Collins Allan J, Liu Jiannong, Ebben James P
Nephrology Analytical Services, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite D-206, Minneapolis, MN 55404, USA.
Nephrol Dial Transplant. 2004 May;19(5):1245-51. doi: 10.1093/ndt/gfh011. Epub 2004 Feb 19.
The reuse of haemodialysers has been practiced in the United States for >20 years. We investigated mortality and hospitalization risk according to various reuse practices, testing the hypothesis that outcomes are improved in patients treated with dialysers cleaned with bleach and sterilized with formaldehyde.
We studied 1998 and 1999 incident Medicare haemodialysis patients, with follow-up through December 31, 2000 (49 273 patients). Clinical conditions and dialysis therapy were characterized from Medicare claims data. Included were patients who could be linked to a dialysis provider. Demographic characteristics were obtained from the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Report. Mortality information was obtained from the CMS ESRD Death Notification; hospitalization information, from Medicare in-patient claims files. Data on reuse practices were obtained from the annual survey of haemodialysis units conducted by the Centers for Disease Control and Prevention.
Cox regression analyses found no significant differences in mortality or first-hospitalization risk for patients in dialysis units not using bleach as a cleaning agent. Outcomes for patients treated in units using glutaraldehyde did not vary according to use of bleach. In the analysis of first-hospitalization risk, there was no difference according to various germicide/bleach combinations. Overall, there was no significant difference in relative risk of death or in hospitalization risk among the reuse groups (including the no-reuse group).
For the 1998-1999 period, reuse practices were not associated with a survival advantage or disadvantage. Our findings may reflect the National Kidney Foundation's 1997 introduction of clinical practice guidelines, the intent of which was to bring about increased consistency of care within the dialysis community in the United States.
血液透析器再利用在美国已实行20多年。我们根据各种再利用做法调查了死亡率和住院风险，检验了以下假设：使用经漂白剂清洗并用甲醛消毒的透析器治疗的患者预后得到改善。
我们研究了1998年和1999年开始接受医疗保险血液透析的患者，随访至2000年12月31日（共49273例患者）。从医疗保险理赔数据中了解临床情况和透析治疗情况。纳入的患者需能与透析服务提供商建立联系。人口统计学特征来自医疗保险和医疗补助服务中心（CMS）的医疗证据报告。死亡率信息来自CMS的终末期肾病死亡通知；住院信息来自医疗保险住院理赔档案。再利用做法的数据来自疾病控制和预防中心对血液透析单位进行的年度调查。
Cox回归分析发现，在不使用漂白剂作为清洁剂的透析单位中，患者的死亡率或首次住院风险没有显著差异。使用戊二醛的单位中患者的预后不因是否使用漂白剂而有所不同。在首次住院风险分析中，根据各种杀菌剂/漂白剂组合，结果没有差异。总体而言，再利用组（包括不进行再利用的组）之间的死亡相对风险或住院风险没有显著差异。
在1998 - 1999年期间，再利用做法与生存优势或劣势无关。我们的研究结果可能反映了美国国家肾脏基金会1997年出台的临床实践指南，其目的是提高美国透析界护理的一致性。
