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Journal articles on the topic 'Dialyzer reuse practice'

Author: Grafiati

Published: 4 June 2021

Last updated: 15 February 2022

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Francoeur, R., S. Vas, and R. Uldall. "Dialyser Reuse: An Automated System Using Peracetic Acid." International Journal of Artificial Organs 17, no. 6 (June 1994): 331–36. http://dx.doi.org/10.1177/039139889401700604.

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For 3 years starting in April 1989, in a 17-station, in-centre haemodialysis unit at the Toronto Western Hospital, re-use of dialysers was performed using the Renatron-2 Dialyser Reprocessing System with peracetic acid as a sterilant. During this period 40,234 treatments were carried out and dialysers were used an average of 4.2 times. Net savings, after taking into account the total costs of re-use, averaged Can $309,000,000 per year. There were no deaths and no discernible morbidity attributable to the practice of re-use. We conclude that dialyzer re-use is an effective way to reduce the costs of haemodialysis and is entirely safe providing that it is carried out properly.

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Levin, Nathan W. "Dialyzer Reuse: A Currently Acceptable Practice." Seminars in Dialysis 6, no. 2 (October 1, 2007): 89–90. http://dx.doi.org/10.1111/j.1525-139x.1993.tb00266.x.

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Lacson, Eduardo, and J. Michael Lazarus. "UNRESOLVED ISSUES IN DIALYSIS: Dialyzer Best Practice: Single Use or Reuse?" Seminars in Dialysis 19, no. 2 (March 3, 2006): 120–28. http://dx.doi.org/10.1111/j.1525-139x.2006.00137.x.

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Rao, Madhumathi, Daqing Guo, Bertrand L. Jaber, Sumuk Sundaram, Miguel Cendoroglo, Andrew J. King, Brian J. G. Pereira, Vaidyanathapuram S. Balakrishnan, and The Hemo Study Group. "Dialyzer membrane type and reuse practice influence polymorphonuclear leukocyte function in hemodialysis patients." Kidney International 65, no. 2 (February 2004): 682–91. http://dx.doi.org/10.1111/j.1523-1755.2004.00429.x.

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Köse, Kader, Pakize Doğan, Zübeyde Gündüz, Ruhan Düşünsel, and Cengiz Utaş. "Oxidative Stress in Hemodialyzed Patients and the Long-Term Effects of Dialyzer Reuse Practice." Clinical Biochemistry 30, no. 8 (December 1997): 601–6. http://dx.doi.org/10.1016/s0009-9120(97)00100-8.

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CHEUNG, ALFRED K., LAWRENCE Y. AGODOA, JOHN T. DAUGIRDAS, THOMAS A. DEPNER, FRANK A. GOTCH, TOM GREENE, NATHAN W. LEVIN, and JOHN K. LEYPOLDT. "Effects of Hemodialyzer Reuse on Clearances of Urea and β2-Microglobulin." Journal of the American Society of Nephrology 10, no. 1 (January 1999): 117–27. http://dx.doi.org/10.1681/asn.v101117.

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Abstract. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, performance of reused dialyzers has not been extensively and critically evaluated. The present study analyzes data extracted from a multicenter clinical trial (the HEMO Study) and examines the effect of reuse on urea and β2-microglobulin (β2M) clearance by low-flux and high-flux dialyzers reprocessed with various germicides. The dialyzers evaluated contained either modified cellulosic or polysulfone membranes, whereas the germicides examined included peroxyacetic acid/acetic acid/hydrogen peroxide combination (Renalin®), bleach in conjunction with formaldehyde, glutaraldehyde or Renalin, and heated citric acid. Clearance of β2M decreased, remained unchanged, or increased substantially with reuse, depending on both the membrane material and the reprocessing technique. In contrast, urea clearance decreased only slightly (approximately 1 to 2% per 10 reuses), albeit statistically significantly with reuse, regardless of the porosity of the membrane and reprocessing method. Inasmuch as patient survival in the chronic hemodialysis population is influenced by clearances of small solutes and middle molecules, precise knowledge of the membrane material and reprocessing technique is important for the prescription of hemodialysis in centers practicing reuse.

