Port F K, Wolfe R A, Hulbert-Shearon T E, Daugirdas J T, Agodoa L Y, Jones C, Orzol S M, Held P J
US Renal Data System Coordinating Center, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Am J Kidney Dis. 2001 Feb;37(2):276-86. doi: 10.1053/ajkd.2001.21290.
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 record abstraction 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 greater in 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.
血液透析器复用在美国是一种常见的做法。最近的研究引发了人们对某些复用做法相关死亡风险的担忧。我们对1994年至1995年期间在1394个透析机构接受治疗的12791例慢性血液透析患者的代表性样本进行了1至2年随访，评估了调整后的死亡风险。病历摘要提供了关于复用做法、漂白剂使用、透析器膜、透析剂量以及患者特征和合并症的数据。通过自抽样Cox模型分析死亡风险，分析内容包括：（1）不复用与复用；（2）复用剂；（3）使用和不使用漂白剂的透析器膜，同时考虑透析和患者因素。复用组与不复用组患者的死亡相对风险（RR）无差异（RR = 0.96；95%置信区间[CI]，0.86至1.08；P > 0.50），不同调整水平和亚组的结果相似（RR = 1.01至1.05；95% CI，下限> 0.90，上限< 1.19；各P > 0.40）。过氧乙酸混合物与福尔马林的RR因膜类型和再处理过程中漂白剂的使用情况而有显著差异，在合成膜中达到临界显著性。在合成膜中，低通量膜的死亡率高于高通量膜（RR = 1.24；95% CI，1.02至1.52；P = 0.04），再处理过程中不使用漂白剂的死亡率高于使用漂白剂的（RR = 1.24；95% CI，1.01至1.48；P = 0.04）。在所有膜中，使用高通量合成膜治疗的患者死亡率最低（RR = 0.82；95% CI，0.72至0.93；P = 0.002）。虽然总体上复用组的死亡率并不高于不复用组，但不同复用剂的死亡风险可能存在差异。使用高通量合成膜透析器与较低的死亡风险相关，尤其是在接触漂白剂的情况下。清除较大分子可能起到了一定作用。
