Dalleska F, Ma JZ, et al. Impact of disease severity and hematocrit level on reuse-associated mortality. Am J Kidney Dis 2000; 35:244.
- Port FK, Wolfe RA, Hulbert-Shearon TE, et al. Mortality risk by hemodialyzer reuse practice and dialyzer membrane characteristics: results from the usrds dialysis morbidity and mortality study. Am J Kidney Dis 2001; 37:276.
- Collins AJ, Liu J, Ebben JP. Dialyser reuse-associated mortality and hospitalization risk in incident Medicare haemodialysis patients, 1998-1999. Nephrol Dial Transplant 2004; 19:1245.
- Lowrie EG, Li Z, Ofsthun N, Lazarus JM. Reprocessing dialysers for multiple uses: recent analysis of death risks for patients. Nephrol Dial Transplant 2004; 19:2823.
- Fan Q, Liu J, Ebben JP, Collins AJ. Reuse-associated mortality in incident hemodialysis patients in the United States, 2000 to 2001. Am J Kidney Dis 2005; 46:661.
- Bond TC, Nissenson AR, Krishnan M, et al. Dialyzer reuse with peracetic acid does not impact patient mortality. Clin J Am Soc Nephrol 2011; 6:1368.
- Lacson E Jr, Wang W, Mooney A, et al. Abandoning peracetic acid-based dialyzer reuse is associated with improved survival. Clin J Am Soc Nephrol 2011; 6:297.
- National Kidney Foundation report on dialyzer reuse. Task Force on Reuse of Dialyzers, Council on Dialysis, National Kidney Foundation. Am J Kidney Dis 1997; 30:859.
- REPROCESSING TECHNIQUES
- Performance testing
- Disinfection and sterilization
- - Chemical disinfection
- - Heat disinfection
- Inspection, labeling, and storage
- POTENTIAL RISKS
- Infection risk
- Loss of performance
- Germicide exposure
- POTENTIAL BENEFITS
- CLINICAL OUTCOMES WITH REUSE
- INFORMED CONSENT
- SUMMARY AND RECOMMENDATIONS