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Port, Friedrich K., Robert A. Wolfe, Tempie E. Hulbert-Shearon, John T. Daugirdas, Lawrence Y. C. Agodoa, Camille Jones, Sean M. Orzol, and Philip J. Held. "Mortality Risk by Hemodialyzer Reuse Practice and Dialyzer Membrane Characteristics: Results From the USRDS Dialysis Morbidity and Mortality Study." American Journal of Kidney Diseases 37, no. 2 (February 2001): 276–86. http://dx.doi.org/10.1053/ajkd.2001.21290.

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Pugliese, Gina, and Martin S. Favero. "Characteristics Associated With Dialyzer Reuse Practices and Mortality." Infection Control & Hospital Epidemiology 20, no. 01 (January 1999): 80–81. http://dx.doi.org/10.1017/s0195941700067898.

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Prasad, Narayan, and Vivekanand Jha. "Hemodialysis in Asia." Kidney Diseases 1, no. 3 (2015): 165–77. http://dx.doi.org/10.1159/000441816.

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Background: Asia is the largest, most populous and most heterogeneous continent in the world. The number of patients with end-stage renal disease is growing rapidly in Asia. Summary: A fully informed report on the status of dialysis therapies including hemodialysis (HD) is limited by the lack of systematic registries. Available data suggest remarkable heterogeneities, with some countries like Taiwan, Japan and Korea exhibiting well-established HD systems, high prevalence and universal access to all patients, while low- and low-middle income countries are unable to provide HD to eligible patients because of high cost and poor healthcare systems. Many Asian countries have unregulated dialysis units, with poor standards of delivery, quality control and outcome reporting. This leads to high mortality due to preventable complications like infections. Modeling data suggest that at least 2.9 million people need dialysis in Asia, which represents a gap in availability of dialysis to the tune of -66%. The population is projected to grow rapidly in the coming years. Several countries are expanding access to HD. Innovative modifications in dialysis practice are being made to optimize outcomes. It is important to develop robust systems of documentation and outcome reporting to evaluate the effects of such changes. HD needs to develop in conjunction with effective preventive programs and improvement of health systems. Key Messages: The practice of HD in Asia is growing and evolving. Rapid expansion will improve the currently dismal access to care for large sections of the population. Quality issues need to be addressed if the full benefit of this therapy is to reach the population. Developed countries of Asia can provide substantial messages to developing economies. HD programs must develop in conjunction with prevention efforts. Facts from East and West: (1) While developed Western and Asian countries provide end-stage renal disease patients full access to HD, healthcare systems from South and South-East Asia can offer access to HD only to a limited fraction of the patients in need. Even though the annual costs of HD are much lower in less developed countries (for instance 30 times lower in India compared to the US), patients often cannot afford costs not covered by health insurance. (2) The recommended dialysis pattern in the West is at least three sessions weekly with high-flux dialyzers. Studies from Shanghai and Taiwan might however indicate a benefit of twice versus thrice weekly sessions. In less developed Asian countries, a twice weekly pattern is common, sometimes with dialyzer reuse and inadequate water treatment. A majority of patients decrease session frequency or discontinue the program due to financial constraint. (3) As convective therapies are gaining popularity in Europe, penetration in Asia is low and limited by costs. (4) In Asian countries, in particular in the South and South-East, hepatitis and tuberculosis infections in HD patients are higher than in the West and substantially increase mortality. (5) Progress has recently been made in countries like Thailand and Brunei to provide universal HD access to all patients in need. Nevertheless, well-trained personnel, reliable registries and better patient follow-up would improve outcomes in low-income Asian countries.

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Balwani, Manish R., Jigar Shrimali, Amit Pasari, Jay Shah, and Vivek Kute. "Knowledge and practices about hemodialysis among dialysis technicians in western part of India." Journal of Nephropharmacology 9, no. 1 (June 28, 2019): e04-e04. http://dx.doi.org/10.15171/npj.2020.04.

