Reuse of Dialyzers. Advantages and Drawbacks

  • Robert J. Wineman
  • Norman Deane

Abstract

The present paper reviews recent research, discussing factors which are relevant to advantages and drawbacks of hemodialyzer reuse. For earlier literature the reader is referred to other sources (1, 2). An especially useful document for any practitioner, when considering reuse of hemodialyzers, is the “Recommended Practice for Reprocessing Hemodialyzers”, developed by a committee of the American Association for Advancement of Medical Instrumentation (AAMI), chaired by Ronald Easterling (3). With respect to the technology of reuse procedures, little new research has been reported on the various steps such as rinsing, cleaning, dialyzer evaluation, etc. Significant new information is available on sterilization, where new developments indicate a strong advantage for reuse. Recent research has also led to a more detailed understanding of biocompatibility of membranes, and the influence of reuse processes on the biocompatibility of reprocessed dialyzers.

Keywords

Fatigue Formaldehyde Urea Heparin Bacillus 

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References

  1. 1.
    Deane N, Wineman RJ, Bemis JA (Eds): Guide to reprocessing of hemodialyzers. Martinus Nijhoff Publishing, Boston, 1986.Google Scholar
  2. 2.
    Deane N, Wineman RJ: Multiple use of hemodialyses. In: “Replacement of renal function by dialysis” (Ed JF Maher), Kluwer Academic Publishers, Boston, 1989, pp 400–416.CrossRefGoogle Scholar
  3. 3.
    AAMI: Recommended practice for reuse of hemodialyzers. Association for Advancement of Medical Instrumentation, Arlington, VA, 1986.Google Scholar
  4. 4.
    Frinak S: Heat sterilization of dialyzers. Paper presented at Seventh Annual Advanced Dialysis Symposium, 18 October, 1991, Toledo, Ohio, U.S.A.Google Scholar
  5. 5.
    Bland LA, Favero MS, Oxborrow GS, Aguero SM, Searcy BP, Danielson JW: Effect of chemical germicides on the integrity of hemodializer membranes. Trans Am Soc Artif Intern Organs, 34: 172–175, 1988.Google Scholar
  6. 6.
    Ishak M, Laverdiere M, Baron C, Nolin L, Labrecque L: Pseudomonas aeruginosa septicemia related to structural damage to hemodializer membranes following disinfection with monoxychlorosene. Canada Diseases Weekly Report, 16-6: 27–28, 1990.Google Scholar
  7. 7.
    Bland LA, Arduino MJ, Aguero SM, Favero MS: Recovery of bacteria from reprocessed high flux dialyzers after bacterial contamination of the header spaces and o-rings. Trans Am Soc Artif Intern Organs, 35: 314–316, 1989.Google Scholar
  8. 8.
    Vincent FC, Tibi AR, Darbord JC: A bacterial biofilm in a hemodialysis system, assessment of disinfection and crossing of endotoxin. Trans Am Soc Artif Intern Organs, 35: 310–313, 1989.Google Scholar
  9. 9.
    Canaud B, Nguyen QV, Garred Li, Nicolle R, Mion C: Germicidal effectiveness of Dialox, a new stable peroxyacetic acid solution, in the reuse of high-flux dialyzers. Nephrol Dial Transplant, 4: 1000–1002, 1989.PubMedGoogle Scholar
  10. 10.
    Beck-Sague CM, Jarvis WR, Bland LA, Arduino MJ, Aguero SM, Verosic G: Outbreak of a gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am J Nephrology, 10: 397–403, 1990.CrossRefGoogle Scholar
  11. 11.
    Fleming SJ, Foreman K, Schanley K, Mihrshahi R, Siskind V: Dialyzer reprocessing with Renalin. Am J Nephrology, 11: 27–31, 1991.CrossRefGoogle Scholar
  12. 12.
    Vanholder R, Ringoir S: Influence of reuse and of reuse sterilants on the first-use syndrome. Artificial Organs, 11: 137–139, 1987.PubMedCrossRefGoogle Scholar
  13. 13.
    Husni L, Kale E, Climer C, Bostwick B, Parker TF: Evaluation of a new disinfectant for dialyzer reuse. Amer J Kidney Dis, 14: 110–118, 1989.Google Scholar
