Who is Johns Hopkins?????

[plugger]

And why does he hate davita?  - or at least their practice of reuse?

Believe I mentioned my site got hacked.  I was digging through an old database and I came upon the reuse studies I mentioned earlier.  I'm in the process of putting them into a DialysisEthics2 site article, but I couldn't resist putting up a preview:

http://www.dialysisethics2.org/open_images/flyers/anti-reuse.pdf

I suppose you can believe davita about the practice of reuse, or you can believe the likes of John Hopkins, the National Institute of Health, the University of Pennsylvania, -even Fresenius, etc..., etc...

4/12/2017 More complete article now at:
http://www.dialysisethics2.org/index.php/reuse-is-abuse

[iolaire]

My DaVita center moved from re-use about a year ago.

[plugger]

My DaVita center moved from re-use about a year ago.

Great to hear!  Is this a corporation-wide move, or just individual clinics making the decision?  I must admit I've been out of the loop for awhile - had a deep hate for the practice ever since 2000 and my daughter was on it.  I did play the role of the Great Satan in the clinic to get her off (at least her doctor and the charge nurse might have thought I was).

[iolaire]

My DaVita center moved from re-use about a year ago.

Great to hear!  Is this a corporation-wide move, or just individual clinics making the decision?  I must admit I've been out of the loop for awhile - had a deep hate for the practice ever since 2000 and my daughter was on it.  I did play the role of the Great Satan in the clinic to get her off (at least her doctor and the charge nurse might have thought I was).

I'd guess in this case its probably the ownership group my center belongs to. i.e. the nephrologist practice that is tied to the centers in the area.

[PrimeTimer]

Back in the early '80's, I worked as a dental asst. Some of the instruments used were plastic and would be placed in a "cold sterilization" solution because they could not withstand the heat of an autoclave. Disposable instruments were used on any patient with a known communicable disease (Hepatitis) and were thrown away. According to this article, some of the cold sterilization solutions kill microorganisms but NOT bacterial spores. WOW!! I am glad that my husband's Fresenius clinic doesn't reuse filters! 


http://www.dentaleconomics.com/articles/print/volume-104/issue-3/practice/appropriate-use-of-cold-sterile-solutions-for-dentistry.html

[Michael Murphy]

My problem with reuse is my belief that they hire the cheapest labor possible to treat them.  Just like I would never trust a moron to pack a chute in today's corporate greedy world cheap is the way companies go.  And if it's so safe why do the companies using them pay for hep c treatments if a patient becomes infected and uses reused filters

[Simon Dog]

My problem with reuse is my belief that they hire the cheapest labor possible to treat them.  Just like I would never trust a moron to pack a chute in today's corporate greedy world cheap is the way companies go.  And if it's so safe why do the companies using them pay for hep c treatments if a patient becomes infected and uses reused filters

Reserve chutes are sealed with a seal that bears the license number of the packer.  Unlike medicine where the focus on error analysis is "find and fix the problem, do not blame people" (medicine calls it "Just culture"), investigations into anything aviation related are focused on assigning blame where and when it is due.   

Now, if re-use techs were required to put a sticker with their license number on each cleaned filter, it might help accountability.  (But that still does not make reuse a good idea)

And if it's so safe why do the companies using them pay for hep c treatments if a patient becomes infected and uses reused filters

It's cheaper than litigation and avoids any determination of fault.  By treating the Hep C, the damage has been mitaged before a case can even get to trial, making it very unappealing to contingency fee counsel.

[Michael Murphy]

One small correction it's Johns Hopkin, who was a single business man who endowed the nations first research university.

[plugger]

One small correction it's Johns Hopkin, who was a single business man who endowed the nations first research university.

I saw that in the study and thought it was a typo and changed it - have to fix the auto-correct in my brain.

[Riki]

I'm going to Atlanta in August, and will be going to a Davita clinic.. since I'm paying cash, I'm hoping that they don't reuse filters.. it's not something I'm used to at all

[iolaire]

I'm going to Atlanta in August, and will be going to a Davita clinic.. since I'm paying cash, I'm hoping that they don't reuse filters.. it's not something I'm used to at all

They would not do that for transit patients unless you were there for a long time.  The reusing of filters is you reusing your own filter repeatedly.  They bag it with your name and have an additional sticker on the filter you are supposed to check each session just to confirm its yours.  I'm sure those filters cost more so there must be some minim use to make the reuse viable.  When I wanted to get off reuse they tried to say the reuse filter was better and after the change I did have a harder time meeting my KTV, but then within six months the entire center moved over to single use.

[plugger]

One small correction it's Johns Hopkin, who was a single business man who endowed the nations first research university.

Should ask are you going to believe davita or a guy who can't spell his own name right (Johns?)  (I crack me up)  - and his friends (sure seem to be a lot of them!)

[plugger]

some of the cold sterilization solutions kill microorganisms but NOT bacterial spores. 

http://www.dentaleconomics.com/articles/print/volume-104/issue-3/practice/appropriate-use-of-cold-sterile-solutions-for-dentistry.html

I wonder what bacterial spores do to a person - my bet is it isn't good!

