IMPACT OF SINGLE-USE VERSUS REUSE OF CELLULOSE DIALYZERS ON CLINICAL-PARAMETERS AND INDEXES OF BIOCOMPATIBILITY

Hemodialysis with reprocessed dialyzers has been associated with an in creased mortality in patients on chronic dialysis, but the causes for this increased mortality have not been identified thus far. The aim of this study was to compare the qualitative and/or quantitative differe nces in activation of cellular and plasma elements, intradialytic sign s and symptoms, adequacy of dialysis, and serum biochemistry and hemat ology in patients dialyzed with new or reprocessed cellulose dialyzers . This study measured the plasma levels and production of interleukin- 1 receptor antagonist (IL-1Ra) by peripheral blood mononuclear cells ( PBMC), indices of cytokine synthesis; plasma C3a levels, an index of c omplement activation; plasma levels of lipopolysaccharide binding prot ein (LBP), an acute phase reactant; and plasma levels of bactericidal- permeability increasing factor (BPI), a neutrophil primary granule pro tein, in 37 patients on chronic hemodialysis with glutaraldehyde and b leach-reprocessed cellulose dialyzers after random assignment to 12 wk of dialysis with new (single use) or reprocessed (reuse) cellulose di alyzers. These indices were studied before dialysis, 15 min after the start of dialysis, and at the conclusion of dialysis in both groups. I ntradialytic clinical symptoms and signs, urea reduction ratios, month ly blood chemistry, and hematology were also studied during the 12-wk period. Before randomization, clinical and laboratory characteristics and IL-1Ra production by PBMC were similar in the two groups. During t he 12-wk study, the mean number of dialyzer reuses was 7 +/- 1 in the reuse group and there were no breaks in protocol in the single-use gro up. At the end of the study, plasma levels of IL-1Ra, cell content and production of IL-1Ra by unstimulated, endotoxin-stimulated, and IgG-s timulated PBMC among patients assigned to reuse were not significantly different from those in the single-use group either before dialysis, at 15 min, or at the conclusion of dialysis. Similarly, plasma levels of C3a, LBP, and BPI were not significantly different between groups a t any of the three time points. During the 12-wk study, none of the pa tients in either arm of the study experienced chills, rigors, or fever , and there were no differences in the number of episodes of symptomat ic hypotension in patients on reused dialyzers (11 +/- 3) compared wit h patients on single-use dialyzers (8 +/- 2). The mean monthly urea re duction ratio during the 3 months of the study was 63 +/- 2% and 65 +/ - 2% for reuse and single-use dialyzers, respectively (not significant ). Similarly, the hematocrit, wt-cite blood cell count, serum calcium, phosphorus, cholesterol, triglycerides, total protein, and albumin le vels were also not significantly different between the two groups at t he end of the 12-wk study period. These results suggest that the repro cessing of cellulose dialyzers with glutaraldehyde and bleach does not affect indices of biocompatibility, intradialytic symptoms and signs, adequacy of dialysis, or serum biochemistry and hematology.