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Reprocessing dialysers for multiple uses: recent analysis of death risks for patients.
Edmund G Lowrie1, Zhensheng Li, Norma Ofsthun
1Fresenius Medical Care (North America), Lexington, MA 02420-9192, USA. edlowrie@prodigy.net
Summary
Switching from reprocessing (reuse) to single-use dialyzers is associated with improved patient survival. This benefit becomes more statistically significant over time, indicating a reduced risk with single-use hemodialysis.
Area of Science:
- Nephrology and Public Health
- Clinical Epidemiology
- Healthcare Economics
Background:
- Dialyzer reprocessing, a cost-saving measure in the USA, persists despite the shift to biocompatible non-cellulosic membranes.
- Historically, reprocessing was linked to complications with older cellulosic membranes but continues for economic reasons.
- A major dialysis provider transitioned 71,000 patients from dialyzer reuse to single-use, creating an opportunity to study associated mortality risks.
Purpose of the Study:
- To evaluate the association between dialyzer reprocessing (reuse) and patient mortality risk.
- To determine if the shift from single-use to reused dialyzers impacts survival outcomes in hemodialysis patients.
- To assess the evolving risk-benefit profile of dialyzer reprocessing practices in the United States.
Main Methods:
- Patients were categorized as 'reuse' or 'single use' as of July 1, 2001.
- Survival time was measured from the classification date (Lag0) and at subsequent 30-day intervals up to 120 days.
- Cox proportional hazards models, including unadjusted, case mix-adjusted, and fully adjusted analyses, were used to evaluate survival over one year post-lag date.
Main Results:
- All analyses indicated a survival advantage for patients using single-use dialyzers.
- Statistical significance of the survival benefit increased at later lag times in adjusted models.
- Hazard ratios for single-use versus reuse showed a trend towards improved survival, becoming statistically significant (P<0.05) by Lag90 and Lag120 in adjusted models.
Conclusions:
- Abandoning dialyzer reprocessing appears to offer a survival benefit, though this advantage may manifest with a time lag.
- The relative risk associated with dialyzer reprocessing may have shifted due to advancements in hemodialysis technology and clinical practices.
- The study highlights a potential shift in the risk-benefit balance of dialyzer reuse in contemporary hemodialysis care.