National Surveillance of Dialysis-Associated Diseases in the United States, 1988


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Abstract

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,734 chronic hemodialysis centers in the United States in 1988 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 91%. These 1,586 centers represented 107,804 patients and 28,501 staff members.Over the last 13 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.2% among patients and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8 to 1.5% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 90% of the centers. By the end of 1988, 17% of susceptible patients and 53% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1988, as a result of receiving vaccine, the prevalence of antibody to HBsAg increased from 12 to 20% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1988 was reported to be 1.0% among patients and 0.1% among staff members.Fifteen percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients and 45% reported septicemia. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 25%.In 1988, 67% of centers reported that they reused disposable dialyzers; these centers treated 72% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 2 to 50 (mean, 11) and the maximum number of times a disposable dialyzer was reused ranged from 3 to 131 (mean, 28). Chemical germicides used for reprocessing dialyzers included formaldehyde; Renalin, a peracetic acid-hydrogen peroxide-based germicide; and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. However, pyrogenic reactions occurring in clusters were more frequently reported in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was only associated with centers that reused these dialyzers in a manual reprocessing system, a result consistent with those obtained in 1986 and 1987.Eighteen percent of centers reported treating at least some of their patients by high flux dialysis. Use of high flux dialyzer membranes was associated with an increased risk of pyrogenic reactions, even in centers that did not reuse these dialyzer membranes. The use of bicarbonate dialysis as the primary method of dialysis increased from 22% in 1986 to 58% in 1988. Bicarbonate dialysis was associated with an increased risk of pyrogenic reactions only in those centers that practiced high flux dialysis. Centers that prepared their own bicarbonate dialysate were more likely to report pyrogenic reactions than centers that used commercially prepared bicarbonate dialysate.Eight percent of centers reported reusing blood lines, 2% reported reusing transducer filters, and 57% reported reusing dialyzer caps. The percentage of centers reusing blood lines and transducer filters was significantly lower than in previous years. Reuse of these disposables was not associated with any increased risk of HBV infection in either patients or staff or of pyrogenic reactions or septicemia.New dialyzer syndrome was reported by 40% of the dialysis centers in 1988, a frequency similar to that reported in previous years.From 1985 to 1988, the percentage of centers that reported providing dialysis for patients with HIV infection increased from 11 to 25%. The number of dialysis patients known to be infected with HIV also increased from 0.3 to 1.2%. Those centers that reported providing dialysis for HIV infected patients were located in 35 states, the District OF Columbia, Puerto Ricol, and the Virgin Islands. IN 1988 19% of centers reported routinely testing their patients for the antibody to HIV.

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