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Related Experiment Videos

Severe dialyzer dysfunction undetectable by standard reprocessing validation tests.

J A Delmez1, C A Weerts, P D Hasamear

  • 1Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.

Kidney International
|September 1, 1989
PubMed
Summary
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Reprocessed dialyzers may malfunction, leading to reduced patient clearances despite standard validation tests. Further investigation into dialyzer function is crucial for patients undergoing dialysis with reused equipment.

Area of Science:

  • Nephrology
  • Biomedical Engineering
  • Materials Science

Background:

  • Reprocessed dialyzers are common in hemodialysis to reduce costs.
  • Standard validation tests (cell volume, ultrafiltration) are used to ensure dialyzer function.
  • A significant increase in patients with low clearances was observed despite adherence to validation protocols.

Purpose of the Study:

  • To investigate the cause of reduced dialyzer clearances in patients using reprocessed dialyzers.
  • To evaluate the impact of reprocessing on dialyzer function in vitro.
  • To identify potential factors contributing to dialyzer malfunction.

Main Methods:

  • Routine urea kinetic measurements were used to monitor patient clearances.
  • Methylene blue injection into the dialysate port assessed dialysate flow.

Related Experiment Videos

  • In vitro studies subjected dialyzers to sequential reprocessing without patient use.
  • Dialyzer clearances were measured before and after reprocessing and soaking in solutions.

    • Main Results:

    • Patient clearances decreased significantly in a subset of patients despite passing validation tests.
    • Methylene blue revealed non-uniform dialysate flow in malfunctioning dialyzers.
    • In vitro reprocessing led to a progressive decline in clearance for one dialyzer lot (218 to 112 ml/min) but not another.
    • Soaking affected dialyzers in disinfectant or dialysate reduced clearance, but less than serial reuse.

    Conclusions:

    • Standard validation tests may not detect all cases of dialyzer malfunction in reprocessed units.
    • Dialyzer reprocessing, particularly serial reuse, can impair dialyzer function and reduce clearances.
    • Further research is needed to understand the full extent of dialyzer malfunction with reuse and to improve reprocessing protocols.