Dialyzer reuse and patient outcomes: what do we know now?

Although some hemodialysis (HD) providers in the United States have recently embarked on programs to discontinue dialyzer reprocessing, the practice of dialyzer reuse is still much more common in the United States than in many other countries. Continuation of reprocessing programs has been justified chiefly as an effort to deliver HD with biocompatible and often expensive higher flux dialysis membranes. However, this rationale is considerably less compelling with the decrease in cost for most types of HD membranes and with ongoing debates about the relative effectiveness of HD membranes according to flux and other characteristics. While it is highly likely that mandated quality control standards have limited catastrophic events, such as outbreaks of blood-borne bacterial infections that can occur due to poor dialyzer reprocessing techniques, hemodialyzer reprocessing remains vulnerable to poor implementation. Reprocessing is no longer indicated in order to improve blood-membrane biocompatibility, due to the marked decrease in first-use syndrome since the widespread adoption of synthetic dialysis membranes. Rather, the possibility exists that certain chronic inflammatory responses observed with dialyzer reuse may be deleterious, although these relationships remain speculative. While observational studies have not consistently demonstrated a large excess mortality attributable to reuse, the association of reuse to mortality remains uncertain. Evaluation of the safety of particular reprocessing techniques, germicides, and cleaners has been even harder to examine. Given the widespread availability of inexpensive biocompatible HD membranes and persistent uncertainties about the safety of dialyzer reprocessing, it is time for providers to reexamine their rationale for continuing hemodialyzer reprocessing programs.