HDCN Article Review/Hyperlink

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)