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Dialyzer reuse

Harold I Feldman
This address was delivered by Harold I. Feldman, MD, MSCE, at the Annual Meeting of the American College of Epidemiology in New Orleans, Louisiana, on September 26, 2017. Dr. Feldman is George S. Pepper Professor of Public Health and Preventive Medicine, Professor of Epidemiology and Medicine, and Chair, Department of Biostatistics, Epidemiology, and Informatics at the Perelman School of Medicine at the University of Pennsylvania. He is recognized nationally and internationally for his expertise in kidney disease epidemiology...
June 2018: Annals of Epidemiology
Murtaza Fakhruddin Dhrolia, Salman Imtiaz, Ruqaya Qureshi, Aasim Ahmed
Despite almost universal practice of dialyzer reuse from the earliest days of haemodialysis, reusing dialyzer always remains a controversial issue and several ethical concerns have been raised. Some of the important are safety of reuse over single use, informed consent of the patient, conflict of interest on the part of physician or manufacturer, fiscal responsibility and environmental stewardship. Indeed, at the beginning of this century, there was a drastic shift of practice in favour of single use in developed countries due to availability of biocompatible haemodialyzers, at favourable price...
August 2017: JPMA. the Journal of the Pakistan Medical Association
Yoshihiro Tange, Shingo Takesawa, Shigenori Yoshitake
Membrane fouling is a primary challenge encountered during the administration of hemodialysis (HD) and hemodiafiltration (HDF). A high-flux membrane is suitable for dialyzer reuse, since it is used repeatedly. Water flux is a benchmark used to assess the effectiveness of the dialysis membrane during treatment and it is usually evaluated to determine whether membrane fouling has occurred. Polysulfone (PS) membrane has good biocompatibility and solute permeability; however, polyethersulfone (PES) is often used as a hemodiafilter membrane because of better hydrophilicity compared to PS...
December 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ezra Gabbay, Klemens B Meyer
No abstract text is available yet for this article.
June 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Chatchai Kreepala, Aroonchai Sangpanich, Phirudee Boonchoo, Warit Rungsrithananon
INTRODUCTION: Dialyzer reprocessing machines have replaced human labor in preparing re-usable dialyzers. It also made the process of total cell volume (TCV) measurement become faster. Nevertheless, there has been a lack of data on efficacy of weight evaluation on TCV by machine compared to volume evaluation by the conventional method. The aim of this study was to evaluate the efficacy of TCV measurement performed by Kidney-Kleen(®) reprocessing machine, produced by MEDITOP Company in Thailand, compared to that of the conventional method...
June 2017: Annals of Medicine and Surgery
Mariana Murea, Gregory B Russell, Pirouz Daeihagh, Anita M Saran, Karan Pandya, Mark Cabrera, John M Burkart, Barry I Freedman
INTRODUCTION: The dose of unfractionated heparin (UFH) administered during hemodialysis (HD) varies widely. This prospective study evaluated the safety and efficacy of UFH dose de-escalation. METHODS: Sixty-six prevalent patients on HD receiving UFH per standard-dose protocol (load dose [LD] 50-75 units/kg, maintenance dose [MD] 500-1000 units/hour) had heparin prescription converted to low-dose protocol (start LD 15 units/kg and MD 500 units/hour; dose adjusted in small increments based on assessments of extracorporeal blood circuit)...
January 2018: Hemodialysis International
Ashish Upadhyay, Bertrand L Jaber
The practice of reprocessing dialyzers for reuse, once predominant in the United States, has been steadily declining over the last 20 years. The professed roles of reuse in improving dialyzer membrane biocompatibility and lowering the risk of first-use syndrome have lost relevance with the advent of biocompatible dialyzer membranes and favorable sterilization techniques. The potential for cost-savings from reuse is also called into question by the easy availability of comparatively cheaper dialyzers and rising regulatory demands and operational cost of reprocessing systems...
March 2017: Seminars in Dialysis
Chris Edens, Jacklyn Wong, Meghan Lyman, Kyle Rizzo, Duc Nguyen, Michela Blain, Sam Horwich-Scholefield, Heather Moulton-Meissner, Erin Epson, Jon Rosenberg, Priti R Patel
BACKGROUND: Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization. STUDY DESIGN: Outbreak investigation, including matched case-control study...
June 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Michael V Rocco
BACKGROUND: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. SUMMARY: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed...
December 2015: Kidney Diseases
Narayan Prasad, Vivekanand Jha
BACKGROUND: Asia is the largest, most populous and most heterogeneous continent in the world. The number of patients with end-stage renal disease is growing rapidly in Asia. SUMMARY: A fully informed report on the status of dialysis therapies including hemodialysis (HD) is limited by the lack of systematic registries. Available data suggest remarkable heterogeneities, with some countries like Taiwan, Japan and Korea exhibiting well-established HD systems, high prevalence and universal access to all patients, while low- and low-middle income countries are unable to provide HD to eligible patients because of high cost and poor healthcare systems...
December 2015: Kidney Diseases
Ruqaya Qureshi, Murtaza F Dhrolia, Kiran Nasir, Salman Imtiaz, Aasim Ahmad
Reusing dialyzers is almost universal in developing countries to reduce the cost of hemodialysis (HD). Economic benefits of dialyzer reuse, when estimated only on the basis of the dialyzer and its consumables are very significant and attractive. In this study, we compared the cost of mechanical reuse of dialyzer considering all of the direct costs (medications, dialyzer, and its consumables, disinfection fluid, and hospitalization if any) in HD treatment, which if significantly different between single use and reuse, can nullify the obvious cost benefits...
