National Surveillance of Dialysis-Associated Diseases in the United States, 1988

Abstract

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,734 chronic hemodialysis centers in the United States in 1988 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 91%. These 1,586 centers represented 107,804 patients and 28,501 staff members. Over the last 13 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.2% among patients and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8 to 1.5% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 90% of the centers. By the end of 1988, 17% of susceptible patients and 53% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1988, as a result of receiving vaccine, the prevalence of antibody to HBsAg increased from 12 to 20% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1988 was reported to be 1.0% among patients and 0.1% among staff members. Fifteen percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients and 45% reported septicemia. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 25%. In 1988, 67% of centers reported that they reused disposable dialyzers; these centers treated 72% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 2 to 50 (mean, 11) and the maximum number of times a disposable dialyzer was reused ranged from 3 to 131 (mean, 28). Chemical germicides used for reprocessing dialyzers included formaldehyde; Renalin, a peracetic acid-hydrogen peroxide-based germicide; and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. However, pyrogenic reactions occurring in clusters were more frequently reported in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was only associated with centers that reused these dialyzers in a manual reprocessing system, a result consistent with those obtained in 1986 and 1987. Eighteen percent of centers reported treating at least some of their patients by high flux dialysis.(ABSTRACT TRUNCATED AT 400 WORDS)