Effects of reuse and bleach/formaldehyde reprocessing on polysulfone and polyamide hemodialyzers

The surface features, morphology, and blood interactions of fibers from pristine, bleach/formaldehyde reprocessed, and reused Fresenius Polysulfone High Flux (Hemoflow F80B) hemodialyzers and Gambro Polyflux 21S Polyamide hemodialyzers have been studied. SEM images of fibers from both hemodialyzer types revealed a dense skin layer on the inner surface and a relatively thick porous layer on the outer surface. The 21S polyamide support layer consisted of interconnected highly porous structures. Environmental scanning electron microscopy and atomic force microscopy images of both membrane types showed alterations in morphology due to reprocessing and reuse; however the changes were more marked for the 21S polyamide dialyzers. Fluorescence microscopy images showed only minimal fluorescence associated with the fibers after patient use and reprocessing, suggesting that blood derived deposits were removed by processing. The protein layers formed on pristine and reused hemodialyzer membranes during clinical use were studied using SDS-PAGE and immunoblotting. Before bleach/formaldehyde treatment, protein layers of considerable amount and complexity were found on the blood side of singly and multiply used dialyzers. Proteins adsorbed on the dialysate side were predominantly in the molecular mass region below 30 kDa. However, some higher molecular mass proteins were detected on the dialysate side of the 21 S polyamide dialyzers. Very little protein was detected on dialyzers that were treated with bleach/formaldehyde after dialysis, regardless of whether they had been used/reprocessed once or 12 times.