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Author Topic: REUSE (part b)  (Read 62255 times)

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REUSE (part b)
« on: August 31, 2009, 05:17:37 AM »
       
       
so



Joined: 18 Feb 2003
Posts: 1

   
PostPosted: Tue Feb 18, 2003 6:22 am    Post subject: here you go!    

The effect of dialyzer reuse on dialysis delivery <
>RA Sherman, RP Cody, ME Rogers and JC Solanchick <
>Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903.<
> <
>It is well documented that the reprocessing of dialyzers may reduce their solute clearance capabilities. However, the effect of dialyzer reuse has never been assessed in an uncontrolled clinical practice setting. We addressed this issue in a prospective 436-patient, 34- center study. All patients underwent formal urea kinetic modeling monthly, usually for 3 sequential months. Dialyzers were reprocessed and reused in the usual manner for each unit. As a result, urea kinetic modeling was performed in individual patients using dialyzers with differing numbers of prior uses. For each patient, Kt/V urea for the treatment using the dialyzer with the most reuses (mean, 13. was compared with that with the treatment using the dialyzer with the fewest reuses (mean, 3. . The mean Kt/V delivered for high reuse treatments was significantly lower than that for low reuse treatments (1.05 v 1.10, P = 0.002). Prescribed Kt/V in high and low reuse treatments was identical. Individual centers appeared to differ substantially (P = 0.06) in the effect of reuse on delivered Kt/V. Of the 23 centers using formalin-based reprocessing, an average difference of > or = 0.12 (mean, 0.17) in Kt/V between high and low reuse treatments was seen in 10 centers. Dialyzer reprocessing significantly impairs dialysis delivery, an effect that may be related to the methods and procedures in individual dialysis centers. <
>

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REUSE



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PostPosted: Sat Feb 22, 2003 6:44 am    Post subject: Reuse is bad    Reply with quote
Read the FYI it contains clinical studies and not those that are industry driven for profit. <
><
>

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REUSE



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PostPosted: Fri Feb 28, 2003 1:33 pm    Post subject: more information    

1980's Renalin reactions<
>--------------------------------------------------------------------------------<
> www.accessdata.fda.gov/sc...ey_Count=0 <
> <
>Roxy<
>Unregistered User<
>(10/3/02 8:28:46 pm)<
>Reply 1980-1989 Renalin Reactions<
>--------------------------------------------------------------------------------<
> www.accessdata.fda.gov/sc...ey_Count=0 <
> <
>Roxy<
>Unregistered User<
>(10/3/02 8:30:06 pm)<
>Reply 1990 Renalin Reactions<
>--------------------------------------------------------------------------------<
> www.accessdata.fda.gov/sc...ey_Count=0 <
> <
>Roxy<
>Unregistered User<
>(10/3/02 8:32:56 pm)<
>Reply 1991 Renalin Reactions<
>--------------------------------------------------------------------------------<
> www.accessdata.fda.gov/sc...ey_Count=0 <
> <
>Roxy<
>Unregistered User<
>(10/3/02 8:35:12 pm)<
>Reply Dializer reuse article<
>--------------------------------------------------------------------------------<
> www.drlerner.com/articles/article9.html <
> <
>

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Hugh



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PostPosted: Thu Dec 18, 2003 9:16 pm    Post subject: This could be the causitive agent    Reply with quote
MSDS: Dihydrogen Monoxide<
>Dihydrogen monoxide (also known as hydric acid) is responsible for injury, death, and property damage all over the world. Visit the Dihydrogen Monoxide Research Division online at www.dhmo.org, or send email to info@dhmo.org for more information. <
><
>------------------------------------------------------------------------------<
>MATERIAL SAFETY DATA SHEET FOR DIHYDROGEN MONOXIDE<
>------------------------------------------------------------------------------<
><
>PRODUCT NAME: DIHYDROGEN MONOXIDE<
>FORMULA WT: 18.00<
>CAS NO.: 07732-18-5<
>NIOSH/RTECS NO.: ZC0110000<
>COMMON SYNONYMS: DIHYDROGEN OXIDE, HYDRIC ACID<
>PRODUCT CODES: 4218,4219<
> EFFECTIVE: 05/30/86 <
> REVISION #01 <
><
>LABORATORY PROTECTIVE EQUIPMENT<
><
>SAFETY GLASSES; LAB COAT<
><
>PRECAUTIONARY LABEL STATEMENTS<
><
>STORAGE: KEEP IN TIGHTLY CLOSED CONTAINER.<
><
>BOILING POINT: 100 C ( 212 F) VAPOR PRESSURE(MM HG): 17.5<
><
>MELTING POINT: 0 C ( 32 F) VAPOR DENSITY(AIR=1): N/A<
><
>SPECIFIC GRAVITY: 1.00 EVAPORATION RATE: N/A<
><
>SOLUBILITY(H2O): COMPLETE (IN ALL PROPORTIONS) % VOLATILES BY VOLUME: 100<
><
>APPEARANCE & ODOR: ODORLESS, CLEAR COLORLESS LIQUID.<
><
>TOXICITY: LD50 (IPR-MOUSE)(G/KG) - 190<
> LD50 (IV-MOUSE) (MG/KG) - 25<
><
>DISPOSAL PROCEDURE<
> DISPOSE IN ACCORDANCE WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL<
> ENVIRONMENTAL REGULATIONS.<
><
>SAF-T-DATA(TM) STORAGE COLOR CODE: ORANGE (GENERAL STORAGE)<
><
>SPECIAL PRECAUTIONS<
> KEEP CONTAINER TIGHTLY CLOSED. SUITABLE FOR ANY GENERAL CHEMICAL STORAGE<
> AREA. DIHYDROGEN MONOXIDE IS CONSIDERED A NON-REGULATED PRODUCT, BUT<
> REACTS VIGOROUSLY WITH SOME MATERIALS. THESE INCLUDE SODIUM, POTASSIUM<
> AND OTHER ALKALI METALS; ELEMENTAL FLUORINE; AND STRONG DEHYDRATING AGENTS<
> SUCH AS SULFURIC ACID. IT FORMS EXPLOSIVE GASES WITH CALCIUM CARBIDE.<
> AVOID CONTACT WITH ALL MATERIALS UNTIL INVESTIGATION SHOWS SUBSTANCE IS <
> COMPATIBLE. EXPANDS SIGNIFICANTLY UPON FREEZING. DO NOT STORE IN RIGID<
> CONTAINER AND PROTECT FROM FREEZING.<
><
>DOMESTIC (D.O.T.)<
><
>PROPER SHIPPING NAME CHEMICALS, N.O.S. (NON-REGULATED)<
><
>INTERNATIONAL (I.M.O.)<
><
>PROPER SHIPPING NAME CHEMICALS, N.O.S. (NON-REGULATED)<
><
>------------------------------------------------------------------------------<
><
><
>

