Reusable dialyzers

[Joe Paul]

I am curious, those of you in center, do you pay attention to how many times your dializers are reused? Before the new Neph took over at my center, the max times reused was 20. Now they go up to 35. I complain because of the color of the dializer at the return end, its black and looks disgusting, but the bio-tech tells me its an optical illusion, sort of like fiber optics. I guess it is doing its job, my clearances have been in the 70's and according to the tag, the dializer passes testing. I just don't feel comfortable seeing all that "gunk".

[BigSky]

Tell them you only want to reuse it twenty times.

My understanding is its up to the patient, not the center.

[Ang]

sorry  but is'nt  re  using  dialysers  unsanitary  unhealthy  etc  etc. at my  unit  in    they  use  new  dialysers  for  each  person  each  treatment.
 i  sort  of  figured  it  was  the  same  all  over  the  world









EDITED: Fixed smiley tag error- kitkatz, moderator

[cris]

Over in the Phils, dialyzers are being re-used up to 10x maximum or it is up to the patient to change it earlier than the 10th time. This is expensive.

[Adam_W]

Ewww! It's black on the end and they are making you reuse it? That's just disgusting. Like everyone else has said, tell them you only want it reused however many times YOU feel comfortable with. It's your health and your life they're messing with here. I'm personally not comfortable with reusing dialyzers period, although I've never actually reused one.

Adam

[kitkatz]

I cannot do reuse. I am allergic to the fibers in those dialyzers.  I am expensive patient!

[thegrammalady]

sorry  but is'nt  re  using  dialysers  unsanitary  unhealthy  etc  etc. at my  unit  in    they  use  new  dialysers  for  each  person  each  treatment.
 i  sort  of  figured  it  was  the  same  all  over  the  world


EDITED: Fixed smiley tag error- kitkatz, moderator

reuseable dialyzers are cleaned between each use and only used for one patient each.  that being said, my center stopped using them about 9 months ago

[KR Cincy]

It's one more thing I like about home hemo with the NxStage...a clean new kidney each and every treatment!

[Bajanne]

They don't reuse at my centre, but I am told that at the centre in the hospital in my home country they do.  In fact, one of my nurses here told me that she did a course at my country's hospital on reusing. They don't reuse at the private centre, only the hospital.  I am told that it is fine, but so far I haven't had to deal with it.  Hearing about the black stuff is not at all pleasant.

[Joe Paul]

It's one more thing I like about home hemo with the NxStage...a clean new kidney each and every treatment!

Nxstage would be great IF your insurance pays for it. I would have to change insurance and doctors to get it, been there tried that.

[glitter]

my husbands center reuses up to 28 times-he has not had any problems and his clearance is good- but it is not up to him how many times. In the beginning when we objected to the policy- we were told it was there policy, if we did not like it we would have to find another center.

[BobT1939]

At my center the patient has an option, reuse or not. Pros and cons are explained, then patient chooses./bobt

[BigSky]

How should my dialyzer look before treatment?

Your dialyzer should look clean. If your dialyzer looks clotted or dirty, speak to your dialysis care team before starting your treatment. Always
check the appearance of your dialyzer before each treatment.

 Make sure the dialyzer:

 looks clean
 has no more than a few clotted fibers
 has clean tops and bottoms that are free of all but small clots
 is not leaking
 is capped on all openings or ports
 is clearly labeled with your name.

Reuse information from :

NKF
http://www.kidney.org/atoz/pdf/dialyzer_reuse.pdf

[plugger]

I've read studies about reuse and it got me real concerned; not only is the performance of the dialyzer degraded, but there is usually remnants of the cleaning fluid left in the dialyzer - not at all good for a person's health.  My daughter was on dialysis years ago and when I saw those studies, I told the doctor I wanted her off.  He put up a little fight, but did as I asked after he saw how worked up I was about it.

I recall I had to sign some piece of paper allowing reuse for her when she first started, but I understand it isn't worth the paper it is written on since a person doesn't know what they are signing and it is usually signed during a stressful time.

[plugger]

You might be told a dialyzer is fine since they use these strips to test them, however the strips only test for less than a small amount of cleaning fluid - not the absence of cleaning fluid.

[willieandwinnie]

When my husband started in center, they used resuse and he kept having a skin reaction. The neph stop his reuse and the skin problem stopped. The nurses always said they recired them a lot, but I never believed them. Lucky when we started home hemo it wasn't an issue and thank God, he now has a transplant. You guys are reminding me of exactly why I hated going to the clinic. 

[Joe Paul]

Well, after reading some of the replies, I am going to ask to be switched to the one time use dialyzer. Thanks to all those who replied 

[charee]

Here in Aus I have never heard of reusing dializers, sounds yuk to me but i suppose it saves them money.

[BigSky]

I've read studies about reuse and it got me real concerned; not only is the performance of the dialyzer degraded, but there is usually remnants of the cleaning fluid left in the dialyzer - not at all good for a person's health.  My daughter was on dialysis years ago and when I saw those studies, I told the doctor I wanted her off.  He put up a little fight, but did as I asked after he saw how worked up I was about it.

I recall I had to sign some piece of paper allowing reuse for her when she first started, but I understand it isn't worth the paper it is written on since a person doesn't know what they are signing and it is usually signed during a stressful time.

Those studies would be outdated now.

They did have a problem at one time.  It was attributed to a combination of what the dialyzers were made of and the cleaning agent used I believe.  Todays dialyzers are made differently and so far studies show there is no difference in mortality rates and very little if any in performance.

[plugger]

I haven't seen anything that would lead me to believe reuse is a good thing, so if you could back that up I would like to see it.  I did a search on my computer and I did find some things I had so we can compare notes.

