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Titolo:
Mortality risk by hemodialyzer reuse practice and dialyzer membrane characteristics: Results from the USRDS dialysis morbidity and mortality study
Autore:
Port, FK; Wolfe, RA; Hulbert-Shearon, TE; Daugirdas, JT; Agodoa, LYC; Jones, C; Orzol, SM; Held, PJ;
Indirizzi:
Univ Michigan, KECC, Dept Internal Med, Ann Arbor, MI 48103 USA Univ Michigan Ann Arbor MI USA 48103 nternal Med, Ann Arbor, MI 48103 USA US Renal Data Syst Coordinating Ctr, Ann Arbor, MI 48103 USA US Renal DataSyst Coordinating Ctr Ann Arbor MI USA 48103 , MI 48103 USA Univ Michigan, KECC, Dept Epidemiol, Ann Arbor, MI 48103 USA Univ Michigan Ann Arbor MI USA 48103 t Epidemiol, Ann Arbor, MI 48103 USA Univ Michigan, KECC, Dept Biostat, Ann Arbor, MI 48103 USA Univ Michigan Ann Arbor MI USA 48103 ept Biostat, Ann Arbor, MI 48103 USA Univ Renal Res & Educ Assoc, Ann Arbor, MI USA Univ Renal Res & Educ Assoc Ann Arbor MI USA uc Assoc, Ann Arbor, MI USA Westside Vet Adm Hosp, Chicago, IL USA Westside Vet Adm Hosp Chicago IL USA tside Vet Adm Hosp, Chicago, IL USA NIDDKD, Bethesda, MD 20892 USA NIDDKD Bethesda MD USA 20892NIDDKD, Bethesda, MD 20892 USA
Titolo Testata:
AMERICAN JOURNAL OF KIDNEY DISEASES
fascicolo: 2, volume: 37, anno: 2001,
pagine: 276 - 286
SICI:
0272-6386(200102)37:2<276:MRBHRP>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
POLYSULFONE DIALYZERS; SURVIVAL; SAFETY; BETA(2)-MICROGLOBULIN; ASSOCIATION; INFECTIONS; CATHETERS; CELLULOSE; OUTBREAK; REMOVAL;
Keywords:
hemodialysis (HD) mortality; dialysis reuse; dialyzer reprocessing; dialysis membrane; bleach in reuse; high-flux dialysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Port, FK Univ Michigan, KECC, Dept Internal Med, 315 W Huron St,Ste 240, Ann Arbor,MI 48103 USA Univ Michigan 315 W Huron St,Ste 240 Ann Arbor MI USA48103 3 USA
Citazione:
F.K. Port et al., "Mortality risk by hemodialyzer reuse practice and dialyzer membrane characteristics: Results from the USRDS dialysis morbidity and mortality study", AM J KIDNEY, 37(2), 2001, pp. 276-286

Abstract

Hemodialyzer reuse is commonly practiced in the United States. Recent studies have raised concerns about the mortality risk associated with certain reuse practices. We evaluated adjusted mortality risk during 1- to 2-year follow-up in a representative sample of 12,791 chronic hemodialysis patients treated in 1,394 dialysis facilities from 1994 through 1995. Medical recordabstraction provided data on reuse practice, use of bleach, dialyzer membrane, dialysis dose, and patient characteristics and comorbidity. Mortality risk was analyzed by bootstrapped Cox models by (1) no reuse versus reuse, (2) reuse agent, and (3) dialyzer membrane with and without the use of bleach, while considering dialysis and patient factors. The relative risk (RR) for mortality did not differ for patients in reuse versus no-reuse units (RR = 0.96; 95% confidence interval [CI], 0.86 to 1.08; P > 0.50), and similar results were found with different levels of adjustment and subgroups (RR = 1.01 to 1.05; 95% CI, lower bound > 0.90, upper bound < 1.19 each; each P> 0.40). The RR for peracetic acid mixture versus formalin varied significantly by membrane type and use of bleach during reprocessing, achieving borderline significance for synthetic membranes. Among synthetic membranes, mortality was greater with low-flux than high-flux membranes (RR = 1.24; 95% CI, 1.02 to 1.52; P = 0.04) and without than with bleach during reprocessing (RR = 1.24; 95% CI, 1.01 to 1.48; P = 0.04), Among all membranes, mortality was lowest for patients treated with high-flux synthetic membranes (RR =0.82; 95% CI, 0.72 to 0.93; P = 0.002). Although mortality was not greaterin reuse than no-reuse units overall, differences may exist in mortality risk by reuse agent. Use of high-flux synthetic membrane dialyzers was associated with lower mortality risk, particularly when exposed to bleach. Clearance of larger molecules may have a role. (C) 2001 by the National Kidney Foundation, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/03/20 alle ore 08:56:34