Does Hemodialyzer Reuse Have a Place in Current ESRD Care: “To Be or Not To Be?”

Abstract

"If you can look into the seeds of time, and say which grain will grow and which will not, speak then unto me." -William Shakespeare. Macbeth. Act 1 scene 3.Because of reliable technology over several decades of experience and apparent cost effectiveness and safety, many in the dialysis industry would have assumed that dialyzer reuse would be a continuing fixture. But dialyzer reuse has become less common in favor of a single-use. In 1997, 82% of dialysis facilities practiced dialyzer reuse for some or all of their patients, but by 2005 this figure had declined to 39% (1, 2). Is there is a continuing role for dialyzer reuse in ESRD programs in the US? To address this, we briefly review the outcomes seen historically and presently between the practices of reuse vs. single-use, and then we discuss the factors that likely contributed to the decline of reuse across the US over the last decade and their implications in making a decision to reuse or not.

Influence of kidney disease on drug disposition: An assessment of industry studies submitted to the FDA for new chemical entities 1999–2010

“…Finally, although the hemodialyzers utilized in PK studies, especially those conducted during the last 5-10 years, were likely high permeability and designed for single use, 25,27,28 up to 40% of dialysis treatments in clinical practice use reprocessed dialyzers. 29 If reprocessing is being used in a dialysis facility, the clearance of some drugs maybe markedly affected and the value of the API dosage recommendations compromised. 30 The utility of the PK data and API dosage recommendations for critically ill patients with AKI have been questioned since the chronicity of renal injury appears to have differential effects on residual renal and nonrenal clearance of several drugs.…”

“…Because marked variability in the hemodialysis clearance of many drugs has been noted when dialyzers of different composition, size, and structure are used, the utility of a PK study of one dialyzer does little to assure clinicians that the dosage recommendations are optimal for all the patients in their care. Finally, although the hemodialyzers utilized in PK studies, especially those conducted during the last 5–10 years, were likely high permeability and designed for single use, up to 40% of dialysis treatments in clinical practice use reprocessed dialyzers . If reprocessing is being used in a dialysis facility, the clearance of some drugs maybe markedly affected and the value of the API dosage recommendations compromised…”

Hemodialyzer Reuse and Gram-Negative Bloodstream Infections

“…This trend has been attributed to a number of factors, including decreased cost for single-use dialyzers and more biologically compatible dialyzer membranes. 3,27,28 …”

Amazing and Fantastic Infection Control: The Case of Dialyzer Reuse

“…In the United States, as the cost of new dialyzers has decreased, reuse has declined. It probably peaked in the late 1990s: w82% of facilities reprocessed dialyzers in 1997, 60%, in 2002, 39%, in 2005 15,20,21 , and according to unpublished 2012 CDC data cited by the authors, 24%, in 2012. Labor costs are high in the United States, and most dialysis treatments are delivered by organizations that obtain discounts on supply costs, either as individual large purchasers or as members of a purchasing cooperative.…”

“…13,14 A subsequent review, which lays out commercial considerations and practical problems in commendable detail, concludes that "The comparison of clinical outcomes in reuse versus single-use has achieved equipoise in our opinion." 15 What do Edens et al add to our understanding of the risks of dialyzer reprocessing? Do their findings tip the balance?…”