The Impact of Reuse Dialyzer Application on Routine Hemodialysis Patients Adequacy and Its Correlation with Cost Efficiency in Type D Hospital

Rulita Ayu Kusuma Ningtiyas

doi:10.22146/ahj.v3i2.66612

The Impact of Reuse Dialyzer Application on Routine Hemodialysis Patients Adequacy and Its Correlation with Cost Efficiency in Type D Hospital

https://doi.org/10.22146/ahj.v3i2.66612

Rulita Ayu Kusuma Ningtiyas^(1*)

(1) Gajah Mada University
(*) Corresponding Author

Abstract

Background: Hemodialysis (HD) is one of the high cost service unit in the hospital which it implemented the cost effciency policy by the application of reuse dialyzer. According to claim recieved from Jaminan Kesehatan Nasional (JKN) system, the HD procedure for type D hospitals received the smallest claim payment if it compared to type A, B and C hospitals. This policy will be measured its effect on the effectiveness in the form of Ureum Reduction Ratio (URR) and Kt/V values and it associated with cost efficiency in type D hospital settings.

Objectives The aims of this study were to 1.) Measure the corellation between the policy of using reuse dialyzer and the HD adequacy value and 2.) Evaluate the cost efficiency policy implemented by type D hospital HD unit in the form of using reuse dialyzer.

Methods: This study was conducted with a cross-sectional design study from URR and Kt/V data on routine HD patients at 4 of type D hospital in Yogyakarta and Cantral Java in period Januari-March 2021. HD adequacy values were compared between the groups using the new and reuse dialyser. Cost efficiency was calculated based on the cost difference between cost of the HD procedure using a reuse dialyser and the projected cost if it is carried out with a single-use dialyzer.

Result and Discussion: HD adequacy data were obtained from 112 subjects consisting of 22 with a new dialyzer, 32 with a reused (R) dialyzer first and R2, 27 with R3-R4 and 31 with R5-R7.The analysis of the effect of using reuse dializer on URR and Kt/V in the group with the new and reuse dialyser was obtained p = 0,90 and 0,91. The HD adequacy value in using reuse dialyser was not significantly different from using the new dialyser. The result of the cost efficiency analysis was 20.55% with using reuse dialyzer when it is associated with a source of income for HD services in type D hospitals.

Conclusion: The application of reuse dialyzer is proved that it did not affect HD adequacy achievement when it compared to the use of a new dialyzer, and saved costs on HD services in type D hospitals.

Keywords: Hemodialysis, reuse dialyzer, HD adequacy, efficiency

Keywords

Hemodialysis, reuse dializer, HD adequacy, efficiency

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References

Perhimpunan Nefrologi Indonesia. 11 th Report Of Indonesian Renal Registry 2018. Afiatin, Widiana I, editors. Jakarta: Perhimpunan Nefrologi Indonesia; 2019.

National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy : 2015 Update. In: American Journal of Kidney Diseases. Minnepolis; 2015. p. 884–930.

Perhimpunan Nefrologi Indonesia. Konsensus Dialisis. 2003. 1–62 p.

Upadhyay A, Sosa MA, Jaber BL. Single-Use versus Reusable Dialyzers: The Known Unknowns. Clin J Am Soc Nephrol. 2007;2(April):1079–86.

Purnama YI, Kandarini Y, Sudhana W, Loekman JS, Widiana R, Suwitra K. Pemakaian Ulang Dialiser Tidak Berpengaruh Terhadap Nilai Urea Reduction Rate dan Kt/V pada Pasien Hemodialisis Kronik. Denpasar; 2015.

Vanholder R, Lameire N, Annemans L, Biesen W Van. Cost of renal replacement : how to help as many as possible while keeping expenses reasonable ? Nephrol Dial Transpl. 2016;(June 2015):1251–61.

Chandrashekar A, Ramakrishnan S, Rangarajan D. Survival analysis of patients on maintenance hemodialysis. Indian J Nephrol. 2014;24(4):206–13.

Twardowski ZJ. Dialyzer Reuse — Part II : Advantages and Disadvantages Dialyzer Reuse-Part II : Advantages and Disadvantages. Semin Dial. 2006;19(May-June):217–26.

