DaVita lets patients reuse filters, now a less-common practice in industry

[okarol]

DaVita lets patients reuse filters, now a less-common practice in industry
By Jennifer Brown
The Denver Post
POSTED: 05/08/2011 01:00:00 AM MDT

DaVita continues to allow patients to reuse their filters — artificial kidneys, in essence — even as many other dialysis companies have abandoned the practice because of the risk of infection.

DaVita executives say letting patients reuse their own filters, called dialyzers, for repeat treatments saves money and is better for the environment.

Dr. Allen Nissenson, DaVita's chief medical officer, said the practice is "safe and effective for patients" and "is nothing that we are ashamed of." It's up to patients whether to reuse filters, and some choose that option because their bodies react better to filters already coated with their proteins.

The government allows filter reuse, but the practice has become less widespread during the past several years.

DaVita's chief rival, Fresenius Medical Care North America, decided several years ago it would start manufacturing disposable filters in the United States and stop reusing filters. Liberty Dialysis does not reuse filters either.

A paper published in 2007 in the Clinical Journal of the American Society of Nephrology said there was no longer any medical need for reusing dialyzers and that "cost saving is clearly driving the continued practice." One- time-use filters cost about $7 or $8.

"Clearly, in a capitated payment system, it's less expensive," Nissenson said. "It's not like it's some big secret."

In Colorado Springs last year, two patients at different DaVita dialysis centers mistakenly were given filters that had been used on other patients. In one case, the patient whose dialyzer was reused by another patient had hepatitis C. In the other case, the patient whose dialyzer was reused by another had a history of MRSA, a persistent staph bacteria sometimes found in hospitals.

"Any complex medical procedure, there's a chance for error," Nissenson said.

In both cases, the state health department faulted the centers for not reporting the breaches. State health inspectors found out after complaints.

In 2007, a DaVita patient in Michigan died after the cleaning agent accidentally left behind in her reusable filter flowed into her bloodstream.

DaVita officials said that "in the rare instances of a patient getting the wrong dialyzer, the risk of infection transmission is virtually nil due to sterilization procedures in place."



Read more: DaVita lets patients reuse filters, now a less-common practice in industry - The Denver Post http://www.denverpost.com/news/ci_18017303?source=pkg#ixzz1LkEPaWJi

[greg10]

DaVita lets patients reuse filters, now a less-common practice in industry
By Jennifer Brown
The Denver Post
POSTED: 05/08/2011 01:00:00 AM MDT..
Dr. Allen Nissenson, DaVita's chief medical officer, said the practice is "safe and effective for patients" and "is nothing that we are ashamed of." It's up to patients whether to reuse filters, and some choose that option because their bodies react better to filters already coated with their proteins....
Read more: DaVita lets patients reuse filters, now a less-common practice in industry - The Denver Post http://www.denverpost.com/news/ci_18017303?source=pkg#ixzz1LkEPaWJi

I would dispute that statement.

[plugger]

Think I could find a few people who might argue about how safe reuse is:

http://www.dialysisethics2.org/forum/index.php?topic=58.0

http://www.dialysisethics2.org/forum/index.php?topic=57.0

[noahvale]

**

[plugger]

He failed to mention that new patients are given a packet of papers to sign off on, usually during their first treatment, which includes the reuse consent form. 

I can remember, back in what are now ancient times, being informed I had signed a reuse consent form before I got my daughter off reuse - couldn't recall it.  My understanding is these forms aren't worth the piece of paper they are written on, since most people don't really understand what they are signing.

