Association of Dialyzer Reuse and Hospitalization Rates Among Hemodialysis Patients in the US

Published in: American Journal of Nephrology, v. 19, no. 6, Nov. 1999, p. 641-648

Posted on RAND.org on December 31, 1998

by Harold I. Feldman, Warren B. Bilker, Monica Hackett, Christopher W. Simmons, John H. Holmes, Mark V. Pauly, Jose J. Escarce

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The objective of this study was to determine if reuse of hemodialyzers is associated with higher rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients. The study was a noncurrent cohort study of hospitalization rates among 27,264 ESRD patients beginning hemodialysis in the United States in 1986 and 1987. The results indicate that dialysis in free-standing facilities reprocessing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02-1.14). This higher rate of hospitalization was observed with dialyzer reuse using paracetic/acetic acids (RR = 1.11, CI 1.04-1.18) and formaldehyde (RR = 1.07, CI 1.00-1.14), but not glutaraldehyde (p - 0.97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reprocessing. Hospitalization for causes other than vascular access morbidity in free-standing facilities reusing dialyzers with formaldehyde was not different from hospitalization in facilities not reusing. However, reuse with peracetic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03-1.15). The authors conclude that dialysis in free-standing facilities reprocessing dialyzers with peracetic/acetic acids or formaldehyde was associated with greater hospitalization than dialysis without dialyzer reprocessing. This greater hospitalization accounts for a large increment in inpatient stays in the U.S. These findings raise important concerns about potentially avoidable morbidity among hemodialysis patients.

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