Development of a novel biocompatible cleaning approach to improve reusability of the hemodialyzer

Abstract

In Bangladesh, the high cost of hemodialysis limits treatment access for many patients with end-stage kidney disease (ESKD), which affects up to 22% of the population. Although single-use dialyzers are intended for one-time application, they are often reused up to three times in dialysis centers around Bangladesh to reduce expenses. However, these reused dialyzers are typically cleaned using protocols designed for reusable models, without validation of their safety or performance. This practice raises concerns about dialysis efficacy and patient outcomes. This study aimed to develop an effective dedicated regeneration method for single-use dialyzers, with the goal of extending their usability for at least five dialysis sessions. Eighteen cleaning protocols were evaluated by varying chemical compositions and mechanical flow parameters. Dialyzer performance was assessed based on solute clearance, ultrafiltration capacity, membrane integrity, and albumin retention. Two methods successfully regenerated thrice-used dialyzers. One used a two-step backwash with an alkaline solution followed by Hemocess, a medical-grade cleaning solution. The other applied a two-step backwash with diluted hydrogen peroxide followed by 50% diluted Hemocess. Both achieved over 90% clearance for low-molecular-weight solutes (urea, creatinine, uric acid) and over 75% for vitamin B-12, a middle-molecular-weight marker. Ultrafiltration coefficients remained above 70% of the original, and albumin retention exceeded 92%, surpassing even new dialyzers. Mechanical and SEM analyses confirmed structural integrity and acceptable pore morphology after cleaning. Among the two, hydrogen peroxide-based method offered additional advantages by using clinically approved reagents while reducing chemical consumption by 50%. It is therefore recommended as a cost-effective and safe reprocessing method to extend single-use dialyzer life up to five times, significantly lowering treatment costs and medical waste in resource limited regions.