Dialysis providers shift towards single-use dialyzers

As of Sept. 1, Satellite Healthcare is only using single-use dialyzers. The nonprofit dialysis provider said it made the decision after examining new data indicating an increased potential risk associated with the practice of reusing dialyzers.

A spokesperson from Satellite told NN&I that quality and safety for patient and staff were factors in the decision to end reuse.

"Patients and dialysis health care staff are at risk and can be harmed by acute accidental exposure to high concentrations of germicides. It is important to consider the health hazards associated with the use of germicides in dialyzer reuse. By employing single use, the rates of infection and contamination, likelihood of errors and accidents, and risks associated with exposure to germicides and denatured blood products decreases."

Many dialysis providers chose reuse policies because it decreased biomedical waste and helped prevent “first use syndrome.”

But "first use" syndrome has become less of a threat. The syndrome is a severe hypersensitivity reaction to new dialyzers, which the U.S. Food and Drug Administration said was potentially caused by traces of residual material from the manufacturing process. Advances in technology and improved sterilization techniques reduced the incidence of the syndrome.

"First-use syndrome was not uncommon years ago when first-generation cellulose membranes were in common use," a DaVita spokesperson told NN&I. "The biocompatible dialyzer membranes in use today are rarely associated with this syndrome. Extensive analysis has shown that there is no material difference between reuse and single use with regard to patient safety, outcomes and the patient experience."

DaVita said that cost saving is not a motivator when choosing between reuse and single use. "We do not see a significant cost difference between the two. However, the combination of the falling costs of high-efficiency dialyzers, and the significant costs associated with the extra supplies needed to reprocess the dialyzers, as well as the costs of the additional personnel needed to safely carry-out reuse, result in lower overall costs with single use."

Satellite told NN&I that cost-savings, as well as a decrease in waste, were historic reasons for choosing reuse. "Reuse was a standard practice across the board in the dialysis community. The historic advantages of dialyzer reuse have included decreased generation of biomedical waste and cost savings. In the past, Satellite Healthcare provided and supported the concept of responsible, safe and regulated reuse practices."

Dialyzer reuse among dialysis providers

According to data from NN&I's 2015 ten largest dialysis providers survey, four of the ten largest providers offer reuse as an option for their patients, including: DaVita, U.S. Renal Care, DCI, and Centers for Dialysis Care. (see figure 1)

Reuse has become less common among providers who use it. According to NN&I's data, gathered in July 2015, the number of patients who chose reuse at DaVita dropped from 50% to 25% between 2014 and 2015. DaVita has been reusing dialyzers for more than 40 years.

I asked a spokesperson from DaVita why they are seeing less dialysis patients reusing dialyzers. "Patients, in consultation with their physicians, choose whether to use reuse or single use dialyzers, and we have seen physician and patient preference shift slowly toward single use. We make sure our operations can support those trends and maintain high-quality dialysis for patients dialyzing with both reuse and single use."

As single-use becomes safer and more cost efficient, the shift away from reusing dialyzers is likely to continue. -by Rebecca Zumoff