The effect of dialyzer reprocessing on performance and beta 2-microglobulin removal using polysulfone membranes

Area of Science:

• Nephrology
• Biomaterials Science
• Medical Device Engineering

Background:

• Routine dialyzer reprocessing is favored for increased biocompatibility and lower cost.
• Longer-term reprocessing of polysulfone membranes (PMs) is critical, with concerns about decreased efficiency, especially in beta 2-microglobulin (beta 2M) removal, linked to dialysis-associated amyloidosis (DDA).

Purpose of the Study:

• To evaluate the impact of up to 24 reuses on the performance of polysulfone membrane dialyzers.
• To assess changes in urea clearance (Kd), urea mass transfer coefficient (h0), ultrafiltration coefficient (K(uf)), and beta 2-microglobulin (beta 2M) removal.

Main Methods:

• Eleven hemodialysis patients underwent testing of PMs reprocessed manually with bleach and formaldehyde.
• Dialyzer efficacy was examined at 1, 5, 10, 15, 20, and 24 uses.
• Measurements included Kd, h0, K(uf), and percent removal of beta 2M (corrected for ultrafiltration).

Main Results:

• Urea clearance (Kd) showed no significant change over 24 uses.
• The urea mass transfer coefficient (h0) significantly increased by the 15th use.
• The ultrafiltration coefficient (K(uf)) significantly increased at the 10th and 20th uses (P < 0.05).
• Percent removal of beta 2M significantly increased from 44.1% in the first use to 63.1% by the 24th use (P < 0.001).

Conclusions:

• Polysulfone membrane dialyzers can be effectively reprocessed up to 24 times.
• Reprocessing does not compromise urea clearance and enhances the removal of beta 2-microglobulin.
• This supports the routine reprocessing of dialyzers for long-term hemodialysis, offering cost and biocompatibility benefits.