  14. 14.
    Cheung AK: Biocompatibility of hemodialysis membranes. J Am Soc Nephrology, 1: 150–161, 1990.Google Scholar
  15. 15.
    Cordonnier DJ, Foret M: Biocompatibility criteria in hemodialysis. In: “Present-day concepts in the treatment of chronic renal failure”. Contrib Nephrol (Eds J Traeger, F Cantarovich, M Olmer), Karger, Basel, 1989, 71, pp. 30–35.Google Scholar
  16. 16.
    Ogden DA: New dialyzer syndrome. N Engl J Med, 302: 1262–1263, 1980.PubMedGoogle Scholar
  17. 17.
    Villarroel F, Ciarkowski AA: A survey of hypersensitivity reactions in hemodialysis. Artif Organs, 9: 231–238, 1985.PubMedCrossRefGoogle Scholar
  18. 18.
    Miller GB, Wilber J: Acute allergic reactions associated with reprocessed hemodialyzers — United States, 1989–1990, From the Centers for Disease Control. JAMA, 265: 1511, 1991.CrossRefGoogle Scholar
  19. 19.
    Heierli C, Markert M, Lambert PH, Kuwahara T, Wauters P: On the mechanisms of hemodialysis-induced neutropenia: a study with five new and reused membranes. Nephrol Dial Transplant, 3: 773–783, 1988.PubMedGoogle Scholar
  20. 20.
    Markert M, Heierli C, Kuwahara T, Frei J, Wauters JP: Dialyzed polymorphonuclear neutrophil oxidative metabolism during dialysis: a comparative study with 5 new and reused membranes. Clinical Nephrology, 29: 129–136, 1988.PubMedGoogle Scholar
  21. 21.
    Kuwahara T, Marken M, Wauters JP: Proteins adsorbed on hemodialysis membranes modulate neutrophil activation. Artificial Organs, 13: 427–431, 1989.PubMedCrossRefGoogle Scholar
  22. 22.
    Kuwahara T, Marken M, Wauters JP: Biocompatibility aspects of dialyzer reprocessing: a comparison of 3 re-use methods and 3 membranes. Clinical Nephrology, 32: 139–143, 1989.PubMedGoogle Scholar
  23. 23.
    Churchill DN, Taylor DW, Shimizu AG, Beecroft ML, Singer J, Barnes CC, Ludwin D, Wright N, Sackett DL, Smith EKM: Dialyzer reuse-a multiple crossover study with random allocation to order of treatment. Nephron, 50: 325–331, 1988.PubMedCrossRefGoogle Scholar
  24. 24.
    Verresen L, Waer M, Vanrenterghem Y, Michielsen P: Angiotensin-converting-enzyme inhibitors and anaphylactoid reactions to high-flux membrane dialysis. Lancet, 336: 1360–1362, 1990.PubMedCrossRefGoogle Scholar
  25. 25.
    Verresen L, Waer M, Vanrenterghem Y, Michielsen P: Anaphylactoid reactions, hemodialysis and ACE inhibitors. Lancet, 337: 1294, 1991.PubMedCrossRefGoogle Scholar
  26. 26.
    Caruana RJ: First-use reactions: a potential hazard for referral centers. Int J Artif Organs, 12: 688–691, 1989.PubMedGoogle Scholar
  27. 27.
    Goldman M, Lagmiche M, Dhaene M, Amraoui Z, Thayse C, Vanherweghem JL: Adsorption of beta-2-microglobulin on dialysis membranes: comparison of different dialyzers and effects of reuse procedures. Int J Artif Organs, 12: 373–378, 1989.PubMedGoogle Scholar
  28. 28.
    Di Raimondo CR, Pollak VE: Beta-2-microglobulin kinetics in maintenance hemodialysis: a comparison of conventional and high flux dialyzers and the effects of dialyzer reuse. Am J Kidney Diseases, 13: 390–395, 1989.Google Scholar
  29. 29.
    Chan MK, Lau N: Optimal reuse of cuprammonium rayon hollow-fiber dialyzers. Int J Artif Organs, 12: 223–228, 1989.PubMedGoogle Scholar
  30. 30.
    Vanholder R, Noens L, De Smet R, Ringoir S: Development of anti-N-like antibodies during formaldehyde reuse in spite of adequate predialysis rinsing. Am J Kidney Dis, 11: 477–480, 1988.PubMedGoogle Scholar
  31. 31.
    Gotch F, Keen, M: Formaldehyde kinetics in reused dialyzers. Trans Am Soc Artif Intern Organs, 29: 396–401, 1983.PubMedGoogle Scholar
  32. 32.
