Faculty of Medicine, University of Brasilia, Brazil.
Am J Nephrol. 2012;35(3):249-58. doi: 10.1159/000336532. Epub 2012 Feb 18.
Robust evidence about dialyzer reuse effects on mortality is not available. Our aim was to summarize the evidence for the effectiveness of dialyzer reuse compared to single use in patients with end-stage renal disease.
We searched MEDLINE, Embase, CINAHL, SciELO, LILACS, USRDS ADR, universities' theses databases and annals of congress from major nephrology societies. Reviewers performed the study selection and data extraction independently. We used the GRADE approach to assess the quality of the evidence. Mortality was the primary outcome.
A total of 1,190 studies were retrieved, and 14 were included in the review (n = 956,807 patients). The disinfectants used on dialyzer reprocessing were hypochlorite, formaldehyde, glutaraldehyde, and peracetic acid. The evidence available from the studies was of very low quality. Most studies found no differences between groups. In studies with statistically significant differences, these differences were not observed in all groups and they varied by the type of disinfectant, time of observation and treatment unit.
No significant differences were identified for the superiority or inferiority of dialyzer reuse versus single use when assessing the mortality of patients with end-stage renal disease. Studies of higher quality, including randomized clinical trials, are required to provide conclusive evidence regarding the effectiveness and safety of dialyzer reuse.
关于透析器复用对死亡率影响的有力证据尚不存在。我们的目的是总结透析器复用与单次使用相比在终末期肾病患者中的有效性证据。
我们检索了 MEDLINE、Embase、CINAHL、SciELO、LILACS、USRDS ADR、大学论文数据库和主要肾脏病学会的会议记录。审查员独立进行了研究选择和数据提取。我们使用 GRADE 方法评估证据的质量。死亡率是主要结局。
共检索到 1190 项研究，其中 14 项研究（n=956807 名患者）被纳入综述。透析器再处理中使用的消毒剂有次氯酸盐、甲醛、戊二醛和过氧乙酸。研究中可用的证据质量非常低。大多数研究未发现两组之间存在差异。在具有统计学意义差异的研究中，这些差异并非在所有组中均存在，并且因消毒剂类型、观察时间和治疗单位而异。
在评估终末期肾病患者的死亡率时，未发现透析器复用优于或劣于单次使用。需要进行更高质量的研究，包括随机临床试验，以提供关于透析器复用的有效性和安全性的结论性证据。