Anyway,  thought I would mention I wasn't too impressed with what Dr. Nissenson had to say:

"because their bodies react better to filters already coated with their proteins."
This sounds like it is the argument I heard from way back when before the synthetic membranes in dialyzers came along.  If this is true, I don't know if I would trust somebody who is trying to use info that is outdated and ancient:

From a 2004 study:
"The synthetic membranes are more biocompatible than their cellulosic predecessors so the reuse-associated medical benefit probably disappeared. The rationale for reusing synthetic membrane dialysers thus became purely financial."
http://www.dialysisethics2.org/forum/index.php?topic=57.0

"in the rare instances of a patient getting the wrong dialyzer, the risk of infection transmission is virtually nil due to sterilization procedures in place."
That looks to be just plain wrong:

"More troubling is the patient who was exposed to Hepatitis C, because neither that virus nor AIDS can be killed with current sterilization techniques"
http://www.dialysisethics2.org/forum/index.php?topic=604.0

[rsudock]

My unit started doing reuse and I was EXTREMELY itchy. I kept complaining and all I kept hearing, "Well your phospherous is high probably." Every month the phospherous came back in the LOW normal range. I demanded a one time use dialyzer and what would you know IMMEDIATELY I noticed a difference in the itching and it hasn't come back since!

xo,
R

[plugger]

Not surprised! I recall the test strips they use to test for any chemical, test that a chemical is below a MINIMAL amount - NOT the absence of the chemical.  So there is a good chance whatever they are using is getting into the bloodstream.

Also recall from years ago, a so-called "expert" tried to convince us renalin was no more harmful than salad dressing.  He never did accept the challenge to put it on his salad and eat it.

[Zach]

Not surprised! I recall the test strips they use to test for any chemical, test that a chemical is below a MINIMAL amount - NOT the absence of the chemical.  So there is a good chance whatever they are using is getting into the bloodstream.

Also recall from years ago, a so-called "expert" tried to convince us renalin was no more harmful than salad dressing.  He never did accept the challenge to put it on his salad and eat it.

Years ago there was the story (or myth) that a sales rep for the chemical Peracetic Acid drank some to prove it was safe for reuse of dialyzers.

Of course nobody asked the question, "just because something is 'safe' to drink, does it mean that it's safe to inject into one's bloodstream?"

 

[M3Riddler]

Davita states that it is better for the environment.....more like better for their pocketbooks.....  In my personal opinion, i would not reuse a dialyzor.   I have known centers who used to reuse the dialyzors and they would get mixed up and they would get used by the wrong patient... If Davita was so worried about the environment...I'm sure they could find many other ways to help out instead of reusing dialyzors.

Not sure what they use now to clean the dialyzors, but they used to use ( perhaps still do ) use formaldehyde  and other chemicals to clean the dialyzors out.  Not sure if I would want this pickeling agent in my bloodstream. Yes, they clean them out, but do they really get 100% of the residue out of the dialyzors before re-use?

One example is when the CEO Kent Thiry was living in El Sdgundo, CA and would have a private charterd jet  take him to the new Davita headquarters in Colorado. This expense alone coast the company over 200,000 in 2009. I wonder how worried Davita was about the environment then with all of that jet fuel flowing into the environent... 

They are trying to save money in all the wrong areas......

[noahvale]

**

[Zach]

While this may be an old study, it finds that peracetic/ acetic acid (which is the chemical of choice for many of today's reuse programs), "... may be associated with worse survival than dialysis in freestanding facilities not reprocessing dialyzers or in those reprocessing with formaldehyde."

http://jama.ama-assn.org/content/276/8/620.short

Effect of Dialyzer Reuse on Survival of Patients Treated With Hemodialysis

Harold I. Feldman, MD, MS; Monica Kinosian, MHS; Warren B. Bilker, PhD; Christopher Simmons; John H. Holmes, MS; Mark V. Pauly, PhD; José J. Escarc, MD, PhD

• Author Affiliations

From the Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology (Drs Feldman, Bilker, and Escarce, Ms Kinosian, Mr Simmons and Mr Holmes), and Renal Electrolyte and Hypertension Division, Department of Medicine (Dr Feldman), University of Pennsylvania Medical Center, Philadelphia; and the Department of Health Care Systems, Wharton School (Dr Pauly), Leonard Davis Institute of Health Economics (Drs Feldman, Pauly, and Escarce, and Ms Kinosian) and Division of General Internal Medicine, Department of Medicine (Dr Escarce), University of Pennsylvania, Philadelphia.
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 freestanding 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.