".......evidence suggests that patients exposed to reuse receive a chronic
stimulus to the inflammatory system by regular infusion of pyrogen and
perhaps by disturbance of the production of bacterial permeability-increasing
protein (BPI), a product of granulocyte degranulation that normally protects
the monocyte from stimulation by endotoxin. Chemical or heat alteration of
protein layering of the reused membrane may play a critical role in
disturbing the balance between BPI and lipopolysaccharide-binding protein
(LBP), which specifically delivers endotoxin to the CD14 receptor of the
monocyte and activates the cytokine cascade. Furthermore, the reused
dialyzer acts as a trap, binding endotoxin that cannot be rinsed out by
aqueous solution, but requires plasma or whole blood to remove it from the
membrane. As chronic activation of the cytokine cascade can cause cachexia,
it is reasonable to suggest that the reuse procedure may contribute to the
bioburden of hemodialysis and explain, in part, the malnutrition and
hypoalbuminuria so often observed in dialysis patients who are dying in the
United States today.
The fact that the symptomatic benefit attributed to reuse a decade
ago has now been refuted leads one to conclude that the sole reason for
practicing reuse is to reduce treatment costs."

By: Stanley Shaldon, MA, MD, FRCP
Dept. of Nephrology,
University Hospital, Nimes, France

In: Dialysis & Transplantation Magazine
Vol. 22, No. 3. pp 122-126,
March, 1993.