EFFECT OF DIALYZER REUSE ON SURVIVAL OF PATIENTS TREATED WITH HEMODIALYSIS

Objective-To evaluate the impact of dialyzer reuse on the survival of US hemodialysis patients. Study Design and Participants.-Nonconcurrent cohort study of 27938 patients beginning hemodialysis in the United S tales in 1986 and 1987. Main Outcome Measure.-Patient survival. Result s-Dialysis in freestanding facilities reprocessing dialyzers with the combination of peracetic and acetic acids was associated with greater mortality than treatment in facilities not reprocessing dialyzers (rat e ratio [RR], 1.10, 95% confidence interval [CI], 1.02-1.18; P=.02) In contrast, there was no significant difference between survival in fre estanding facilities reprocessing dialyzers with either formaldehyde ( RR, 1.03, 95% CI, 0.96-1.10; P=.45) or glutaraldehyde (RR, 1.13, 95% C I, 0.95-1.35; P=.18) and survival in freestanding facilities not repro cessing dialyzers. Among freestanding facilities reprocessing dialyzer s, use of peracetic/acetic acid was associated with a higher rate of d eath than use of formaldehyde (RR=1.08, 95% CI, 1.01-1.14, P=.02). The re was no statistical difference between survival in hospital-based fa cilities reprocessing dialyzers with either peracetic/acetic acid (RR= 0.95, 95% CI, 0.85-1.06; P=.40), formaldehyde (RR=1.06, 95% CI, 0.98-1 .15; P=.12), or glutaraldehyde (RR=1.09, 95% CI, 0.71-1.67; P=.70) and survival in hospital-based facilities not reprocessing dialyzers. In addition, choice of sterilant was not associated with a statistically significant difference in survival among hospital-based facilities rep rocessing dialyzers. Conclusions.-Dialysis in freestanding facilities reprocessing dialyzers with peracetic/acetic acid may be associated wi th worse survival than dialysis in freestanding facilities not reproce ssing dialyzers or in those reprocessing with formaldehyde. We were un able to determine whether these relationships arose from greater comor bidity among patients treated in facilities using peracetic/acetic aci d, poor quality of dialysis procedures in these facilities, or direct toxicity of peracetic/acetic acid. These findings raise important conc erns about potentially avoidable mortality among US hemodialysis patie nts treated in dialysis facilities reprocessing hemodialyzers.