[Michael Murphy]

Johns was a family name.

[LorinnPKD]

Respectfully, most of the studies presented here are more than 10 years old.

I think most centers have moved to disposable, and certainly my DaVita center has.  My father dialyzed in the late 1980s to late 1990s and they used reusables back then.

I have lots of reasons to grar on DaVita (and boy howdy, this past week alone...) but they use disposables so that's not one of them.

[Simon Dog]

When I wanted to get off reuse they tried to say the reuse filter was better and after the change I did have a harder time meeting my KTV

That is only because the center mandated a cheaper filter if non on re-use.  There was nothing, other than $$ motivation, to prevent them from using a reusable filter only once.

[plugger]

There was nothing, other than $$ motivation, to prevent them from using a reusable filter only once.

I used to say money wasn't a problem in dialysis, there was more than enough of it!  I was wrong, there is TOO MUCH of it and has attracted the wrong element, people who want to scam off as much of it for themselves as they can.  By going on single-use some of that money is actually being funneled to better care - and in the big picture of things, it is not breaking the bank.

LorinnPKD, thank you for pointing out there are other problems.  As for old studies, I would label them "having stood the test of time".  I see nothing to refute them, as I stated here:
http://www.dialysisethics2.org/index.php/reuse-is-abuse
How big a problem is it?  It might depend on who you are.  For Betty Allen, who I've mentioned, it was a huge problem.  For somebody like my daughter, who was 18 at the time, it might also be a bigger problem.  Even if reuse is done right (big if), I recall they used test strips to test for any chemical in the dialyzer.  The strips would test for NOT any absence of the chemical - but that the chemical would only be below a certain level.  So each time she or anybody else was getting a treatment, they also get a small shot of chemical straight to the blood stream!  What are the cumulative effects of this?  Can't be good.

Even for older patients, the effects of using a dialyzer that is degrading the majority of the time also can't be good.  And when somebody older goes off reuse, they might be paving the way for somebody younger to go off.

As for the bull about just having to use a cheaper dialyzer for single-use, it does have the smell of pure BS to me.  When my daughter went off reuse, DialysisEthics (now Dialysis Advocates) had me check the dialyzer the daughter was using - Arlene there called it "the cadillac of dialyzers" being used for single-use, so it is possible to get a better dialyzer.  Having the clinic save a few pennies on a dialyzer so some fat cat at headquarters can get more $$ on their bonus just doesn't seem worth it to me!

[Simon Dog]

Having the clinic save a few pennies on a dialyzer so some fat cat at headquarters can get more $$ on their bonus just doesn't seem worth it to me!

This is Fresenius policy.   MDs are required to move you from 4 hours to 4.5 hours treatment if you are on a 180 filter and cannot meet goal, whereas, you might hit goal in 4 hours on a 200 or even a 250.

[Charlie B53]

I aked, our Fresenius is using 180's unless the Dr has ordered differently.

[plugger]

This is Fresenius policy.   MDs are required to move you from 4 hours to 4.5 hours treatment if you are on a 180 filter and cannot meet goal, whereas, you might hit goal in 4 hours on a 200 or even a 250.

Just have to mention since 2000 I've been taught from almost day one, the longer, slower, more gentle dialysis was the way to go - but I must admit it was tough trying to tell that to my then teenager.  Should have had her wear a crash helmet!  Jeez, I'm really going back to my roots with this latest incident!

But for everybody else who isn't a speed-crazy teenager I thought I would throw this out from Home Dialysis Central:

Hemodialysis - Why More is Better
Beta-2 microglobulin (B2M)
    Part of a form of amyloid, a waxy protein. In time, it can build up in the blood of people on dialysis and form lumps in the body ( amyloidosis ). Often, B2M goes to the joints, which can cause pain and make it hard to move (such as carpal tunnel syndrome). Lumps can also form in blood vessels, on organs, or even in the eyes or skin. B2M is a "middle molecule;" one that takes a long time to remove. The 3-4 hours of standard HD are not long enough to remove much B2M. Extended HD does a better job.
http://www.homedialysis.org/life-at-home/articles/hemodialysis-why-more-is-better

[plugger]

Well, I've been waiting patiently for a magical and whiz-bang reuse study that would convince me reuse is a fine and wonderful practice - and Johns Hopkins and his friends are just being mean.  I imagine others have been looking too!  If they found something looks like they aren't bringing it back here.  So I decided to look on my own.  At first I found hope!  A study from the NIH!  They can be reliable!

Dialyzer Reuse with Peracetic Acid Does Not Impact Patient Mortality:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109934/

I read blah-blah, yakity-yakity, then:
Disclosures:
The authors are employees of DaVita Inc

BIAS!!!!   TRASH CAN!  Oh, well.  I tried.

[plugger]

I've been re-reading that reuse study I just mentioned above.  I figure if I re-read it enough times I too will become a reuse fan!  But while I was at it, I did come upon this: "The patients at high reuse centers were significantly more likely to be Hispanic or non-African American".  What if that had read: "The patients at high reuse centers were significantly more likely to be Hispanic or African American".  Boy couldn't that be problem!

Just thinking out loud this morning.