Dialyzer reprocessing: Considerations and pitfalls for effective and safe hemodialysis

Dialyzer reprocessing for dialyzer reuse in the same patient has been developed since the early time in hemodialysis history to save cost and time related to reassembling the new dialyzer during that time. The procedure can reduce the first-use and allergic reactions from using incompatible cellulosic dialyzer membrane by altering some manufacturing chemicals.All of established literatures regarding recent dialyzer reprocessing methods and considerations were extensively reviewed and summarized.Dialyzer reprocessing can be performed by multiple protocols but involves common steps including bedside rinsing after use, cleaning, dialyzer testing to prevent excessive drop in dialyzer clearance and membrane integrity, high-level disinfection or sterilization either by chemicals or heat, storage, and preparation for subsequent dialysis session by adequate rinsing to reduce the residual reprocessing chemical to the safe level. Compared with the single-use strategy, evidence is conflicting for the mortality advantages or disadvantages of dialyzer reuse, with some showing increased mortality in patients receiving peracetic acid sterilization. Keys for the effective and safe dialyzer reuse involve strict adherence to specific manufacturer's protocol, adequate dialysis water quality complied with the Association for the Advancement of Medical Instrumentation standard, measurement of the total cell volume to prevent inadequate hemodialysis, and infectious control consideration. In the present era, single-use strategy is increasingly adopted due to the decreased cost for dialyzer manufacturing. Environmental concerns of higher solid waste from dialyzer disposal in single-use dialysis should be compared with the liquid waste from reprocessing chemicals along with plastic waste and cardboard in reuse dialysis.Dialyzer reprocessing with adequate regulation is considered as an acceptable option for cost-effective hemodialysis, compared with the single-use strategy.