[plugger]

Why Fresenius Medical Care Decided Not to Reuse Dialyzers
By J. Michael Lazarus, MD


In the early 1970s, I joined with the late Dr. Peter Lundin in a pro and con debate on the use of reused dialyzers which was printed in this magazine. Peter argued against reuse of dialyzers and I supported reuse. My decision to recommend reused dialyzers for my patients (and to argue for that approach) was based on the fact that cuprophane membranes were being used at that time and there was a very significant occurrence of "first use" syndrome related to the exposure of patients to new cuprophane membranes. I also argued at the time, that dialyzers were expensive and reuse would allow dialysis facilities to use savings in other ways in the delivery of care for patients. My willingness to ask my patients to be dialyzed on reused dialyzers was based on my commitment that dialyzers would be properly processed and would be as safe as a new dialyzer. The American Association of Medical Instrumentation (AAMI) subsequently developed policies and procedures to assure safe dialyzer reuse.



The vast majority of dialysis units and dialysis patients have utilized reused dialyzers over the ensuing years. With the availability of more biocompatible synthetic membranes in the late 1980s and early 1990s, concerns about "first use" syndrome and any medical advantage, however small it may have been, disappeared. However, synthetic membranes, which were developed in Europe and shipped to the United States, were extremely expensive. The only possible way to use dialyzers with synthetic membranes was to continue with reuse. In the 1990s, there were several studies with large retrospective analyses, which suggested that either reused dialyzers or certain chemicals used in the reuse process were linked to an increased mortality in those facilities in which reuse was utilized. This topic and the analyses have been hotly debated for a number of years with no clear resolution.


In 1995, Fresenius USA made a decision to bring the manufacture of dialyzers to the United States where they could be produced in greater quantities at a lower cost. Over the subsequent five years, this has been accomplished. Based on this capability, Fresenius Medical Care (FMC) recently made the decision to abandon reuse of dialyzers over the next two years. The two-year period is necessary because it will take that long to ramp up production of polysulfone dialyzers to an adequate quantity to supply all FMC facilities as well as Fresenius' external customers. We have come to the conclusion that the cost of reuse related to the cost of personnel, reuse materials, and compliance with federal and state regulatory issues regarding reuse, is now equal to or more than the cost of a new polysulfone dialyzer.



We believe that our conversion to non-reuse will allow staff to dedicate more time and attention to other patient care issues. We believe there is no disadvantage whatsoever to patients receiving new kidneys utilizing polysulfone membranes. For those physicians and patients who are comfortable and confident with reuse, we will allow them to continue to utilize reused dialyzers if that is their wish. For those who choose otherwise, we now have the ability to provide high quality single-use biocompatible dialyzers.



I wish my good friend, Peter Lundin, were here to see that we have arrived at an approach which he and I would agree is in the best interest of our patients and the program at-large.




J. Michael Lazarus, MD is the Medical Director and Senior Vice President of Clinical Quality for Fresenius Medical Care North America (FMCNA). Dr. Lazarus is Vice Chairman of the Board of Directors of Renaissance Health Care, Inc., and is on the Board of Directors of Optimal Health Care, Inc. Both are FMCNA-affiliated companies. He is an Associate Professor of Medicine at Harvard Medical School.

This article originally appeared in the January 2002 issue of aakpRENALIFE, Vol. 17, No. 4.

[plugger]

http://sprojects.mmi.mcgill.ca/heart/carecharsum3.html
Pyrogenic or endotoxic reactions reported in the reuse of hemodialysers are associated with a high number of reuses and use of manual reprocessing systems. Despite earlier reports of decreased mortality with reprocessed dialysers, a major U.S. study has found a higher incidence of mortality in free-standing dialysis clinics which reprocess with Renalin. Reuse of dialysers prevents the "first- use syndrome" seen with new dialysers. No longer is this an argument to favor reuse now that all new units are degassed and rinsed prior to use. A controversial result of dialyser reuse is the development of anti-N antibodies in patients being dialysed by units reprocessed with formaldehyde. These antibodies are thought to cause early graft failure in organ transplants, although other researchers believe that their significance is unknown.

[plugger]

(I did some googling and found the following that is more recent.  It seems the author worried about a single use dialyzer having manufacturing chemicals - but I seem to recall a couple of bags of saline run through a dialyzer should take care of that problem)

Although single dialyzer use and reuse by chemical reprocessing are both associated with some complications, there is no definitive advantage to either in this respect. Some complications occur mainly at the first use of a dialyzer: a new cellophane or cuprophane membrane may activate the complement system, or a noxious agent may be introduced to the dialyzer during production or generated during storage. These agents may not be completely removed during the routine rinsing procedure. The reuse of dialyzers is associated with environmental contamination, allergic reactions, residual chemical infusion (rebound release), inadequate concentration of disinfectants, and pyrogen reactions. Bleach used during reprocessing causes a progressive increase in dialyzer permeability to larger molecules, including albumin. Reprocessing methods without the use of bleach are associated with progressive decreases in membrane permeability, particularly to larger molecules.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1525-139X.2006.00158.x?journalCode=sdi

Zbylut J. Twardowski (2006)
Dialyzer Reuse—Part II: Advantages and Disadvantages
Seminars In Dialysis 19 (3), 217–226.
doi:10.1111/j.1525-139X.2006.00158.x

[BigSky]

I haven't seen anything that would lead me to believe reuse is a good thing, so if you could back that up I would like to see it.  I did a search on my computer and I did find some things I had so we can compare notes.

http://www.aakp.org/aakp-library/Reuse-Hemodialyzers/index.cfm

[Joe Paul]

I requested to use non-reusable dializers, but was shot down. They want me to try another re-usable, and when I feel its too dirty looking, will get another re-usable. We will see how this works out though, maybe Santa will bail me out and get me the transplants I asked for