Association of dialyzer reuse and hospitalization rates among hemodialysispatients in the US

Objectives: To determine if reuse of hemodialyzers is associated with highe r rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients. Methods: Noncurrent cohort study of hospitalizatio n rates among 27,264 ESRD patients beginning hemodialysis in the United Sta tes in 1986 and 1987. Results: Dia lysis in free-standing facilities reproc essing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02-1.14). This higher rate of hospitalization was observed with dialyzer reuse using peracetic/acetic acids (RR = 1.11, CI 1.04-1.18) and formaldehyde (RR = 1.07, CI 1.00-1.14), but not glutaraldehyde (p = 0. 97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reproces sing. Hospitalization for causes other than vascular access morbidity in fr ee-standing facilities reusing dialyzers with formaldehyde was not differen t from hospitalization in facilities not reusing. However, reuse with perac etic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03-1.15). Conclusions: Dialysis in free-stand ing facilities reprocessing dialyzers with peracetic/acetic acids or formal dehyde was associated with greater hospitalization than dialysis without di alyzer reprocessing. This greater hospitalization accounts for a large incr ement in inpatient stays in the USA. These findings raise important concern s about potentially avoidable morbidity among hemodialysis patients. Copyri ght (C) 1999 S. Karger AG, Basel.