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Introduction: Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems. Objectives: To determine the knowledge and practices regarding end-stage renal disease and hemodialysis (HD) among dialysis technicians. Patients and Methods: Total of 157 technicians participated in a study carried out at Ahmedabad city of Gujrat state. A validated written questionnaire was distributed among dialysis technicians who gave their consent to participate in the study and responded questionnaires were analyzed. Data entry was made in Excel software in codes and analysis was conducted by SPSS software version 17.0 Results: Out of 157, 113 participants were routinely using online clearance monitoring. Around, 19.1% carried out disinfection of water loop once per week, while 23.6% and 28% were doing it once in 15 days and 30 days respectively. Reverse osmosis (RO) plant parameters like pH, hardness of water, chlorine content were checked once daily by 46.5% of technicians while 17.8% and 24.2% technicians were doing it once a week and once a month respectively. About 87.3% of technicians said that dialyzer was reused at their center. Accordingly, 33.8% and 51.6% of technicians were using formalin and per-acetic based disinfectants for dialyzer reprocessing. Additionally 7.6% of technicians were using hypochlorite as disinfectant at their center. Around 63.7% of technicians said they were not reprocessing dialyzers of HCV positive patients. They preferred to use single dialyzers in these subsets of patients at their center. Around, 79.6% of technicians said that endotoxin filter was installed in their dialysis unit. Likewise, 45.9% knew correctly the permissible level of endotoxin in RO water used for HD. Only 15.3% of technicians had correct knowledge of permissible level of bacteria in treated RO water as per association for the advancement of medical instrumentation (AAMI) standards. Conclusion: Better knowledge and awareness about dialysis standards among dialysis technicians will help in better patient’s care. Effective dialysis education campaign needs to be driven at regular intervals with relevant information among dialysis technicians to address the knowledge gap.

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Held, Philip J., Robert A. Wolfe, Daniel S. Gaylin, Friedrich K. Port, Nathan W. Levin, and Marc N. Turenne. "Analysis of the Association of Dialyzer Reuse Practices and Patient Outcomes." American Journal of Kidney Diseases 23, no. 5 (May 1994): 692–708. http://dx.doi.org/10.1016/s0272-6386(12)70280-9.

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Collins, A. J., J. Z. Ma, E. G. Constantini, and S. E. Everson. "Dialysis unit and patient characteristics associated with reuse practices and mortality: 1989-1993." Journal of the American Society of Nephrology 9, no. 11 (November 1998): 2108–17. http://dx.doi.org/10.1681/asn.v9112108.

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The diverse patient and dialysis unit characteristics in the United States pose challenges for assessing the safety and efficacy of reuse practices. A 10% random sample of period-prevalent hemodialysis patients from units practicing conventional dialysis (<25% of patients with high-efficiency/high-flux dialysis) were analyzed. The data included 13,926 patient observations in 1989-1990 and 20,422 in 1991-1993. Centers for Disease Control and Prevention and Health Care Financing Administration facility survey Medicare data were analyzed with a Cox regression model, evaluating the risk of reuse compared with no reuse and adjusting for comorbidity, unit characteristics, and profit status. In 1989-1990, freestanding and hospital-based units that did not reuse dialyzers were not significantly different from each other in mortality rates. In 1991-1993, however, no-reuse, freestanding, for-profit units had higher risks (relative risk [RR] = 1.23, P = 0.003) compared with no-reuse, hospital-based, nonprofit units. No-reuse, hospital-based, for-profit units, in contrast, were associated with a lower mortality risk (RR = 0.70, P = 0.0001). An isolated higher risk associated with peracetic acid manual reuse in freestanding units (1989-1990) was identified in for-profit units only. In the 1991-1993 period, an increased mortality risk was noted in hospital-based, nonprofit units practicing formaldehyde automatic reuse, and in freestanding, for-profit units using glutaraldehyde, which accounted for <5% of all units. All other interactions of reuse germicide and technique were not different from no-reuse. The varying mortality rates identified in both no-reuse and reuse units using conventional dialysis suggest that other factors, such as dialysis therapy and anemia correction (both known predictors of patient survival), have a greater influence on U.S. mortality than reuse germicides and techniques.

