May 9, 2022 admin

Is your dialyzer safe to reuse?

Know your dialyzer’s mechanism:

Dialyzers are artificial kidneys that filter the blood outside your body. It filters the blood outside your body when the kidneys are not functioning well. Wastes and excess water are removed during hemodialysis using an external filter called a dialyzer, which has a semipermeable membrane. The wastes are separated by establishing a counter-current flow gradient, with blood flowing in one direction and dialyzer fluid flowing in the opposite. Dialyzers are categorised as low-flux membrane dialyzers or high-flux membrane dialyzers. Low-flux membrane dialyzers have an ultrafiltration rate of less than 15 mL/mmHg/h and a 2MG clearance rate of less than 15 mL/min. Small solutes are effectively eliminated by diffusion, but only trace amounts of middle-sized solutes, which are more toxic and difficult to remove by diffusion, are separated. In comparison to low-flux membrane dialyzers, high-flux membranes have higher hydraulic permeability and a higher solute permeability for middle-sized solutes. 

The diffusion of solute particles through a semipermeable membrane is the primary process involved in dialysis. Urea and creatinine, among other metabolic waste products, flow along the concentration gradient from the circulation into the dialysate (sodium bicarbonate (NaHCO3), sodium chloride (NaCl), acid concentrate, and deionized water). The size of particles impacts the pace of diffusion across the membrane during their diffusion into the dialysate. Although dialysis is the favoured method of restoring kidney function, it has been linked to oxidative stress, thyroid abnormalities, and cardiac difficulties. Dialysis extends a person’s life but does not heal the underlying illness, therefore it stands to reason that dialysis difficulties could be caused by renal inflammation.

Dialyzer reprocessing for reuse of dialyzer:

Dialyzer reuse is a multistep procedure that includes rinse, cleaning, performance testing, and disinfection of dialyzers before they are used again. The procedure necessitates the use of potentially harmful cleaning and germicidal agents, and accidental contact with these compounds could put patients and dialysis personnel at risk. Dialyzer reprocessing or reuse is a procedure that has been used in the United States in the past for supposed benefits to dialysis clinics and patients. Economic benefits, the ability to utilise formerly more expensive high-flux dialyzers, and a positive environmental impact through reduced biomedical waste output are the three main motivations for dialysis centres. There have also been cases of Gram-negative bacteraemia outbreaks due to infection-control system failures, and even low-level exposure to toxins and microbiological contaminants can cause chronic inflammation. Despite these hazards, no randomised controlled trials comparing single-use and reuse procedures exist, and the evidence from observational research is mixed. Bleach, hydrogen peroxide, and peracetic acid are some of the chemical cleaning agents used in dialyzer reprocessing. Formaldehyde and peracetic acids are two commonly used chemical disinfectants and sterilants.

On a limited scale, a method of replacing chemical germicides with hot citric acid has been utilised. One of the main problems with reusing hemodialyzers is that the dialyzer’s capacity to execute the essential duties involved with hemodialysis is unaffected. Electrolyte balance, elimination of small and mid-sized molecular waste products, and water removal are the key functions. Urea has long been utilised as a dialysis effectiveness indicator. When testing a dialyzer in process, the fluid content of the dialyzer blood compartment must be removed and replaced with air. The air must be entirely cleansed from the dialyzer’s blood and dialysate compartments before it can be injected with a high-level disinfectant or sterilant. This is performed in both automated and human reprocessing by first flushing the tested dialyzer with enough treated water to verify that it is air-free and fluid-filled throughout. Flushing ensures that air does not obstruct the passage of fluid disinfectants/sterilants and that chemical germicides are applied to all sections of the dialyzer.

Pros and cons of dialyzer reuse:

Although dialysis is the most common way to restore kidney function, it has been associated with oxidative stress, thyroid problems, and heart problems. Dialysis prolongs a person’s life but does not cure the underlying sickness, so it stands to reason that renal inflammation could be the cause of dialysis complications. The three key benefits for the provider are cost savings, the opportunity to employ high-flux dialyzers, which are generally more expensive, and a positive environmental impact due to reduced biomedical waste output. Economic factors are thought to be motivating the continued use of dialyzer reuse procedures in the United States, in light of falling and increasingly stringent Medicare reimbursement for hemodialysis treatments. Because cheaper single-use high-flux dialyzers are now available, the previous benefit of being able to reuse such dialyzers is no longer valid. Dialyzer reuse must take into account the health risks associated with the use of germicides. Acute inadvertent exposure to high amounts of germicides from the dialyzer or water treatment system can endanger patients and health care staff. Furthermore, long-term exposure to low amounts of germicide residue within the dialyzer has the potential to cause major health problems. Using insufficient germicide concentrations increases the risk of pyrogen reactions and bacteraemia outbreaks.

From 1980 to 1999, the CDC reviewed 16 outbreaks of bacteraemia or pyrogenic responses in haemodialysis patients, eight of which were linked to dialyzer reuse, and four of which were caused by a low disinfectant dosage. Membrane polarity and clearance of small and medium molecules can be affected by changes in membrane integrity caused by reuse. Increased environmental pollution as a result of reuse is also a possible risk. Dialysis service providers, on the other hand, continue to find dialyzer reuse appealing due to cost considerations. However, economic reasons differ around the world and, in many cases, even within the same country. There is a case to be made that the cost-benefit of reuse is minimal in places where the costs of reuse-related employees and safe storage space are considerable. However, relative cost savings are likely to be greater in locations with low people and space costs. Even a little cost reduction would be significant in financially strapped health systems or when individuals split the cost of dialysis treatment.

Secure pro offers total security to dialysis patients:

IMAEC offers a range of dialysis consumables with total security for the dialysis patient. The secure pro haemodialysis concentrated solution is the best solution for safe and effective dialysis. We also provide the anticoagulant for the dialysis process that is Nephure heparin injection. Nephure Heparin injection is an anti-coagulant that keeps blood from clotting abnormally. It keeps severe blood clots from forming in the legs, lungs, and heart. It also prevents clots from becoming larger. Patient care does not stop here. We also provide Nephure iron sucrose injection which is used to treat iron deficiency in patients with chronic kidney disease and on dialysis.

Reference:

1. Carlson, W. (2013). Dialyzer Reprocessing. In A. T. Azar (Ed.), Modelling and Control of Dialysis Systems: Volume 1: Modeling Techniques of Hemodialysis Systems (pp. 481–517). Springer. https://doi.org/10.1007/978-3-642-27458-9_10
2. Upadhyay, A. (2019). Dialyzer reuse: Is it safe and worth it? Jornal Brasileiro de Nefrologia, 41(3), 312. https://doi.org/10.1590/2175-8239-JBN-2019-0134
3. Upadhyay, A., Sosa, M. A., & Jaber, B. L. (2007). Single-Use versus Reusable Dialyzers: The Known Unknowns. Clinical Journal of the American Society of Nephrology, 2(5), 1079–1086. https://doi.org/10.2215/CJN.01040207