Qureshi R, Dhrolia MF, Nasir K, Imtiaz S, Ahmad A. Renal Data from Asia-Africa Comparison of Total Direct Cost of Conventional Single Use and Mechanical Reuse of Dialyzers in Patients of End-stage Renal Disease on Maintenance Hemodialysis: A Single Center Study. Saudi J Kidney Dis Transpl [Internet]. 2016;27(4):774–80. Available from: http://www.sjkdt.org

Creese A, Parker D. Cost analysis in primary health care [Internet]. Geneva, Switzerland. 1994. 155 p. Available from: http://cdrwww.who.int/entity/immunization_financing/data/methods/en/caphc_creese.pdf

U.S. Departemen of Health & Human Services. Chronic Kidney Disease (CKD) Surveillance System [Internet]. 2019. Available from: https://nccd.cdc.gov/ckd/detail.aspx?Qnum=Q68&Strat=Year%2C+Gender#refreshPosition

Bawazir A, Aziza L, Bonar MM, Sianipar W, Luthariana L. The impact of reusable dialyzer membrane on end-stage renal disease patients’ Quality of life: A multicenter study in Jakarta, Indonesia. Saudi J Kidney Dis Transpl. 2019;30(6):1285–94.

Kementrian Kesehatan RI. Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehatan RI 2019 p. 1689–99.

Aggarwal HK, Jain D, Sahney A, Bansal T, Yadav RK, Kathuria KL. Effect of Dialyser Reuse on the Efficacy of Haemodialysis in Patients of Chronic Kidney Disease in Developing World. JIMSA [Internet]. 2012;25(2):81–3. Available from: https://www.researchgate.net/publication/271839557

Dewi NM, Suprapti B, Widianai I. Effect of Dialyzer Reuse upon Urea Reduction Ratio (URR), KT/V Urea and Serum Albumin in Regular Hemodialysis Patient. Indones J Pharm. 2015;26(3):166–70.

Edens C, Wong J, Lyman M, Rizzo K, Nguyen D, Blain M, et al. Hemodialyzer Reuse and Gram-Negative Bloodstream Infections. Am J Kidney Dis. 2016 Jun 1;69(6):726–33.

Hamid A, Dhrolia MF, Imtiaz S, Qureshi R, Ahmad A. Comparison of Adequacy of Dialysis between Single-use and Reused Hemodialyzers in Patients on Maintenance Hemodialysis. Jounal Coll Physicians Surg Pakistan. 2019;29(8):720–3.

Pratiwi IA, Herlina S. Relationship Between Reuse Dialyzer With Adequacy of the Dialysis in Hemodialysis Patients at RSUD Pasar Minggu South of Jakarta. In: Advance in Health Sciences Research. 2020. p. 54–9.

Adas H, Al-Ramahi R, Jaradat N, Badran R. Assessment of adequacy of hemodialysis dose at a Palestinian hospital. Saudi J Kidney Dis Transpl. 2014;25(2):438–42.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults: Report from The Panel Members Appointed to The Eighth Joint National Committee (JNC 8). Vol. 311, JAMA - Journal of the American Medical Association. American Medical Association; 2014. p. 507–20.

Somji SS, Ruggajo P, Moledina S. Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania. Int J Nephrol. 2020;2020.

Arbor Research Collaborative for Health. DOPPS Practice Monitor [Internet]. 2021. Available from: https://www.dopps.org/DPM/DPMSlideBrowser.aspx

Fatati A. Korelasi antara Tinggi Badan dan Panjang Jari Tangan. Dep Antropol Fak Ilmu Sos dan Ilmu Polit. 2013;40–4.

Kashem A, Chowdhury D, Dutta PK, Khan M, Hussein A. Dialyzer reuse and its logical practice. Bangladesh Ren J. 2003;22(1):9–12.

Armelia L. Efektifitas pemakaian ulang ginjal buatan The effectiveness of dialyzer reuse. 2015; Available from: file:///C:/Users/Hp/Downloads/238-452-1-SM.pdf

Dewi IGAPA, Malawat KY, Hariyati TS. Hubungan antara QB dengan Adekuasi Hemodialisis pada Pasien yang Menjalani Terapi Hemodialisis di Ruang HD BRSU Daerah Tabanan Bali. Universitas Indonesia. 2010.

Hou X, Zhang D, Zhang P, Hu Z. Study on the Reusing of Dialyzer. Int J Sci. 2016;3(9):27–32.

