DIALYZER REUSE EXPERIENCE IN BEFELATANANA HEMODIALYSIS CENTER : ASSESSMENTS AFTER SIX YEARS OF PRACTICE

8 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-2833, Poster Board= SAT-609

Introduction:

Hemodialysis is the only renal replacement therapy available in Madagascar. According to the last edition of Kidney Health Atlas, less than 5% of people under Chronic Kidney Disease (CKD) in developing countries can do it because of its costs. We have started dialyzer reuse practice in our Hemodialysis Center since the 13th of January 2016 after some training in HUE Hospital in Vietnam. The objectif of this study is to report the assessments of this technique after six years of practices.  

Methods:

This is a descriptive and retrospective study in single center. Before starting, patients were well informed of advantages and eventual side effects of this technique. An oral and written consent were done. All chronic hemodialyzed patients who practiced reuse technique were included.  HCV, HVB and HIV tests were requested systematically and all infected patients were excluded.

Results:

In total, 18751 reuse were conducted with 1555 dialyzers. We used Polyflux F10 HPS as dialyzer. Average reuse of one dialyzer with lines were 12 times a month. Extremes number of reuse were 3 and 18.  All the characteristics of the patients are summarized in Table 1. Urea reduction ratio was 74 %. Any death and any clinical side effects related to the practice of reuse were reported. One broken dialyzer  were recorded. Practice of reuse increased in 94 % of cases the irregular hemodialysis to regular periodic hemodialysis  with 3 times a week. And it decreased also in 59 % the total monthly coasts of treatments compare to single use dialyzer. Since 2016, it could save up to 933 000 000 Fmg (38 000 Dollars) for patients’s economies.

 

Table 1. Patient’s characteristics

Number of patients

 

30 patients 

 male 53.3 %

female 46.7 % 

Average weight before reuse  

58 Kg (30, 80)

Average weight after reuse  

54 Kg (28,77)

Average urea before reuse

20 mmol/l (10, 25)

Average urea after reuse

5 mmol/l (3,10)

Causal nephropathies

·        Diabetic nephropathy

·        Vascular nephropathy due to chronic Hypertension

·        Others Glomerulopathies

·        Chronic tubulo-interstitial nephropathy

·        Undetermined nephropathy

 

30%

30%

20%

2%

18%

Vascular access

·        Native arterio-veinous fistula

·        Permanent catheter

·        Temporary catheter

 

74 %

16 %

10 %

Conclusions:

The technique of reuse dialyzer with lines was started in several countries since 1964. Its specific objectif is to reduce the coasts of the treatments. According to the literature, one dialyzer may be reused up to 21 times. It doesn’t change the effectiveness of treatments mainly the quality of extrarenal purification. Side effects are due to the presence of disinfectants agents like citric acid or peracetic acid before dialysis. Some cases as abdominal pain, diarrhoea and skin eruption were reported. An optimal rinsing time with a systematic control of pH of dialyzer may avoid theses complications. To conclude, reuse of dialyzer is safe and less expensive to treat End Stage Renal. It may be an alternative treatment in developing countries. Three  anothers public and private hemodialysis centers practice currently the technique of reuse in Madagascar.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.