Reuse of hemodialyzers. Results of nationwide surveillance for adverse effects

Alter, Miriam J.; Favero, Martin S.; Miller, Jacqueline; Coleman, Patrick J.; Bland, Lee A.

doi:10.1001/jama.260.14.2073

Cited by 24 publications

(11 citation statements)

References 9 publications

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“…In the USA there has been an increase in the number of centres reprocessing dialysers from 19% in 1980 to 63% in 1986 [2]. By way of contrast only 11.7% of Euro pean centres were reusing in 1985 [13].…”

Section: Discussionmentioning

confidence: 99%

“…By way of contrast only 11.7% of Euro pean centres were reusing in 1985 [13]. Coincident with the increase in the number of USA centres reprocessing dialysers there has been a decrease in the use of formal dehyde as the sterilant from 94%in 1983 to 69%in 1986 and an increase in the number of centres using Renalin from 5 to 28% [2], Many studies have been carried out on the effect of reprocessing dialysers with formalde hyde, but comparatively little data are available using Renalin.…”

Section: Discussionmentioning

confidence: 99%

“…Haemodialyser reprocessing commenced in the 1960s [1], and since then it has become an increasingly com mon practice particularly in the USA where over 60% of dialysis centres now reuse [2], Originally reuse was prac tised to contain costs, but there is now substantial evi dence that it improves patient well-being by a reduction in frequency of symptoms of the 'first-use' syndrome [3,4], Despite the beneficial effects of dialyser reprocessing it has not been universally adopted because of concerns about patient and staff welfare and even some doubts about its cost effectiveness [5], Many of these reserva tions have resulted from undesirable clinical and labora tory side effects associated with the use of formaldehyde as a sterilizing agent [6].…”

Section: Introductionmentioning

confidence: 99%

“…Recently increasing use has been made of alternative sterilizing agents to formaldehyde [2], However most studies published on reuse have been based in centres using formalin, and comparatively little data are avail able on other sterilants. In a 6-month prospective study we evaluated the use of one such sterilant, Renalin® (Re nal Systems, Minneapolis, Minn., USA) in our 11-bed chronic dialysis centre.…”

Section: Introductionmentioning

confidence: 99%

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Dialyser Reprocessing with Renalin®

Fleming¹,

Foreman²,

Shanley³

et al. 1991

Am J Nephrol

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We evaluated the dialyser reprocessing agent Renalin® in a 6-month prospective study of 2,759 dialyses on 59 patients. Dialysers were withdrawn after a maximum of 6 uses, and the average number of uses achieved was 4.5. Dialyser survival varied with the type of dialyser but was unaffected by the dialysate base. In vivo clearances of urea, creatinine and phosphate were not altered by reuse, but there was a small decrease in ultrafiltration characteristics of used dialysers. No clinically significant adverse event was attributed to reuse. Blood pressure was better preserved with used dialysers, and patients experienced significantly fewer intradialytic symptoms. Savings of over $A 25,000 were achieved during the study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dialyser Reprocessing with Renalin®

Fleming¹,

Foreman²,

Shanley³

et al. 1991

Am J Nephrol

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“…Centers that re ported using chlorine dioxide employed manual reprocess ing, and most of these centers reused dialyzers >20 times. Manual dialyzer reprocessing has consistently been associ ated with higher frequency of PR [51]. Alter et al [52] also reported that centers using Renalin for manually reproces sing dialyzers >20 times had more clusters of PR than cen ters that reused less than 20 times and used automated sys tems or 4% formaldehyde for reprocessing.…”

Section: Overview Of Outbreaks Of Pyrogenic Reactionsmentioning

confidence: 99%

Water Treatment for Hemodialysis

1996

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Water treatment is a vital aspect of hemodialysis in which knowledge and technical skills are of utmost importance. The recognition that nontuberculous mycobacteria can be resistant to certain germicides spurred the establishment of the current safety microbiologic standards for dialyzer reprocessing. Monitoring the dialyzer membrane integrity is as important as meeting the standards for bacterial and endotoxin levels for dialyzer reprocessing. Ensuring the use of product water that meets the chemical and microbiologic standards of the Association for the Advancement of Medical Instrumentation is necessary to reduce the incidence of endotoxemia and chemical hazards associated with the use of water for hemodialysis. The pathogenesis of febrile reactions during hemodialysis remains controversial. The weight of evidence, however, favors transmission of endotoxin fragments across dialysis membranes to induce mononuclear cell cytokine production.

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Pyrogenic Reactions Associated With the Reuse of Disposable Hollow-Fiber Hemodialyzers

Gordon

Tipple²,

Bland³

et al. 1988

JAMA

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We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment. Pyrogenic reactions to dialysis sessions during the epidemic period (July 1 through 14) were associated with the use of a reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The water used to rinse the dialyzers after use and to dilute the germicide for disinfecting the dialyzers contained high concentrations of endotoxins (greater than 6 ng/mL) and bacteria (greater than 10(4) colony forming units/mL). After reuse of dialyzers was discontinued at the center, the PR rate fell to pre-epidemic levels. We concluded that PRs were associated with reuse of dialyzers, probably contaminated with endotoxins. Active surveillance for PRs among patients undergoing long-term hemodialysis should be routine at all dialysis centers; an increase in PRs should prompt timely review of water treatment and dialyzer reprocessing systems.

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Reuse of hemodialyzers. Results of nationwide surveillance for adverse effects

Cited by 24 publications

References 9 publications

Dialyser Reprocessing with Renalin®

Dialyser Reprocessing with Renalin®

Water Treatment for Hemodialysis

Pyrogenic Reactions Associated With the Reuse of Disposable Hollow-Fiber Hemodialyzers

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Reuse of hemodialyzers. Results of nationwide surveillance for adverse effects

Cited by 24 publications

References 9 publications

Dialyser Reprocessing with Renalin&reg;

Dialyser Reprocessing with Renalin&reg;

Water Treatment for Hemodialysis

Pyrogenic Reactions Associated With the Reuse of Disposable Hollow-Fiber Hemodialyzers

Contact Info

Product

Resources

About

Dialyser Reprocessing with Renalin®

Dialyser Reprocessing with Renalin®