A Prospective Study on Intradialytic Symptoms Associated with Reuse of Hemodialyzers

Cheung, Alfred K.; Dalpias, David; Emmerson, Rita Y.; Leypoldt, John K.

doi:10.1159/000168345

Cited by 15 publications

(5 citation statements)

References 6 publications

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“…Reprocessing may thus be viewed as a suspected contributory factor to mortality in dialysis dependent patients. Many studies attest to the absence of negative outcomes in the short term (i.e., absence of symptoms attributable to reuse [18][19][20] or acti- vation of inflammatory mediators [15,21]), but there are only a few rigorously controlled studies in the literature comparing the adequacy of dialysis achieved with the first use of a dialyzer with subsequent uses. We believe it is appropriate to consider this question with prospective well designed trials at this time.…”

Section: Discussionmentioning

confidence: 99%

Urea Kinetics with Dialyzer Reuse – A Prospective Study

et al. 1999

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We performed a prospective study to examine the impact of dialyzer reuse on KT/V under rigidly standardized conditions on 3 membrane types. Heparin dosage was standardized with ACT during an eight week run-in period and remained unchanged through the study. Post dialysis BUN and weight were obtained at five minutes after exactly 80 ± 0.5 l of blood were processed through the dialyzer. Dialyzers were reused after automated glutaraldehyde processing and after ensuring >80% open fiber bundles. Each membrane type was utilized 3 times on a set of 3 patients; each individual dialyzer was reused 8 times. KT/V was done on the 1st, 2nd, 4th and 8th uses of each dialyzer (36 measurements) starting mid week; BUN measurements were grouped. The KT/V (mean ± SD) for the 1st, 2nd, 4th, and 8th uses of the cellulose acetate dialyzer were 1.3 ± 0.2, 1.3 ± 0.3, 1.3 ± 0.2, 1.3 ± 0.2 respectively; the corresponding values of the cuprophane dialyzer were 1.4 ± 0.3, 1.4 ± 0.3, 1.3 ± 0.4, 1.3 ± 0.3 respectively; and those of the polysulfone dialyzer 1.7 ± 0.3, 1.6 ± 0.2, 1.6 ± 0.2 respectively. By a 3 way ANOVA there were no significant differences between the 1st and subsequent uses of any of the dialyzers tested. Conclusions: Reuse of dialyzers up to 8 times does not result in a loss of urea clearance. We believe this model is useful for further studies on reuse and quality assurance.

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Section: Discussionmentioning

confidence: 99%

Urea Kinetics with Dialyzer Reuse – A Prospective Study

et al. 1999

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“…While some have declared it a flawed prac tice [1], there is considerable evidence that, when done carefully, dialyzer reuse is not associated with adverse consequences for pa tients [40,41], However, it is equally clear that poorly done reuse does expose patients to undue risk. The risk may be amplified when dialysis therapy is prescribed using urea kinet ics if reuse leads to an unrecognized decrease in dialyzer performance.…”

Section: Resultsmentioning

confidence: 99%

Technical Challenges to Successful Dialyzer Reuse

Ward

1995

Blood Purif

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Limitations of dialyzer reuse technology may contribute to adverse patient outcomes. Assessing changes in dialyzer performance by measuring changes in total cell volume may not be valid for all membranes and reprocessing methods. Systems which determine dialyzer performance on-line are superior. Compliance with standards for microbial contamination of reprocessing fluids is poor and improvements in water treatment system design and monitoring are needed. Technological innovation is required to enable dialyzer performance to be monitored over an expanded molecular weight range and to ensure that dialyzer reprocessing can be routinely performed with sterile, non-pyrogenic solutions.

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“…No previous study has considered the type of hollow‐fibre use and recurrent VAT in HD patients. The only similar work was prospective study on the intradialytic symptoms associated with dialyzer reuse (20). In the present study, approximately 50% (239/483) of patients reused hollow fibres.…”

Section: Discussionmentioning

confidence: 99%

Anticardiolipin antibody and Taiwanese chronic haemodialysis patients with recurrent vascular access thrombosis

Cai

et al. 2005

International Journal of Clinical Practice

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Vascular access failure is a major cause of morbidity in chronic haemodialysis (HD) patients. However, some factors (such as homocysteine levels) are known regarding the risk factors predisposing certain HD patients to vascular access thrombosis (VAT). Immunoglobulin-G anticardiolipin antibody (IgG-ACA) is strongly associated with venous and arterial thrombosis in patients with normal renal function. Previous investigations have reported the characteristics of patients with raised IgG-ACA titre and recurrent VAT of HD in Western countries, but few equivalent studies exist for Taiwan. This retrospective study attempts to determine whether raised IgG-ACA titres are associated with an increased risk of recurrent VAT in chronic HD patients. This study enrolled 483 patients undergoing HD. IgG-ACA titre and hepatitis B&C marker were measured for all patients. A history of recurrent (VAT more than one) and/or VAT was elicited by using information from the patient questionnaires and was verified by means of careful inpatient and outpatient chart review. Raised IgG-ACA titres were present in 21.7% (105/483) of patients. In both groups (raised IgG-ACA and normal IgG-ACA), the type of shunt differed significantly (p = 0.029). In predicting for more or one episodes of VAT by using multiple logistic regression with all significant factors, synthetic graft was also a significant factor (p < 0.0001). The 105 raised IgG-ACA titres and 378 normal IgG-ACA titres were associated between chronic HD patients and recurrent VAT (p = 0.034). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, raised IgG-ACA titre was a non-significant factor (p = 0.336). The presence of hepatitis C had a higher percentage in group with raised IgG-ACA titres of HD patients (p = 0.042). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, the presence of hepatitis C was also a significant factor (p = 0.022). In conclusion, the prevalence of raised IgG-ACA titres was 21.7% among HD patients. There was a weak association between raised IgG-ACA titre and recurrent VAT and this finding may be the consequence of pathogenetic role of raised IgG-ACA titres in the development of VAT status for chronic HD patients. The presence of hepatitis C was a cofactor.

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A Prospective Study on Intradialytic Symptoms Associated with Reuse of Hemodialyzers

Cited by 15 publications

References 6 publications

Urea Kinetics with Dialyzer Reuse – A Prospective Study

Urea Kinetics with Dialyzer Reuse – A Prospective Study

Technical Challenges to Successful Dialyzer Reuse

Anticardiolipin antibody and Taiwanese chronic haemodialysis patients with recurrent vascular access thrombosis

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