I have been charged with selecting a reuse system for a new facility in Northern California. I am familiar with the Renatron system but have no experience with the MAKY. Is there anyone in California that has a MAKY system and, if so, what has been your experience?

gtechman,

I have a few mounths experience with an older macky system and should say that it's an ok unit. The equipment worked fine, and it's user friendly. As for longevity, I can't say much about that. Three years ago, technical instructional classes (cerification) for this equipment was defficult to obtain (due to in-availability). And tech support was nominal. However, the company may have changed. As for the tried an true, Minntech's Renatron II w/renalog has been the way to go. I have experienced the purchacing of used (and new) Minntech equipment and they worked just fine. I recommend utilizing Renalin, because you get the PM kits at a discount and a parts replacemnet (free) warranty for the Renatron. As for tech support for the Renatron, Mike, Tony and Greg have been with the company for many years and provide an excellent support system.

I hope this asist you.

I have been using the MAKY for almost two years and have found it to perform and hold up well, and tech support has been available and helpful when needed.
I have used the Renatron in the past and would recommend purchasing the Maky

Both systems work well. Renatron's have a longer track record. MAKY is more flexable with configuration and they wont void your warranty if you choose to use chemicals not bought from them.

All of our four units have switched to MAKY machines. So far in my clinic I haven't encounter any problem yet. It's a user friendly machine and our reuse averages went up high. With regards to tech. support I always get a prompt response and always helpful when i need help and will go through the process on the phone until the problem is fix. We have a renatron in one of our units but we switched to the MAKY machine. PM is nominal.

I had thought that the industry was moving away from reuse ???

I've been working in the field of dialysis since 1973. Back then, the composite rate payment from Medicare was $138. Sadly, it's still $138, but compared to what $138 was worth in 1973, today's $138 is only worth about 20% of what it was back in 73. The ESRD industry keeps growing in population, but the reimbursement is lagging, severely. The only reason why Fresenius can afford to do single use, is due to the fact that they manufacture their own dialyzer. And, even with that fact in mind, if you compare their profit margin with DaVita, a company that still does dialyzer reprocessing, DaVita's profit margin is higher. Dialyzer reprocessing is the major factor, which gives DaVita the financial edge over Fresenius.

To give you an idea of just how far we are behind where we could have been, if Congress and CMS had match the dialysis composite rate to the rate of inflation since 1973, go to:
http://groups.msn.com/DialysisTransplantCity/kidneynews...=4675604292730649372
To make a long story short, if the composite rate had kept up with the rate of inflation, we would be getting around $664.49 per treatment, instead of $138. In fact, if it were not for patients (a small percentage I might add) with commercial insurance, ESRD providers would be closing their doors. Possibly only Fresenius and DaVita and a few of the smaller chains would be able to continue providing care. Independent providers wouldn't exist, period.

Dialyzer reprocessing is a long way from disappearing from the mainstream of ESRD provider care. Until the composite rate is significantly raised, dialyzer reprocessing will remain a financial necessity. On average, a dialysis facility with a modest average reuse number of 15 uses per patient could save a lot of money. At fifteen reuses, at a total cost of $5 per reprocessing, your dialyzer cost will be $810 for the entire year. However, at $13 per dialyzer, your cost will be $2106 for the entire year. That's a savings of $1,296 per year, per patient. If you have a facility with 200 patients, that comes out to an annual savings of $259,200 per year.

Clearly, the only people pushing non-reuse are those that manufacture the dialyzer. There is no medical or scientific reason why dialyzer reprocessing should be stopped, at this time. Unless one of the larger dialyzer manufacturers begins making a $5 dialyzer, reuse will continue to make sense.

One other point that needs to be made is that you can provide your patients higher quality dialyzers when you practice reuse. A higher quality dialyzer clears the by-products of protein metabolism much more efficiently. This makes the patients time on dialysis more effective and provides the patient with a higher level of wellness, reducing morbidity and mortality. When you buy your patients a cheap dialyzer, you get what you pay for, which results in a lower Kt/V, a lowered level of wellness, increased morbidity and increased mortality.

Joe Atkins, RN,MBA,CNN,CHT

Mr. Atkins brings up some great points. If I may add, a well managed reuse program may come close to the $5.00 dollar/dialyzer average, Furthermore, it requires some skilled laborers as well.

Studies show, through several years of accumulated data (Minntech), central dialysis, with the above personal (however, less skilled labor, equipement, PM and maintenance requirements), will in-fact, allow for the $5.00/dialyzer and reuse averages more consistantly.

Plus, If you had some good inventory management and procurement, you could bring the cost (ancillary supplies) per-Tx. within $15.00.

All the above and good medication management allows for some serious savings.

