This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Harold I. Feldman, MD, MS; Monica Kinosian, MHS; Warren B. Bilker, PhD; Christopher Simmons; John H. Holmes, MS; Mark V. Pauly, PhD; José J. Escarc, MD, PhD

JAMA. 1996;276(8):620-625.

Abstract
Objective.
—To evaluate the impact of dialyzer reuse on the survival of US hemodialysis patients.

Study Design and Participants.
—Nonconcurrent cohort study of 27938 patients beginning hemodialysis in the United States in 1986 and 1987.

Main Outcome Measure.
—Patient survival.

Results.
—Dialysis in freestanding facilities reprocessing dialyzers with the combination of peracetic and acetic acids was associated with greater mortality than treatment in facilities not reprocessing dialyzers (rate ratio [RR],1.10, 95% confidence interval [CI], 1.02-1.18; P=.02) In contrast, there was no significant difference between survival in freestanding facilities reprocessing dialyzers with either formaldehyde (RR,1.03, 95% CI, 0.96-1.10; P=.45) or glutaraldehyde (RR,1.13, 95% CI, 0.95-1.35; P=.18) and survival in freestanding facilities not reprocessing dialyzers. Among freestanding facilities reprocessing dialyzers, use of peracetic/acetic acid was associated with a higher rate of death than use of formaldehyde (RR=1.08, 95% CI, 1.01-1.14; P=.02). There was no statistical difference between survival in hospital-based facilities reprocessing dialyzers with either peracetic/acetic acid (RR=0.95, 95% CI, 0.85-1.06; P=.40), formaldehyde (RR=1.06, 95% CI, 0.98-1.15; P=.12), or glutaraldehyde (RR=1.09, 95% CI, 0.71-1.67; P=.70) and survival in hospital-based facilities not reprocessing dialyzers. In addition, choice of sterilant was not associated with a statistically significant difference in survival among hospital-based facilities reprocessing dialyzers.

Conclusions.
—Dialysis in freestanding facilities reprocessing dialyzers with peracetic/acetic acid may be associated with worse survival than dialysis in freestanding facilities not reprocessing dialyzers or in those reprocessing with formaldehyde. We were unable to determine whether these relationships arose from greater comorbidity among patients treated in facilities using peracetic/acetic acid, poor quality of dialysis procedures in these facilities, or direct toxicity of peracetic/ acetic acid. These findings raise important concerns about potentially avoidable mortality among US hemodialysis patients treated in dialysis facilities reprocessing hemodialyzers.

Author Affiliations
From the Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology (Drs Feldman, Bilker, and Escarce, Ms Kinosian, Mr Simmons and Mr Holmes), and Renal Electrolyte and Hypertension Division, Department of Medicine (Dr Feldman), University of Pennsylvania Medical Center, Philadelphia; and the Department of Health Care Systems, Wharton School (Dr Pauly), Leonard Davis Institute of Health Economics (Drs Feldman, Pauly, and Escarce, and Ms Kinosian) and Division of General Internal Medicine, Department of Medicine (Dr Escarce), University of Pennsylvania, Philadelphia.

Footnotes
The research reported in this article was supported, in part, by HCFA Cooperative Agreement 17-C90045/ 30-1, NIH Training Grant DK-07006, NIH Center Grant DK 45191, and by administrative/educational funds from the DCI RED Fund.

Reprints: Harold I. Feldman, MD, MS, Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, 423 Service Dr, 720 Blockley Hall, Philadelphia, PA 19104-6021.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Greater First-Year Survival on Hemodialysis in Facilities in Which Patients Are Provided Earlier and More Frequent Pre-nephrology Visits
Hasegawa et al.
CJASN 2009;4:595-602.
ABSTRACT | FULL TEXT  

Single-Use versus Reusable Dialyzers: The Known Unknowns
Upadhyay et al.
CJASN 2007;2:1079-1086.
ABSTRACT | FULL TEXT  

Reprocessing dialysers for multiple uses: recent analysis of death risks for patients
Lowrie et al.
Nephrol Dial Transplant 2004;19:2823-2830.
ABSTRACT | FULL TEXT  

Dialyser reuse-associated mortality and hospitalization risk in incident Medicare haemodialysis patients, 1998-1999
Collins et al.
Nephrol Dial Transplant 2004;19:1245-1251.
ABSTRACT | FULL TEXT  

Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis
Stoves et al.
Postgrad. Med. J. 2001;77:586-588.
ABSTRACT | FULL TEXT  

Adjustments for Center in Multicenter Studies: An Overview
Localio et al.
ANN INTERN MED 2001;135:112-123.
ABSTRACT | FULL TEXT  

Haemodialyser reuse: facts and fiction
Vinhas and Santos
Nephrol Dial Transplant 2000;15:5-8.
FULL TEXT  

Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center
ARORA et al.
J. Am. Soc. Nephrol. 1999;10:1281-1286.
ABSTRACT | FULL TEXT  

Retrospective Analyses of Large Medical Databases: What Do They TellUs?
WARD and BRIER
J. Am. Soc. Nephrol. 1999;10:429-432.
FULL TEXT  

Effects of Hemodialyzer Reuse on Clearances of Urea and {beta}2-Microglobulin
CHEUNG et al.
J. Am. Soc. Nephrol. 1999;10:117-127.
ABSTRACT | FULL TEXT  

Dialysis Therapy
Pastan and Bailey
NEJM 1998;338:1428-1437.
FULL TEXT