Effect of dialyzer reprocessing methods on complement activation and hemodialyzer-related symptoms

Area of Science:

• Nephrology
• Biomaterials Science
• Clinical Immunology

Background:

• Dialyzer reuse is a common practice in maintenance hemodialysis.
• Processing methods for new and reused dialyzers can influence biocompatibility.
• Complement activation is a key factor in dialyzer-related symptoms.

Purpose of the Study:

• To investigate the effects of various dialyzer processing methods on complement activation.
• To assess the impact of dialyzer reuse on complement activation and patient symptoms.
• To correlate complement activation levels with the severity of dialyzer-related symptoms.

Main Methods:

• Ninety-six maintenance hemodialysis patients participated in the study.
• New dialyzers were either unprocessed or machine-washed with bleach and stored in formaldehyde.
• Reused dialyzers underwent manual or machine cleansing using bleach, formaldehyde, or peracetic acid.

Main Results:

• Machine-washed new dialyzers showed increased complement activation compared to unprocessed new dialyzers.
• Reused dialyzers processed without bleach (formaldehyde or peracetic acid) exhibited reduced complement activation.
• Patients using reused dialyzers reported significantly fewer symptoms during dialysis compared to those using new dialyzers.

Conclusions:

• Dialyzer processing and reuse significantly affect complement activation.
• Reduced complement activation correlates with fewer patient-reported symptoms during hemodialysis.
• While complement activation is linked to symptoms, other factors may contribute to specific symptoms like chest pain.