THOMAS DEPNER

John Van Stone, MD, from the University of Missouri and Dialysis Clinic, Inc., Columbia, Missouri, reviewed the pros and cons of hemodialyzer reuse. He corrected several previous misconceptions about use of peracetic acid that were promoted in the lay press and were subsequently disproved by more careful statistical analyses. He reviewed the evidence for loss of albumin (first reported by Kaplan in 1992) associated with the use of bleach and formaldehyde during the processing of polysulfone membranes, and the improved clearance of B₂-microglobulin that also results from bleach treatments of these same membranes. Apparently the change in membrane permeabiity depends not only on the cleaning agent (bleach) but also on the sterilant used. The combination of formaldehyde and bleach results in more albumin loss and higher B₂-microglobulin clearance than the use of glutaraldehyde and bleach.

In general, Dr. Van Stone offered an optimistic but balanced view of reuse and called for careful surveillance and control of the reuse process to detect problems before they endanger patients.