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Calderón- Rodríguez, Nelly Patricia. "Different Clinical Practice in Hemodialysis in Mexico and Colombia." Mexican Journal of Medical Research ICSA 7, no. 14 (July 5, 2019): 1–5. http://dx.doi.org/10.29057/mjmr.v7i14.3831.

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Chronic kidney disease is the structural or functional damage of the kidneys for more than three months and is considered a public health problem, since one out of every ten adults suffer from; the hemodialysis is a therapeutic modality that replaces kidney function (excretion of waste products, regulation of water balance and regulation of the acid-base balance) improving the quality and years of life in patients with chronic kidney disease. However, clinical practices used (dialyzers, duration of hemodialysis sessions, vascular access and health personnel) vary in each country, which has an impact on the quality of life and patient mortality. Objective: To describe the differences in the reuse of dialyzers, duration of hemodialysis sessions, goals for the type of vascular access used and the health personnel who are in each renal unit, from the rules, between Mexico and Colombia. Conclusions: The differences that exist in clinical practices of hemodialysis between Mexico and Colombia are given from the health standards, however, it is necessary reinforce aspects in the both countries to provide better care for patients with chronic kidney disease.

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Fabrizi, Fabrizio, Roberta Cerutti, and Piergiorgio Messa. "Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis." Pathogens 10, no. 9 (September 7, 2021): 1149. http://dx.doi.org/10.3390/pathogens10091149.

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Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.

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Backman, Lauren, Diane G. Dumigan, Adora Harizaj, Marylee Oleksiw, Evelyn Carusillo, Sue Malo, Acacia Ransom, et al. "2454. A Cluster of Gram-Negative Bloodstream Infections in Connecticut Hemodialysis Patients Associated with Contaminated Wall Boxes and Priming Buckets." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S848—S849. http://dx.doi.org/10.1093/ofid/ofz360.2132.

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Abstract Background Patients requiring maintenance hemodialysis (HD) are at increased risk of bloodstream infections. We investigated a cluster of infections due to unusual Gram-negative bacilli that affected patients undergoing HD at an outpatient unit with 19 stations (Clinic A). Methods A case was defined as a HD patient at Clinic A with >1 blood or urine culture positive for Delftia acidovorans, Enterobacter absuriae, or Burkholderia cepacia during the period February 1 – April 30, 2018. An investigation included review of patient records, facility policies, practice observation, environmental cultures, and a 1:4 case–control study. Controls were patients without bloodstream infection (BSI) during the outbreak period. Results The cluster included 3 patients. Patient 1 had BSI due to D. acidovorans (2/08), E. absuriae (3/15) and B. cepacia (3/17). Patient 2 had BSI due to D. acidovorans (3/17 and 3/27) and S. maltophilia (4/5). Patient 3 had a urine culture positive for D. acidovorans and S. maltophilia (4/2). The case–control study showed that cases had been dialyzed more often than controls on the third shift (P < 0.0001) and at station 2 (P < 0.0001), where subsequently a wall box spent dialysate drain connection swab culture yielded D. acidovorans. E. absuriae was recovered from wall boxes and spent dialysate drain connection at two stations and from used prime buckets from two stations; one wall box culture grew S. maltophilia. D. acidovorans and E. absuriae patient isolates were not available for genomic analysis. Observations revealed that waste water was leaking onto the floor from several wall boxes, and that priming buckets were often rinsed with tap water after being disinfected with 1:100 bleach solution and not allowed to dry before reuse. Multiple deficiencies in hand hygiene and station disinfection were observed. No deficiencies in water treatment practices were identified. Multiple water cultures obtained in August were negative for the observed pathogens. Conclusion A cluster of unusual Gram-negative infections in outpatient HD patients was most likely due to exposures to contaminated wall boxes or priming buckets; poor hand hygiene and station disinfection can contribute to transmission to patients. Disclosures All authors: No reported disclosures.

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