Respectfully,

One other issue that I failed to mention is that Medicare, for the first time, is seriously considering bundling the dialysis treatment, IV drugs and lab test, all in one global composite reimbursement. The new House and Senate are going to be going after Amgen and dialysis facilities for over use of EPO. When that happens, ASP+6% could become a thing of the past. If this happens, the IV drugs that have been supporting ESRD providers will be gone. If that scenario should become reality, a well managed dialyzer reprocessing program may be the only thing standing between remaining in operation or closing your doors.

As for the myth that dialyzer reprocessing is dead, and it is a myth, I find it ironic that the very people who created dialyzer reprocessing are the ones who are now trying to kill it. When it was convenient and profitable to do reprocessing, great efforts were put forth to medically and scientifically justify the practice. Now, those same people have turned 180 degrees in the other direction, even when the research proves that dialyzer reprocessing is not only medically safe, but also has medical benefits for the patient, as well as finacial benefits for the facility (helping ESRD providers afford staff raises, afford new equipment and improved technology, being able to afford to hire more staff).

The next major consideration of dialyzer reprocessing are the ecological implications of non-reuse, which is that it more than doubles your medical biohazardous waste. This not only increases costs for operations, but also increases the biohazardous disposables heaped upon a waste disposal system that is already strained. Burn dialyzers and you add to the polution of our air. Bury dialyzers and you add to the volume of our hazardous waste dumps. A facility that practices non-reuse has to dispose of 162 sets of blood tubing and 162 dialyzers per patient, per year. A facility that practices dialyzer reuse disposes of 162 set of blood tubing per patient, but, with 16 average reuses, only disposes of 10.125 dialyzer per year. Now I want you to consider that there are well over 300,000 patients dialyzing in the United States each year. If no one is doing reuse that's 48,000,000 bloodly dialyzers, along with 48,000,000 sets of blood tubing each year. By comparrison, if everyone reused their dialyzer, at 16 reuses, we would only have 3,037,500 dialyzers to dispose of. That would be 44,962,500 fewer dialyzers going to the dump.

For those concerned about high cost of oil, please consider that dialyzers are made of plastic, which, in turn, is made from oil. Let's be clear that it take a lot of oil and natural gas to make one dialyzer. It takes 1,851 gallons of water to refine one barrel of oil and one barrel of oil to make one pound of plastic. How many soldiers are dying in Iraq because of our need for more oil?

You see, there are a lot of things to consider when deciding whether or not to reuse dialyzers. For me, dialyzer reuse is a no brainer. It should be a no brainer for anyone who can count to ten.

Joe Atkins, RN,MBA,CNN,CHT

Mr. Atkins,

Great points and informative, dialysis providers should take note. It seems that the trend being thrown at us by uncle sam, is better business management. One can only hope that more business minded individuals are in the dialysis community. Todays cost efficiency equates to tomorrows succession.

As they said in Basic, "Lead, Follow, or get out of the way".

Thanks. I have one more thought about dialyzer reprocessing, which goes back to the quality of patient care.

I've been in dialysis long enough to remember when we used to do Lee/White Clotting Times to determine the efficacy of our patient's heparinization. Then, we went to a simpler method of Activated Clotting Times, which were measured in seconds, as opposed to minutes. But, the fact is that, due to fears of dirty needle sticks and OSHA, no one does clotting times, anymore.

One thing that dialyzer reprocessing offers the nephrologist is a picture of just how well the patient's heparinization is working. When you are doing single use, you simply strip the dialysis machine and throw everything away. Except for a visual examination for clotting, you have no idea of how much volume is actually left in the dialyzer. With single use, it's actually possible for a dialyzer to look clear post dialysis, but, in reality, be well below the 80% cut off for efficacy. If you have a patient getting a great blood flow rate, great dialysate flow rate, a good dialyzer and their access studies are doing well, theoretically, you should be getting a great Kt/V. Often, with single use, this is not the case.

However, if you are doing dialyzer reprocessing, not only can you afford the very best dialyzer available for your patients, but you can actually evaluate the volume of the dialyzer each and every treatment.

For those of you who do reuse, how many times has the reprocessing tech come out to tell the nurse or physician that the patient needs more heparin due to low volume? This is vital clinical data, which will validate that the patient's getting enough heparin to assure an efficient dialysis treatment.

On the other hand, non-reuse facilities are stumbling in the dark, without any idea of whether, or not, their patients are getting the excellent dialysis treatment they deserve.

We certainly don't want to over use heparin during the patients' dialysis treatments. But, on the other hand, we must not forget that heparin is the oil that allows hemodialysis to occur. Without heparin, there would be no practicle, widespread application of hemodialysis (with the exception of patients with clotting disorders).

Presently, with single use, the only continuous evaluation of patients' heparinization being done is emperericle, which is not very scientific. On the other hand, checking the volume of the dialyzer on a computerized dialyzer reprocessing unit, such as the MAKY or the Renatron, gives clear, scientific evidence of the dialyzer's volume.

Enough said.

Joe Atkins, RN,MBA,CNN,CHT