Effect of dialyzer reuse on survival of patients treated with hemodialysis

JAMA. 1996 Aug 28;276(8):620-5.

Abstract

Objective: To evaluate the impact of dialyzer reuse on the survival of US hemodialysis patients.

Study design and participants: Nonconcurrent cohort study of 27938 patients beginning hemodialysis in the United States in 1986 and 1987.

Main outcome measure: Patient survival.

Results: Dialysis in freestanding facilities reprocessing dialyzers with the combination of peracetic and acetic acids was associated with greater mortality than treatment in facilities not reprocessing dialyzers (rate ratio [RR],1.10, 95% confidence interval [CI], 1.02-1.18; P=.02) In contrast, there was no significant difference between survival in freestanding facilities reprocessing dialyzers with either formaldehyde (RR,1.03, 95% CI, 0.96-1.10; P=.45) or glutaraldehyde (RR, 1.13, 95% CI, 0.95-1.35, P=.18) and survival in freestanding facilities not reprocessing dialyzers. Among freestanding facilities reprocessing dialyzers, use of peracetic/acetic acid was associated with a higher rate of death than use of formaldehyde (RR = 1.08, 95% CI, 1.01-1.14; P=.02). There was no statistical difference between survival in hospital-based facilities reprocessing dialyzers with either peracetic/acetic acid (RR=0.95, 95% CI, 0.85-1.06; P=.40), formaldehyde (RR=1.06, 95% CI, 0.98-1.15; P=.12), or glutaraldehyde (RR=1.09, 95% CI, 0.71-1.67; P=.70) and survival in hospital-based facilities not reprocessing dialyzers. In addition, choice of sterilant was not associated with a statistically significant difference in survival among hospital-based facilities reprocessing dialyzers.

Conclusions: Dialysis in freestanding facilities reprocessing dialyzers with peracetic/acetic acid may be associated with worse survival than dialysis in free-standing facilities not reprocessing dialyzers or in those reprocessing with formaldehyde. We were unable to determine whether these relationships arose from greater comorbidity among patients treated in facilities using peracetic/acetic acid, poor quality of dialysis procedures in these facilities, or direct toxicity of peracetic/acetic acid. These findings raise important concerns about potentially avoidable mortality among US hemodialysis patients treated in dialysis facilities reprocessing hemodialyzers.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Disinfectants
  • Equipment Reuse / standards
  • Female
  • Formaldehyde
  • Glutaral
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Kidneys, Artificial* / standards
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peracetic Acid
  • Proportional Hazards Models
  • Renal Dialysis / instrumentation*
  • Renal Dialysis / mortality*
  • Renal Dialysis / standards
  • Sterilization
  • Survival Analysis
  • United States

Substances

  • Disinfectants
  • Formaldehyde
  • Peracetic Acid
  • Glutaral