MO667SWITCHING TO ONE-TIME USE OF DIALYZERS FOR HEMODIALYSIS: A ONE-YEAR SURVIVAL ANALYSIS IN TASHKENT
Authors: Sharapov Olimkhon 
Published: May 2021

Abstract

Background and Aims
Until recently, for various reasons in Uzbekistan, it was often necessary to reuse disposable dialyzers for hemodialysis procedures. On June 13, 2018, a Resolution of the President of the Republic of Uzbekistan was issued on measures to improve the effectiveness of the provision of nephrological and dialysis care to the population of our country. Thanks to this, funding and provision of all nephrological and dialysis centers have sharply increased, as well as the country's transplant service has been re-established. Since the end of 2018, dialyzers are used exclusively once in all dialysis centers in our country. We were interested in comparatively studying the survival rate of dialysis patients during one year, before and after the transition to the use of single dialyzers in our center.

Method
We conducted a prospective observation of 120 (63 men and 57 women) patients with end-stage CKD and receiving programmed hemodialysis at our dialysis center in Tashkent. Our observation took place for 2 years: from the beginning of 2018 to the end of 2019. The study took place in 2 stages, 1 year each: at the first stage, within 1 year (from the beginning to the end of 2018), the survival rate of the observed patients receiving hemodialysis with repeated use of disposable dialyzers was assessed. At the second stage (after the transition to one-time use of dialyzers throughout the country), also for 1 year (from the beginning to the end of 2019), all the patients we observed received hemodialysis sessions with a single use of dialyzers. All patients were diagnosed with end-stage CKD. The average age of the patients was 49.7 ± 14.1 years. The average duration of hemodialysis was 29.4 (6-252) months. All patients underwent hemodialysis sessions with identical apparatus and dialyzers of the same manufacturer. The primary diseases in the patients were glomerulonephritis (n = 44, 36.7%), type 2 diabetes (n = 38, 31.7%), urolithiasis (n = 13, 10.8%), polycystic kidney disease (n = 7, 5.8%), lupus (n = 5, 4.2%) and others (n = 13, 10.8%). Survival was assessed using the Kaplan-Meier method, the confidence interval was determined by Greenwood.

Results
During the entire period (24 months) of observation, out of 120 patients, 26.7% (n = 32) patients died, 73.3% (n = 88) survived (of which 10 patients underwent kidney transplantation). We will assess the survival rate depending on the periods of dialyzer use.
During 1 year of follow-up (the period of repeated use of disposable dialyzers), 19.2% (n = 23) patients died, 80.8% (n = 97) survived and continued to receive hemodialysis, of which 2 (1.7%) patients underwent a kidney transplant and knocked out of observation. The main cause of death was cardiovascular complications (sudden cardiac death, myocardial infarction, stroke, etc.), as a result of which 69.6% (n = 16) of patients died. The survival rate for 1 year was S (t) = 0.815 [95% CI, 0.745-0.885].
Over the next 12 months (single use period), out of 95 patients continuing to receive hemodialysis, 9.5% (n = 9) patients died, 82.1% (n = 78) patients survived. 8.4% (n = 8) of the observed patients underwent kidney transplantation. 55.6% (n = 5) of all deceased patients died from cardiovascular complications. The survival rate at 1 year was S (t) = 0.901 [95% CI, 0.839-0.962].

Conclusion
Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival by 10.6%.