July 2016: Saudi Journal of Kidney Diseases and Transplantation
Cuong Minh Duong, Mary-Louise McLaws
BACKGROUND: Hepatitis C virus (HCV) is a risk for all hemodialysis patients. Over a 2-month period in 2013, there were 11 HCV seroconversions at a satellite hemodialysis unit in Vietnam. We report the epidemiologic investigation of the transmission mode in the absence of unavailable phylogenetic analysis. METHODS: The outbreak occurred during a 2-year dynamic cohort study. All patients were tested every 2 months, and staff was tested annually for hepatitis B virus surface antigen and HCV core antigen...
May 1, 2016: American Journal of Infection Control
Jolanta Malyszko, Andrzej Milkowski, Ewa Benedyk-Lorens, Teresa Dryl-Rydzynska
No abstract text is available yet for this article.
February 1, 2016: Archives of Medical Science: AMS
Alexandra do Rosário Toniolo, Maíra Marques Ribeiro, Marina Ishii, Cely Barreto da Silva, Lycia Mara Jenné Mimica, Kazuko Uchikawa Graziano
A cross-sectional study was conducted to evaluate the effectiveness of manual and automated dialyzer reprocessing. Dialyzers were filled with fluid thioglycollate medium from blood and dialysate chambers after being reprocessed and chemically sterilized with 0.2% peracetic acid. They were incubated for 14 days at 35°C ± 2°C, and microbiologic analysis was performed. Microorganisms were identified in 3 of the 11 samples (27.3%) from the blood chambers: Sphingomonas paucimobilis (2/3) and Penicillium spp (1/3) and in 11 of the 11 samples (100%) from the dialysate chambers: S paucimobilis (7/11), Stenotrophomonas maltophilia (4/11), Pseudomonas aeruginosa (3/11), Candida spp (1/11), and Acinetobacter baumannii (1/11)...
June 1, 2016: American Journal of Infection Control
Cuong Minh Duong, Dariusz Piotr Olszyna, Phong Duy Nguyen, Mary-Louise McLaws
BACKGROUND: Hemodialysis is an increasingly common treatment in Vietnam as the diagnosis of end stage renal disease continues to rise. To provide appropriate hemodialysis treatment for end-stage renal disease patients, we conducted a 1-year cross-sectional study to measure the prevalence of bloodborne infection and factors associated with non-compliant behaviors in hemodialysis patients. METHODS: One hundred forty-two patients were tested for hepatitis B virus (HBV) surface antigen and hepatitis C virus (HCV) core antigen...
2015: BMC Nephrology
Christos Argyropoulos, Maria-Eleni Roumelioti, Abdus Sattar, John A Kellum, Lisa Weissfeld, Mark L Unruh
BACKGROUND: The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. METHODS: Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse...
2015: PloS One
Garima Mittal, Pratima Gupta, Bhaskar Thakuria, Gulshan K Mukhiya, Manish Mittal
BACKGROUND AND AIM: Viral hepatitis and human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality in hemodialysis (HD) patients. The present study was performed to assess the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and HIV infections in hemodialysis patients of a tertiary care hospital in Uttarakhand. METHODS: All patients undergoing maintenance HD at our center were screened for hepatitis B surface antigen (HBsAg), antibody to HCV (anti-HCV), antibody to HDV (anti-HDV) and HIV antibody by ELISA...
March 2013: Journal of Clinical and Experimental Hepatology
Murtaza F Dhrolia, Kiran Nasir, Salman Imtiaz, Aasim Ahmad
In spite of controversies, dialyzer reuse has remained an integral part of hemodialysis because of lower cost, good overall safety record, and improved membrane biocompatibility. Reuse declined in developed countries from the beginning of this century because of mass production of hemodialyzers at favourable price with better biocompatible membrane. Abandoning dialyzer reuse became challenging in South Asian region, where more than 40% of the population live below the International Poverty Line of $1.25 per day, less than 10% of end stage renal disease patients receive renal replacement therapy, and upto 70% of those starting dialysis stop treatment due to cost within the first 3 months...
August 2014: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Jenny I Shen, Maria E Montez-Rath, Aya A Mitani, Kevin F Erickson, Wolfgang C Winkelmayer
PURPOSE: Heparin is commonly used to anticoagulate the hemodialysis (HD) circuit. Despite the bleeding risk, no American standards exist for its administration. We identified correlates and quantified sources of variance in heparin dosing for HD. METHODS: We performed a cross-sectional study of patients aged 67 years or older who underwent HD with heparin on one of two randomly chosen days in 2008 at a national chain of dialysis facilities. Using a mixed effects model with random intercept for facility and fixed patient and facility characteristics, we examined heparin dosing at patient and facility levels...
May 2014: Pharmacoepidemiology and Drug Safety
Natalia C V Melo, Rosa M A Moyses, Rosilene M Elias, Manuel C M Castro
There are no studies evaluating the impact of dialyzer reprocessing on solute removal in short-daily online hemodiafiltration (OL-HDF). Our aim was to evaluate the impact of dialyzer reuse on solute removal in daily OL-HDF and compare with that in high-flux short-daily hemodialysis (SDH). Fourteen patients undergoing a SDH program were included. Pre-dialysis and post-dialysis blood samples and effluent dialysate were collected in the 1st, 7th, and 13th dialyzer uses in SDH sessions and in daily OL-HDF sessions...
April 2014: Hemodialysis International
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