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American Journal of Kidney Diseases, 32(2), 295-301.

Leypoldt, J.K., Cheung, A.K., & Deeter, R.B. (1998). Effect of hemodialyzer reuse: Dissociation between clearances of small and large solutes. American Journal of Kidney Diseases, 32(2), 295-301

Summary. Clearance of small solutes has been well characterized for both new and reused dialyzers. While clearance of urea, creatinine, and other small solutes does decrease slightly with each subsequent use, the change is not clinically significant as long as the fiber bundle (or total cell) volume remains above 80% of its initial value for that individual dialyzer. This remains tree regardless of the common dialyzer reprocessing solutions.

Clearance of larger solutes, such as amino acids, [[Beta].sub.2] Microglobulin, albumin, and total protein, has been shown to vary with reprocessing method and numbers. Clearance of [[Beta].sub.2] Microglobulin and protein decreased with each reuse for each high flux membrane listed, indicating that effective pore size is progressively decreased with Renalin. The authors set about to clarify the effect of extensive reprocessing (up to 15 uses) with Renalin[TM] on small and large solute clearances for two each of commonly used low and high flux dialyzers. Patients are thus protected from inadvertent albumin (protein) loss, while clearance of [[Beta].sub.2] Microglobulin is progressively reduced. They found the clearances of small solutes identical to those identified in earlier studies, showing no significant change over 15 treatments. Clearance of [[Beta].sub.2] Microglobulin and protein decreased with each reuse for each high flux membrane, indicating that pore size is not increased with Renalin, as it is with bleach. Patients are thus protected from inadvertent albumin (protein) loss.

The authors concluded that measuring fiber bundle volume of reprocessed high flux dialyzers cannot be used to predict clearance of large solutes. They called for development of a convenient method for measuring the performance of reprocessed high flux dialyzers.

Commentary. It is valuable for nursing and dietitian staff to know that patients who undergo uncomplicated dialyses and exhibit adequate vascular access function may nevertheless be experiencing dialyzer clearance problems. The reuse method employed with high flux dialyzers may explain some cases of poor nutritional lab parameters, despite the patient's claims of adequate protein intake. Lab data for high flux patients should be interpreted in the context of where the dialyzer was in the reuse life cycle when the specimen was drawn. Some patients may foul the membrane sooner than others and, thus, require more frequent replacement.

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Title Annotation:Review
Author:Hansen, Susan K.
Publication:Nephrology Nursing Journal
Article Type:Brief Article
Date:Dec 1, 2000
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