If there is any successful long-term organ substitutive therapy today, it has to be Hemodialysis. Although the mortality rate on dialysis is 4-6 times that of the general population, it is the most prevalent treatment option amongst patients with renal failure, followed by kidney transplantation and peritoneal dialysis. Since patients with ESRF (End Stage Renal Failure) are increasing faster than the supply of transplantable organs, there is a rising need of ‘maintenance dialysis’ or hemodialysis.
The technique is used to achieve the extracorporeal removal of waste products such as urea and creatinine and excess water from the blood when the kidneys are in a state of renal failure.
Dialyzer reuse has been practiced in the US for decades and is generally considered safe when performed under the guidelines by the Association for the Advancement of Medical Instrumentation (AAMI). However, it has always been a controversial subject as stringent disinfection processes can be challenging to maintain.
Enter Single Use Dialysers…
Several kinds of observations and studies in the past have compared and contrasted single-use and reused dialyzers, and have demonstrated an increased mortality risk with reuse of dialyzers.
Some important arguments favoring Single Use Dialysers were proposed by Lacson and Lazarus
- On Medical Grounds:
There are reduced occurrences of infection and contamination, chances of errors and accidents, and risks through exposure to germicides associated with single-use dialyzers. Also, there might also be a favorable immune response and a better clearance of small molecules.
- On Operational Grounds:
Reuse comes with an additional significant burden of maintaining training standards, regulatory documentation, and a stringent quality assurance program. Single use dialysis is convenient to perform as it simplifies many operational aspects. Dialyzer verification too, takes much less time. The risk for medicolegal liability is also negligible in single-use compared with reuse techniques.
- On Economic Grounds:
For dialysis providers that are vertically integrated in terms of dialyzer manufacturing capabilities, there is a financial advantage not just in terms of decreased need for personnel and space but also significant savings on utility bills, medico-legal expenses, and dialyzer reuse supplies.
Reuse of dialyzers also raises numerous important environmental concerns. Spillage of heated contaminated water used for dialyzer rinsing into the sewer system; increased plastic waste from packaging materials used for reuse chemicals; and additional waste generated from disposable items such as masks, gloves, test strips, plastic aprons, and labels, are all important potential pollutants associated with reuse.
Dialysis health care delivery continues to rapidly evolve, and the move to single-use dialyzers is but one example of how improvements in technology can help improve patient outcomes.
References:
- Does hemodialyzer reuse have a place in current ESRD care: “To be or not to be”?
- What You Should Know About Dialyzer Reuse?
- Single-Use versus Reusable Dialyzers: The Known Unknowns
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