Frinak S, Besarab A, Abrego PH, Narins RG
Heat sterilization of dialyzers: maximized reuse with 1.5% citric acid and 95 degrees C
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:488 1995

The initial heat sterilization protocols called for heating the dialyzer to 105 degrees C for 24 hours. The newer method is to heat to 95 degrees C for the same amount of time after filling with 1.5% citric acid to enhance bacterial spore killing. This method was shown to be effective in killing Bacillus stereothermophilus spores and also was found to increase the number of reuses; in 10 patients addition of citric acid resulted in an increase in mean reuse number from 6 to 12, and also the urea clearance was better maintained from the first to the fifth use in the citric acid group. Decreasing the sterilization temperature from 105 to 95 degrees C also reduced the potting compound failure rate by a factor of 10.

Comment: Heat sterilization is becoming an increasingly attractive alternative method for reuse of dialyzers in the United States. (Daugirdas)

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Am Soc Nephrol
Basic hemodialysis : Reuse, theory and practice


Correction by Author) The study used 20 patients in a randomized cross-over design. Ten patients were treated with dialyzers reprocessed at 105 deg.C and 10 patients used dialyzers reprocessed with 1.5% citric acid at 95 deg.C. When a dialyzer failed the reuse criteria or reached maximum reuse the patient was changed to the alternate reuse procedure. Dialyzer appearance was greatly improved with citric acid, indicating that citric acid is also and effective cleaning agent. Our recent studies have shown that there is no significant difference in dialyzer clearance between the 1st and 20th use with citric acid reprocessing.
Stan Frinak (zasuwa@earthlink.net)
Detroit, MI USA-Friday, June 28, 1996 at 10:47:29 (CDT)

Stan: Many thanks for your comments. Do you have any information about preservation of beta-2 microglobulin clearance with heat sterilization? With non-bleach methods of reuse, a fall in beta-2 clearance over time is a potential area of concern.
John T. Daugirdas MD ()
Chicago, IL USA-Friday, June 28, 1996 at 11:40:38 (CDT)