Collins A, Ma J
Reuse associated mortality: 1989-1990 vs. 1991-1993
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1443 1996
Reuse is commonly practiced in the USA, affecting some 75% of HD patients.
It is uncommon in Europe and nearly non existent in Japan. The issue of any
association between reuse and mortality has been controversial. One large
study in 1992 reported increased mortality with peracetic acid and
glutaraldehyde
compared to no reuse and formalin, only in free standing units, but not in
hospital based units.
In this study, the authors analyzed a 10 % US sample of period-prevalent
patients from 1989-1993, comparing hospital and free standing units,
adjusting for age, 9 comorbidities, center profit status and unit size,
using a Cox regressional model. The authors found that in 1989-90, manual
peracetic and manual formalin had higher associated risk, but only in free
standing for profit centers. In 1991-93, such findings were not present.
ers.
Hospital based 1989-90 non profit and for profit units showed non
significant risks. In 1991-93, only automated formalin had significant
effects, in non profit units. All others were non significant. The authors
conclude that hospital based and free standing units interacted with profit
status in the 1989-90 data, and that reuse in 1991-93 is no different
from no reuse.
Comment: This study supports the view of those who feel that reuse
practices can be improved and monitored to make it a safe and cost
effective procedure. Continued surveillance will be helpful and necessary.
(Jose Ganel, M.D., University of California Davis at Sacramento,
CA)
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Am Soc Nephrol
Basic hemodialysis :
Reuse, theory and practice
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)