Document Detail


Reprocessing dialysers for multiple uses: recent analysis of death risks for patients.
MedLine Citation:
PMID:  15316099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Reprocessing dialysers is a common cost-saving practice in the USA. It began when patients were treated with bio-incompatible cellulosic membranes that were associated with medical complications, but has continued for economic reasons despite the current use of more biocompatible non-cellulosic membranes. A dialysis services and product provider using primarily its own non-cellulosic membranes recently embarked on a staged programme to stop reprocessing dialysers. Approximately a quarter of 71,000 patients had been switched from reuse to single use by July 1, 2001. The transition offered a unique opportunity to re-evaluate death risk associated with the reuse practice. METHODS: Patients were classified as reuse or single use as of July 1, 2001. Survival time measurements started on that date (Lag0) and at four 30 day intervals after it (Lag30, Lag60, Lag90 and Lag120). Thus, patients must have been treated in their reuse group after Lag0 for at least 30, 60, 90 or 120 days, respectively. Survival time was evaluated during 1 year following the lag date using the Cox method in unadjusted, case mix-adjusted and case mix plus other measure-adjusted models. RESULTS: All analyses suggested favourable survival advantage among patients treated with single use dialysers. The differences were statistically significant at all lag times in the unadjusted models but became significant only at later lag times in the case mix- and case mix plus other measure-adjusted models. For example, single use/reuse hazard ratios in the case mix-adjusted models at Lag0-Lag120 were 0.96 (NS), 0.96 (NS), 0.94 (P = 0.02), 0.93 (P = 0.02) and 0.92 (P = 0.01), respectively. CONCLUSIONS: A risk benefit appears associated with abandonment of the dialyser reuse practice, although the benefit may lag behind the change. In the USA, the relative risk burden associated with the reprocessing of dialysers may have changed over time with the evolution of clinical practice.
Authors:
Edmund G Lowrie; Zhensheng Li; Norma Ofsthun; J Michael Lazarus
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Publication Detail:
Type:  Journal Article     Date:  2004-08-17
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  19     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-21     Completed Date:  2005-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2823-30     Citation Subset:  IM    
Affiliation:
Fresenius Medical Care (North America), Lexington, MA 02420-9192, USA. edlowrie@prodigy.net
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MeSH Terms
Descriptor/Qualifier:
Aged
Cluster Analysis
Disinfection
Equipment Reuse
Female
Humans
Male
Middle Aged
Polymers
Renal Dialysis / instrumentation*,  mortality
Risk Adjustment
Risk Assessment
Sulfones
Chemical
Reg. No./Substance:
0/Polymers; 0/Sulfones; 25135-51-7/polysulfone P 1700

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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