    Miller GB, Sikes RK: Acute allergic reactions associated with reprocessed hemodialyzers-Virginia, 1989. JAMA, 263: 501, 1990.CrossRefGoogle Scholar
  33. 33.
    Charoenpanich R, Pollak VE, Kant KS, Robson MD, Cathey M: Effect of first and subsequent use of hemodialyzers on patient well-being: the rise and fall of a syndrome associated with new dialyzer use. Artif Organs, 11:123–127, 1987.PubMedCrossRefGoogle Scholar
  34. 34.
    Moss AH, Hamrick RM, Shen SH: Limulus Amebocyte lysate reactivity, complement activation, and patients’ symptoms; comparison of dialyzer membranes. Trans Am Soc Artif Intern Organs, 35: 812–815, 1989.Google Scholar
  35. 35.
    Alter MJ, Favero MS, Miller JK, Coleman PJ, Bland LA: Reuse of hemodialyzers — results of nationwide surveillance for adverse effects. JAMA, 260: 2073–2076, 1988.PubMedCrossRefGoogle Scholar
  36. 36.
    Alter MJ, Favero MS, Miller JK, Moyer LA, Bland LA: National surveillance of dialysis-associated diseases in the United States, 1987. Trans Am Soc Artif Intern Organs, 35: 820–831, 1989.Google Scholar
  37. 37.
    Alter MJ, Favero MS, Moyer LA, Miller JK, Bland LA: National surveillance of dialysis-associated diseases in the United States, 1988. Trans Am Soc Artif Intern Organs, 36: 107–118, 1990.Google Scholar
  38. 38.
    Alter MJ, Favero MS, Moyer LA, Bland LA: National surveillance of dialysis-associated diseases in the United States,1989. Trans Am Soc Artif Intern Organs, 37: 97–109, 1991.Google Scholar
  39. 39.
    Pollak VE: Adverse effects and pyrogenic reactions during hemodialysis. JAMA, 260: 2106–2107, 1988.PubMedCrossRefGoogle Scholar
  40. 40.
    Shusterman NH, Feldman HI, Wasserstein A, Strom BL: Reprocessing of Hemodialyzers: a critical review. Amer J Kidney Dis, 14: 81–91, 1989.Google Scholar
  41. 41.
    Gordon SM, Tipple M, Bland LA, Jarvis WR: Pyrogenic reactions associated with reuse of disposable hollow-fiber hemodialyzers. JAMA, 260: 2077–2081, 1988.PubMedCrossRefGoogle Scholar
  42. 42.
    Delmez JA, Werts CA, Hasamear PD, Windus DW: Severe dialyzer dysfunction undetectable by standard reprocessing validation tests. Kidney Int, 36: 478–484, 1989.PubMedCrossRefGoogle Scholar
  43. 43.
    Garred LJ, Canaud B, Flavier JL, Poux C, Polito-Bouloux C, Mion C: Effect of reuse on dialyzer efficacy. Artif Organs, 14: 80–84, 1990.PubMedCrossRefGoogle Scholar
  44. 44.
    Levin NW, Striker GE: Research on problems of the dialysis patient. J Am Soc Nephrology, 1: 1055–1056, 1991.Google Scholar
  45. 45.
    Challan S, Wing AJ, Brunner FP, Brynger HOA, Oules R, Selwood NH: Use and reuse of dialyzers in Europe. In: “Guide to reprocessing of hemodialyzers” (Eds N Deane, RJ Wineman, JA Bemis), Martinus Nijhoff Publishing, Boston, 1986, pp 99–106.CrossRefGoogle Scholar
  46. 46.
    Jacobs C, Branner FP, Chantier C, Donckerwolcke RA, Gurland HJ, Hathway RA, Jacobs C, Seiwood NH, Wing AJ: Combined report on regular dialysis and transplantation in Europe, VII. Proc Eur Dial Transplant Assoc, 14: 3–69, 1977.PubMedGoogle Scholar
  47. 47.
    Wing AJ, Branner FP, Brynger H, Chantier C, Donckerwolcke RA, Gurland HJ, Jacobs C, Selwood NH: Mortality and morbidity of reusing dialyzers. Br Med J, 2: 853–855, 1978.PubMedCrossRefGoogle Scholar
  48. 48.
    Held PJ, Pauly MV, Diamond L: Survival analysis of patients undergoing dialysis. JAMA, 257: 645–650, 1987.PubMedCrossRefGoogle Scholar
  49. 49.
    Held PJ, Levin NW, Bovbjerg RR, Pauly MV, Diamond LH: Mortality and duration of hemodialysis treatment. JAMA, 265: 871–875, 1991.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • Robert J. Wineman
    • 1
  • Norman Deane
    • 1
  1. 1.National Nephrology FoundationSouth Bronx Kidney CenterNew YorkUSA

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