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Coil



Joined: 14 Jan 2003
Posts: 27

   
PostPosted: Sat Dec 20, 2003 3:25 am    Post subject: Renalin    Reply with quote
Hugh, what documentation do you have stating Renalin contains DMHO?

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little joke



Joined: 28 Mar 2004
Posts: 1

   
PostPosted: Sun Mar 28, 2004 6:50 am    Post subject: Don't take the post from Hugh seriously    

Seems Hugh was having a little fun. DHMO is H20, water.

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plugger



Joined: 11 Jan 2003
Posts: 226

   
PostPosted: Wed Aug 09, 2006 4:54 am    Post subject: 2004 study    

All analyses suggested favourable survival advantage among patients treated with single use dialysers.

The reprocessing of disposable dialysers was first proposed for economic reasons [1]. Early studies suggested that the reprocessing and reuse of dialysers manufactured using cellulosic membranes conferred medical benefits to patients, apparently rendering the membrane more biocompatible with blood?

Dialysers using synthetic membranes have largely replaced those using cellulosic membranes in recent years. More than 80% of dialysis units used cellulosic dialysers in 1990 while <25% used any dialysers with a synthetic membrane. Those statistics were reversed by 2000 such that <25% of facilities used any cellulosic dialysers while >80% used synthetic membrane dialysers [4]. The synthetic membranes are more biocompatible than their cellulosic predecessors so the reuse-associated medical benefit probably disappeared. The rationale for reusing synthetic membrane dialysers thus became purely financial.?

Reprocessing dialysers is essentially limited remanufacturing that involves the cleaning and disinfection of a medical device. The practice is subject to few controls in the USA. Manufacturers could not follow such an uncontrolled practice for first use dialysers under current regulations in the USA (United States Code of Federal Regulations, Title 21, Parts 1, 26, 110, 211, 860, 876. April 1, 2003). The exposure of membranes to different disinfection chemicals and processes may

 alter those membranes in unpredictable ways [14]. Hence, the membrane used may not be functionally equivalent to the membrane purchased if it has been reprocessed. Simply said, dialysis facilities and regulatory agencies that oversee their operation in the USA do not require the levels of process control or quality surveillance that are required of manufacturers before a product is used to treat patients.

http://ndt.oxfordjournals.org/cgi/content/full/19/11/2823
« Last Edit: February 27, 2011, 02:37:40 PM by cschwab »
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Re: REUSE (part b)
« Reply #1 on: February 20, 2011, 08:45:59 AM »
Abandoning Peracetic Acid-Based Dialyzer Reuse Is Associated with Improved Survival

   1. Eduardo Lacson Jr,
   2. Weiling Wang,
   3. Ann Mooney,
   4. Norma Ofsthun,
   5. J. Michael Lazarus,
   6. Raymond M. Hakim

+ Author Affiliations

   1.
      Fresenius Medical Care
« Last Edit: February 20, 2011, 08:51:48 AM by cschwab »
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Re: REUSE (part b)
« Reply #2 on: February 20, 2011, 08:58:59 AM »
Beta(2)-microglobulin clearance decreases with Renalin reuse.
(increased risk of Amyloidosis)

Castro R, Morgado T.

