Comparison of Adequacy of Dialysis between Single-use and Reused Hemodialyzers in Patients on Maintenance Hemodialysis

Objective: To compare adequacy of dialysis between single-use and reused dialyzer in order to ascertain whether reuse of dialyzers provides adequate dialysis and thereby enable provision of effective yet affordable renal replacement therapy in resource-limited countries. Study Design: Observational cross-sectional study. Place and Duration of Study: Department of Nephrology, The Kidney Centre, Postgraduate Training Institute (TKC-PGTI), Karachi, from December 2017 to February 2018. Methodology: Equal number of patients on thrice weekly hemodialysis with either single-use (group A; n=33) or reuse (group B; n=33) dialyzer for at least six months were reviewed. Both groups were compared for dialysis adequacy measured as urea reduction ratio (URR); as well as adequacy of patient care in terms of anemia, bone-mineral control and nutritional status. Serum hemoglobin and erythropoietin stimulating agent (ESA) dose were taken as markers for anemia management, serum calcium, phosphate and intact parathyroid hormone (iPTH) for bone-mineral control and serum albumin as index for nutritional status. Results: The mean age of patients in Group A was 51.36 +/- 13.9 years and in Group B was 54.78 +/- 15.4 years. Female to male ratio was 1.75:1. The mean number of dialyzer reused in group B was 47.5 +/- 27.8. There was no significant difference between the study groups in terms of URR (p=0.362), hemoglobin (p=0.347), ESA dose (p-=0.556), serum calcium, phosphorus and iPTH (p=0.868, p=0.138 and p=0.323, respectively), and serum albumin (p=0.777). All the parameters were in accordance with KDOQI guidelines. Conclusion: Reuse of dialyzer does not affect dialysis efficiency. Adequate dialysis therapy can be provided economically through reprocessed dialyzers in at least resource-poor countries.