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      Association of Dialyzer Reuse and Hospitalization Rates among Hemodialysis Patients in the US

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          Objectives: To determine if reuse of hemodialyzers is associated with higher rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients. Methods: Noncurrent cohort study of hospitalization rates among 27,264 ESRD patients beginning hemodialysis in the United States in 1986 and 1987. Results: Dialysis in free-standing facilities reprocessing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02–1.14). This higher rate of hospitalization was observed with dialyzer reuse using peracetic/acetic acids (RR = 1.11, CI 1.04–1.18) and formaldehyde (RR = 1.07, CI 1.00–1.14), but not glutaraldehyde (p = 0.97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reprocessing. Hospitalization for causes other than vascular access morbidity in free-standing facilities reusing dialyzers with formaldehyde was not different from hospitalization in facilities not reusing. However, reuse with peracetic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03–1.15). Conclusions: Dialysis in free-standing facilities reprocessing dialyzers with peracetic/acetic acids or formaldehyde was associated with greater hospitalization than dialysis without dialyzer reprocessing. This greater hospitalization accounts for a large increment in inpatient stays in the USA. These findings raise important concerns about potentially avoidable morbidity among hemodialysis patients.

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          The impact of comorbid and sociodemographic factors on access to renal transplantation.

          To assess the impact of sociodemographic factors and comorbid conditions on access to renal transplantation for adult US dialysis patients with end-stage renal disease (ESRD). Cohort analytic study. Data on comorbid conditions at onset of ESRD were abstracted from patients' medical records and matched to sociodemographic and ESRD data from the United States Renal Data System database. United States Medicare dialysis population. Random, national sample of ESRD patients starting dialysis in 1986 and 1987 (n = 4118). Time to first renal transplant (living or cadaver donor) since onset of ESRD regressed with two nested Cox proportional hazards models, first against sociodemographic factors alone, and then against sociodemographic factors and comorbid conditions. Cardiovascular diseases are most predictive of who received a transplant; patients with coronary heart disease, congestive heart failure, or left ventricular hypertrophy showed lower transplantation rates relative to patients without the disease (relative rate [RR] = 0.65 to 0.80, P < .05 each). Obese patients and patients with peripheral vascular disease also showed lower transplantation rates (RR = 0.65 to 0.75, P < .05 each). Previously reported sociodemographic effects of lower transplantation rates for older patients, women, nonwhite patients, and lower income patients were confirmed (P < .01). Sociodemographic effects remained essentially unchanged when adjusted for comorbid conditions. These findings indicate that sociodemographics have strong independent effects on access to transplantation that cannot be explained away as "surrogate" effects related to comorbid factors. Furthermore, the results suggest that lower mortality rates for transplant recipients relative to dialysis patients are due, in part, to a healthier case mix among patients receiving transplants.
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            Effect of dialyzer reuse on survival of patients treated with hemodialysis.

            To evaluate the impact of dialyzer reuse on the survival of US hemodialysis patients.

              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              December 1999
              26 November 1999
              : 19
              : 6
              : 641-648
              aCenter for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, bDepartment of Health Care Systems, Wharton School, University of Pennsylvania, cRenal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, dLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa., and eRand Corporation, Santa Monica, Calif., USA
              13535 Am J Nephrol 1999;19:641–648
              © 1999 S. Karger AG, Basel

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              Page count
              Tables: 4, References: 22, Pages: 8
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/13535
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