Dialyzer Reuse in Hemodialysis: Safety, Risks, and Prevention

Safety and Efficacy of Dialyzer Reuse

The American Journal of Kidney Diseases reports that reprocessing dialyzers for reuse in the same patient has been a common practice in the United States, with 78% of hemodialysis clinics reprocessing dialyzers as of 2002, though this practice has declined in recent years 1.
Multiple large retrospective analyses have shown no significant differences in mortality or hospitalization risk between patients treated with single-use dialyzers versus those treated with properly reprocessed dialyzers 2.
A large study examining 49,273 incident Medicare patients from 1998-1999 found no significant differences in mortality or first hospitalization risk among patients treated with single-use dialyzers compared to those treated with dialyzers cleansed using different reprocessing techniques 3.

Hemodialyzer performance, measured as blood-side urea clearance, may decline as a result of dialyzer reuse, with some reports showing up to 20% decrease in urea clearance by 10 reuses even when following conventional reprocessing practices 4, 5.
The HEMO Study showed that average loss of urea clearance was only 1-2% per 10 reuses for both low-flux and high-flux membranes reprocessed with different germicidal regimens 6.

Risks include potential for infection, pyrogenic reactions, toxicity from disinfectants, reduced dialyzer performance, and impaired removal of large molecules 2.

Dialysis facilities choosing to reuse dialyzers should follow the Association for the Advancement of Medical Instrumentation (AAMI) recommendations for reprocessing, and dialyzers intended for reuse should have a blood compartment volume not less than 80% of the original measured volume or a urea (or ionic) clearance not less than 90% of the original measured clearance 1, 3, 4, 7.
Monitoring relevant patient data, specifically examination of Kt/V and/or URR over time, is essential to ensure that all parameters relating to dialyzer clearance are being met 8.

Total Cell Volume (TCV) measurements, ionic clearance, or urea clearances can all be used to assess the function of either fresh or reused dialyzers, and a 10% decrease in urea clearance could lead to inadequate dialysis if the dialysis prescription was marginal to begin with 8.
Direct measurements of ionic clearance (conductivity or sodium clearance) or urea clearances correlate closely with TCV results and can be used as alternatives to assess dialyzer function 8.

The choice of germicide for reprocessing affects dialyzer performance, and the use of poorly biocompatible, unmodified cellulose dialyzer membranes for hemodialysis is discouraged due to their association with adverse effects including activation of the complement pathway 1, 6, 7.
Rinsing associated with the reprocessing procedure may help remove undesirable dialyzer residuals such as ethylene oxide, bore fluids, potting compound fragments, and other noxious substances remaining after dialyzer manufacture 8.