Unidade de Hemodi
« Last Edit: February 20, 2011, 09:00:34 AM by cschwab »
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Re: REUSE (part b)
« Reply #3 on: February 20, 2011, 09:04:41 AM »
UpToDate
Official reprint from UpToDate
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Re: REUSE (part b)
« Reply #4 on: February 20, 2011, 09:09:48 AM »
A deadly error: Routine dialysis leads to Heights woman's death

Published: Saturday, October 04, 2008, 10:51 PM     Updated: Monday, October 06, 2008, 9:02 AM
Lynn Moore | The Muskegon Chronicle By Lynn Moore | The Muskegon Chronicle

Chronicle/Kendra Stanley-Mills

"He's the only thing keeping me going," said James Allen of his dog, Duke, shown in the background. Allen, 72, of Muskegon Heights, lost his wife, Betty, after a mistake was made at a dialysis clinic. "He's my baby," Allen said of Duke. "He's all I've got."

It is too much for James E. Allen to talk about the day his wife died -- the day she left for her regular dialysis treatment and never came home.
By the numbers

69: Muskegon County residents newly diagnosed with end stage renal (kidney) disease in 2007.
197: County residents undergoing dialysis for chronic renal failure as of Dec.31, 2007.
17,000: Estimate of county residents with diabetes.
« Last Edit: February 20, 2011, 09:13:33 AM by cschwab »
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Re: REUSE (part b)
« Reply #5 on: February 21, 2011, 08:34:10 PM »
From the Colorado Springs, Colorado Gazette: stories about reuse and the inability to take out human error:

http://www.dialysisethics2.org/forum/index.php?topic=604.0

http://www.dialysisethics2.org/forum/index.php?topic=619.0

« Last Edit: February 21, 2011, 08:36:46 PM by cschwab »
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Re: REUSE (part b)
« Reply #6 on: February 25, 2011, 07:25:57 AM »
Wow a lot of information on reuse! Thank you for posting all this as little is known about reuse by those who get dialysis with reuse and have every right to know the stories!
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Re: REUSE (part b)
« Reply #7 on: February 26, 2011, 11:52:39 AM »
It has been ingrained in me since I first started with DialysisEthics over ten years ago that reuse is a bad thing - haven't seen much to change my mind.  Thought this section might need some updating though.

I did find another study:

Water Permeability:


    * Kidney Int. 2007 Aug;72(3):379; author reply 379-80.

Abstract

Dialysis with high-flux membranes is widely used, in part, because they are thought to increase the removal of middle molecules when compared with low-flux membranes. Dialyzer reprocessing; however, is thought to alter middle molecule clearance. Renalin, a mixture of germicidal agents, has widespread use in dialyzer reprocessing. We determined the effect of Renalin reprocessing on the water permeability of three different dialyzers of Fresenius (F80A and 200A) and Gambro (17R) manufacture using the dead-end filtration method. Two hundred and seventeen, predominantly used but some new, dialyzers were evaluated. Water permeability of the used, but not the new, dialyzers fell abruptly and dramatically with reprocessing. The permeability fell almost 70% in the F80A dialyzer after three reprocessing procedures with similar, but somewhat slower declines, seen in the other two dialyzers. We conclude that there is a decline in water permeability seen in Renalin reprocessed dialyzers. This factor and the associated change in solute clearance and ultrafiltration characteristics should be considered in assessing the effectiveness of dialyzer reprocessing.

http://www.ncbi.nlm.nih.gov/pubmed/17377505
« Last Edit: February 26, 2011, 12:23:15 PM by cschwab »
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Re: REUSE (part b)
« Reply #8 on: February 26, 2011, 12:21:43 PM »
Low water permeability in a dialyzer isn't sounded very good from what I'm reading:

"The potential for CIS convective transport from contaminated dialysate can occur across dialyzer membranes of relatively low water permeability for which the only relevant mechanism is diffusion"

http://books.google.com/books
 

I might have to translate it to English though.
« Last Edit: February 27, 2011, 12:08:26 PM by cschwab »
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Re: REUSE (part b)
« Reply #9 on: February 26, 2011, 03:45:55 PM »
Great info! :)

Wow what a long Google books link haha! Might want to use a url shortener sometime ;) Bit.ly is reliable and good and is the one I use when I post long links even though I go sparingly on them because I don't trust most shortened url's ;)
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Re: REUSE (part b)
« Reply #10 on: February 27, 2011, 12:11:48 PM »
Quote from: Angie on February 26, 2011, 03:45:55 PM

Might want to use a url shortener sometime ;)
 

How about bbcode?
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Re: REUSE (part b)
« Reply #11 on: February 27, 2011, 07:44:56 PM »
Quote from: cschwab on February 27, 2011, 12:11:48 PM
Quote from: Angie on February 26, 2011, 03:45:55 PM

Might want to use a url shortener sometime ;)
 

How about bbcode?

Smarty pants! ;) Yes that works too.  :D
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Re: REUSE (part b)
« Reply #12 on: March 01, 2011, 06:48:24 PM »
Just thought there might be a reason not to use it!  :)
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