Dialysis nightmares

By Michael Fraase

Sunday, 30 March 2008 10:57AM CST

Section: ESRD

DialyzerNightmares about dialysis are fairly infrequent for me, but when one comes it takes its toll. I wake up in a cold sweat, horrified, and unable to get back to sleep. The reason for dialysis nightmares is simple: there’s just so damn much that can go wrong.

For-profit dialysis providers—and they’re almost all for-profit—cut corners wherever they can to increase profits. After all, as corporations their sole function, by law, is to deliver value to shareholders; any provision of quality dialysis services is a byproduct—an unintended consequence. Of course, if one dialysis provider started killing off its customers, they’d proportionately start to lose profits. The problem is that there’s only two major dialysis providers in the US. Heads they win; tails you lose, as it were.

But back to the nightmares.

One of the ways for a dialysis provider to cut costs is to convince patients to participate in dialyzer reuse.

When dialyzers are reused, they are disinfected with poisonous chemicals—usually formaldehyde or renalin—after each use, then rinsed, and tested. I was a reuse patient for several years because I was told that more red blood cells would be retained between uses and I’d be less likely to have a reaction to new dialyzers. Besides, I’d be able to use a larger and more expensive dialyzer under reuse. Non-reuse patients were doomed to crappy, throw-away dialyzers.

While various studies in the US indicate no conclusive evidence of increased morbidity or mortality with dialyzer reuse, some older studies have shown increased mortality rates related to reuse. In other words, there’s at least some evidence that dialyzer reuse can kill you.

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