Hot Water Reuse (HWR) of Dialyzers Gives Smoother Dialysis than Single Use (SU) or Chemical Reuse (CRU)

Abstract

Background: Hemodialyzers can be used once or reused after treatment with chemicals or hot water. SU results in infusion of plastic compounds, particularly phthalic acid metabolites, into patients and chemical reuse releases formaldehyde, glutaraldehyde, or peracetic acid into the blood during dialysis.Methods: We studied the increase in pulse rate (PR) and fall in systolic and diastolic blood pressure (BP) and patients' subjective overall quality evaluation (OE) of dialysis (1 worst, 5 best) during 3706 daily dialyses in 23 patients. Fall in blood pressure and rise in PR during dialysis and overall quality evaluation were compared as patients changed from SU or chemical reuse to hot water reuse. During SU and chemical reuse, dialysis time was shorter (121 vs. 148 min), urea clearance higher (241 vs. 175 ml/min) but ultrafiltration lower (1.5 vs. 1.7 kg/dialysis) than during hot water reuse.Results: The results are summarized in the table. Methods n Systolic BP Diastolic BP PR OE CRU 98 −30 ± 19 −17 ± 21 4 ± 4 3.8 ± 0.4 SU 2443 −17 ± 21 −6 ± 13 2 ± 13 4.0 ± 0.7 HWR 1165 −8 ± 21 −1 ± 11 −0.2 ± 12 4.2 ± 0.7 All comparisons were of SU and chemical reuse to hot water reuse, p < 0.0001. The results were the same whether cellulosic or polysulfone membranes were used. Hot water reuse, up to 25 times, did not result in changes in urea clearance, albumin leakage or Kuf, and β‐2‐microglobulin reduction rates declined by only 10% over 15 reuses.Conclusion: Hot water reuse results in the most comfortable dialysis and the best cardiovascular stability, with less decline in blood pressure and less tachycardia, when compared to chemical reuse or SU of dialyzers.