Just wanted to let any patients . . . reading these boards, that if your unit does re-use . . . you have the right to demand single use. When I first requested single use, I was refused and lied to about the so-called "excessive cost" of single use.
Dialysis units have to make money, that's fair. But if they are manipulating patients, or scaring them to remain on re-use, they are breaking the rules, and preventing their patient from receiving a requested modality.
Units that have a re-use room active for reprocessing, want to keep that equipment active.
When on re-use, there are many oportunities for contamination. I have watched as techs put dialyzers on garbage can lids before taking them into the processing room. I have watched techs hold the dialyzer in the same hand as an empty bi-carb jug, on the way to the back. While the techs are stripping machines and returning dialyzers, they are also emptying garbage bags. Imagine the opportunities for cross-contamintion. Many patients react to the formaldehyde and sterillants used in re-use. Symptoms such as night sweats, BP and pulse drop, and various chemical reations are common.
If you are a patient on re-use, demand to have your options explained in detail. In Japan, there is no re-use, and mortality is 10% lower. Educate yourself. Do a searh for "re-use" on this site and you can read about 200 posts. Or go to PubMed.com, and read a thousand entries.

[This message has been edited by Michael Williams (edited 06-30-2004).]

You are right it all comes down to economics. Do you want a large, highly efficient dialyzer that will remove a lot of toxins, or a small dialyzer with less efficiency. And what about the very large patients that require two dialzyers? Even new dialyzers have sterilants in them. Not to mention lots of particulates. Cutting the fiber head creates lots of particles. A new dialyzer is not as clean as you think. And I have seen first use syndrome. You can also look at the FDA database and see this also. Some patients have an agenda based on emotion and not facts.

The cross contamination that you are trying to suggest is all happening before the high level disinfection process.

The ten percent lower mortality in Japan could be a lot of things. To determine which you would have to do a regression analysis. Either forward or backwards. They probably have lighter patients and treat them longer.

I also believe patients should be proactive in there treatments. Establish a good relatioonship with your Doctor. They have the final say as to your treatment. I also believe the Stark laws should apply to dialysis.

As much as I would like to join this debate here, I can only see this whole thing getting into a huge argument with everyone basing their stance on opinion, rather than fact. There likely not many people that can PROVE reuse is the cause for higher mortality rates in clinics who do so nor is there a way to PROVE that reuse is better than single use. Varying people react uniquely to reuse/non-reuse. What's okay for one may not be good for another. We all have our opinion and that's fine. However, when you're arguing over opinion, nobody will win and it's just a waist of time. Unless someone can show PHYSICAL PROOF one way or the other, I think we should stop beating the horse. It's dead already!! Lets just stick to the Q&A and keep it real.

m micone while I understand your point I am not sure that individuals on dialysis have the right to demand a new kidney each treatment. There may be State regulations to the contrary but under the Federal ESRD Conditions of Coverage it says:
�If the ESRD facility is engaged in the practice of hemodialyzer reuse, the governing
body ensures that there are written policies and procedures with respect to reuse, to assure that recommended standards and conditions are being followed, and requires that patients be informed of the policies and procedures.�

There are other references to reuse in the Conditions of Coverage but they all speak to informing people and following procedures. I think patient focused units should give people the choice of reuse/single use but I do not see where units are compelled to give that choice.

As someone who uses the Aksys PHD I suppose I'm in an different category but I feel being able to reuse an F-80 through heat disinfection is an advantage of the Aksys.

Hi:

m.micone, I do believe you are a bit dramatic in some of your postings.
You are entitled to express "real" concerns, but I can't help detecting a bit of sarcasm and over-the-top conclusions, such as being lied to.
Many of your postings have been provocative. That's OK, but I would also suggest trying to insert a bit of balance.
These forums, and others, are not based on cajones, demands and accusations. They are intended to share ideas and experiences with the sincere hope of enlightening others.

[This message has been edited by Michael Williams (edited 06-30-2004).]

Actually, I worked with reuse for many years and now have gone single use - I can't honestly say adequacy outcomes have changed, nor greatly improved. There are many more important factors in maintaining good patient outcomes than reusing the dialyzer. For instance, access and BFR, dialyzing your prescription, dietary issues to name a few. Reuse when practiced with proper procedures is generally safe.

I hate to beat a dead horse but.... Look at all of the large Dialysis chains that have stopped Re-use The Hand writing is on the wall it will be a non issue in a few years... Finally

Any body who supports reuse would have to be cavalier about putting renalin - which has never been approved by the FDA for re-use use, into your system 3x a week, or formaldehyde.

In Japan they have no re-use and mortality is 10% less. Sure, they eat more fish, or pick another silly reason to support a system that is furthered ONLY to put dollars into the pockets of the corporations.

In my clinic we're all on non-reuse, and the mortality rate hasn't gone down at all. I think the only thing it's done is reduce the cost since Fresenius now makes its own dialyzers.

As far as the FDA approving ANYTHING, they never "APPROVE" anything. They just clear the device or chemical disinfectant for marketing. Renalin has been cleared for marketing, and therefore, can be used for dialyzer reprocessing. This has been a myth that has circulated for way too long.

Wow - here, from FDA site

What FDA Regulates

FDA is the federal agency responsible for ensuring that foods are safe, wholesome and sanitary; human and veterinary drugs, biological products, and medical devices are safe and effective; cosmetics are safe; and electronic products that emit radiation are safe. FDA also ensures that these products are honestly, accurately and informatively represented to the public. Some of the agency's specific responsibilities include:

Drugs

* product approvals
* OTC and prescription drug labeling
* drug manufacturing standards

Comprende?

So they approve drugs. I never knew Renalin to be used as a drug. Could you enlighten us on it's usual prescribed dosage, and what it's used to treat? Also, how it actually administered to the patient? Sorry, just don't comprende.

http://www.oah.state.mn.us/aljBase/190111970.FDG.htm

Hi:

Some might find information at above site interesting.
Mike

http://www.rpc-rabrenco.com/PI/Microxfx.pdf

Hi:
Also this site.

Mike

Just a note to all--
Reuse if practiced correctly is safe,
if not practiced correctly it can be deadly...
but low and behold, the final sterilant usually makes the device sterile, again if practices are followed correctly.....thisis the trick

Just think of those new dialyzers that were used recently and dialysis patients died becuase proper routine was not followed, so there is no guarantee gentlemen/women...the answer is in educating staff to proper handling...
as the patient expressed fear--let us not forget he is at the end and many times we forget to listen before we talk....what if he were we...and we had a complaint, would he listen?
Everyone lighten up, peoples lives are at stake, do not be defensive, and do not be attackful...work together to make any program safe for both the user and the associate providing the servives for the end user.

Think of this, who is the lowest paid person in your program if you have reuse...is it not 99% of the time the person doing the reuse, and what are his/her qualifications for the job? Now, if you knew this and were a patient-what do you think you would think?

Good programs take the inquirying patient and use him to sell the program forif you can make him happy, all will be happy and in turn patient and staff will work togehter...for too long the patient has been omitted from this process, who's life is it? They should have a sy, and there will always be troublemakers, but be smart and plan to incorpaorate the person for use not abuse!

Good luck to all!! Mikey