Increases in membrane porosity after reuse with citric acid and heat.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:158A 1997
Dialyzer reuse is common in dialysis units in the United States and is driven primarily by financial considerations. The sterilants used for dialyzer reuse are peracetic acid/hydrogen peroxide, bleach, glutaraldehyde and formaldehyde. Each is associated with its own peculiar set of disadvantages.
Bleach has been shown to increase albumin loss when used with Polysulfone dialyzers, while Formaldehyde may produce allergic reactions in healthcare workers and hemolytic anemia in patients exposed to dialyzers sterilized with formaldehyde. Peracetic acid/hydrogen peroxide has been implicated in causing higher mortality of hemodialysis patients although the precise mechanisms are in question.
The authors of this study report on the use of heat with citric acid to sterilize Polysulfone dialyzers and report on the increase in membrane porosity after the use of this modality of sterilization. Fresenius F-80B dialyzers were reused up to 15 times using citric acid and heat processing at 95 degrees for 20 hours. The entire dialysate was collected and measured for albumin and beta-2 microglobulin.
By the tenth reuse, there was a significant increased amount of beta-2 microglobulin recovered from the dialysate. Albumin loss, however, did not change with up to 15 reuses implying an increase in porosity of the polysulfone membrane sufficient to increase loss of beta -2 microglobulin but not of the larger albumin molecule.
Comment: Heat sterilization is slightly more expensive than bleach or formaldehyde. At present, only polysulfone dialyzers have been studied. Further developments in the process will allow other dialyzers to be processed likewise and will avoid problems with blood leak and cosmetic deterioration due to heat exposure. Further studies with other synthetic dialysers are needed. (Shahab Arfeen, M.D., Valparaiso, IN)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Reuse, theory and practice