Cheung AK, Agodoa L, Daugirdas J, Depner T, Levin N, Leypoldt J, et al. Effects of Hemodialyzer Reuse on Clearances of Urea and β2-Microglobulin [Internet]. 1999. Available from: https://www.researchgate.net/publication/279371979

Perhimpunan Nefrologi Indonesia. Surat Pemakaian Dialiser Ulang nomor 310/PB PERNEFRI/X/2016. Jakarta: Perhimpunan Nefrologi Indonesia; 2016. p. 1.

Barzegar H, Moosazadeh M, Jafari H, Esmaeili R. Evaluation of dialysis adequacy in hemodialysis patients: A systematic review. Urol J. 2016;13(4):2744–9.

Movahed SM, Tahereh KM, Ahmad KM, Masoumeh D. Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006. 2007;

Chou JA, Kalantar-Zadeh K. Volume Balance and Intradialytic Ultrafiltration Rate in the Hemodialysis Patient. Curr Heart Fail Rep. 2017;14(5):421–7.

Saran R, Bragg-Gresham JL, Port FK, Gillespie B. Response to ’Longer treatment time and slower ultrafiltration in hemodialysis: Associations with mortality in the Dialysis Outcomes and Practice Patterns Study [2]. Kidney Int [Internet]. 2006;70(10):1877–8. Available from: http://dx.doi.org/10.1038/sj.ki.5001829

Flythe JE, Kimmel SE, Brunelli SM. Rapid Fluid Removal during Dialysis is Associated with Cardiovascular Morbidity and Mortality. Kidney Int [Internet]. 2011;79(2):250–7. Available from: http://dx.doi.org/10.1038/ki.2010.383

Agar JWM. Personal viewpoint: Limiting maximum ultrafiltration rate as a potential new measure of dialysis adequacy. Hemodial Int. 2016;20(1):15–21.

Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4(12):1925–31.

Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: Determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914–20.

Eldehni MT, McIntyre CW. Are there Neurological Consequences of Recurrent Intradialytic Hypotension? Semin Dial [Internet]. 2012;25(3):253–6. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1525-139X.2012.01057.x

McIntyre CW, Harrison LEA, Eldehni MT, Jefferies HJ, Szeto CC, John SG, et al. Circulating endotoxemia: A novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(1):133–41.

Jefferies HJ, Crowley LE, Harrison LEA, Szeto CC, Li PKT, Schiller B, et al. Circulating endotoxaemia and frequent haemodialysis schedules. Nephron - Clin Pract [Internet]. 2014;128(1–2):141–6. Available from: https://www.karger.com/Article/Abstract/366519

Marants R, Grant C, Lee T, McIntyre C. Renal Perfusion Falls during Hemodialysis: An Explanation for the Loss of Residual Renal Function in Dialysis Patients. J Am Soc Nephrol. 2016;27(Supplement):327A.

Chuang FR, Lee CH, Chang HW, Lee CN, Chen TC, Chuang CH, et al. A quality and Cost-benefit Analysis of Dialyzer Reuse in Hemodialysis Patients. Ren Fail. 2009;30(5):521–6.

Upadhyay A, Jaber BL. Reuse and Biocompatibility of Hemodialysis Membranes : Clinically Relevant ? Semin Dial. 2017;30(2):121–4.

Surendra NK, Manaf MRA, Seong HL, Bavanandan S, Nor FSM, Khan SSF, et al. The Cost of Dialysis in Malaysia: Haemodialysis and Continuous Ambulatory Peritoneal Dialysis. Malaysian J Public Heal Med. 2018;18(2):70–81.

Djamhari, Eka Afrina dkk. Defisit Jaminan Kesehatan Nasional ( JKN ): Mengapa dan Bagaimana Mengatasinya ? [Internet]. Cetakan 1. 2020. 67–68 p. Available from: https://repository.theprakarsa.org/media/302060-defisit-jaminan-kesehatan-nasional-jkn-m-4c0ac9c6.pdf

Kaur G, Prinja S, Ramachandran R, Malhotra P, Gupta KL, Jha V. Cost of Hemodialysis in a Public Sector Tertiary Hospital of India. Clin Kidney J. 2018;11(5):726–33.

DOI: https://doi.org/10.22146/ahj.v3i2.66612