Effects of hemodialyzer reuse on clearances of urea and beta(2)-microglobulin

Although dialyzer reuse in chronic hemodialysis patients is commonly practi ced in the United States, performance of reused dialyzers has not been exte nsively and critically evaluated. The present study analyzes data extracted from a multicenter clinical trial (the HEMO Study) and examines the effect of reuse on urea and beta(2)-microglobulin (beta(2)M) clearance by low-flu x and high-flux dialyzers reprocessed with various germicides. The dialyzer s evaluated contained either modified cellulosic or polysulfone membranes, whereas the germicides examined included peroxyacetic acid/acetic acid/hydr ogen peroxide combination (Renalin(R)), bleach in conjunction with formalde hyde, glutaraldehyde or Renalin, and heated citric acid. Clearance of beta( 2)M decreased, remained unchanged, or increased substantially with reuse, d epending on both the membrane material and the reprocessing technique. In c ontrast, urea clearance decreased only slightly (approximately 1 to 2% per 10 reuses), albeit statistically significantly with reuse, regardless of th e porosity of the membrane and reprocessing method. Inasmuch as patient sur vival in the chronic hemodialysis population is influenced by clearances of small solutes and middle molecules, precise knowledge of the membrane mate rial and reprocessing technique is important for the prescription of hemodi alysis in centers practicing reuse.