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Article Review/Hyperlink
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Pereira BJG, Natoy SN, Sundaram S, Schmid C, Trabetlsi FR,
Strom JA, King AJ
Impact of single use versus reuse of cellulose dialyzers on
clinical parameters and indices of biocompatibility
J Am Soc Nephrol
(Jun) 7:861-870 1996

With early data from the USRDS suggesting that mortality is higher in
patients treated with reused dialyzers, an explanation for the findings
continues. One popular notion has been, that reuse somehow adversely affects
cytokines in patients, leading to an early demise. In this paper, Pereira et
al put the idea to a test, when they measured in dialysis patients undergoing
reuse vs. single use, the plasma levels of interleukin 1 receptor antagonist,
and the ability of monocytes to generate this compound, and plasma levels of
a whole host of other compounds associated with biocompatibility, including
C3a, lipopolysaccharide binding protein (LBP), and bactericidal-permeability
increasing factor (BPI). The Terumo cuprammonium rayon dialyzer was used,
and the reuse procedure was glutareldehyde with bleach. 39 patients were
split into two groups for 12 weeks, one using single-use dialyzers, one using
reused dialyzers.
To make a long story short, there were no differences found in any plasma
measure of biocompatibility studied, predialysis, postdialysis, or 15 minutes
into dialysis. The conclusions of the study were, that reuse of cuprammonium
dialyzers with glutaraldehyde and bleach does not alter their
biocompatibility, and does not induce an altered state of cytokines in
patients. A number of clinical parameters (hospitalizations, transfusions,
URR) also were not different between single-use and reuse patient groups.
Comment: This is an elegantly done study by one of the premier groups
in the US working on biocompatibility. It throws considerable cold water on
those prophets of doom (e.g., Dr. Stanley Shaldon) who claim that reuse of
dialyzers is a dangerous practice that should be abandoned.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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