Influence of reuse and of reuse sterilants on the first-use syndrome

Over a 4 year period, five of 98 patients at our dialysis unit developed signs and symptoms consistent with first-use syndrome (FUS). Marked improvement was noted after subjecting new dialyzers to automated processing using either formaldehyde or peracetic acid. No episodes of FUS occurred in patients being treated with reused dialyzers. Use of formaldehyde sterilization was associated with development of anti-N-like antibodies in the blood of four (8%) of 50 patients over a follow-up period of 14 months. In two patients on the reuse program, itching during dialysis resolved after changing from formaldehyde-sterilization to a method using peracetic acid. Our results confirm the beneficial effects of reuse with regard to first-use syndrome. However, our data also suggest that use of formaldehyde, the most common reuse sterilant, continues to be associated with undesirable clinical and laboratory side effects.