National surveillance of dialysis-associated diseases in the United States, 1989.

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,867 chronic hemodialysis centers in the United States in 1989 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 92%. These 1,726 centers represented 122,734 patients and 32,486 staff members. The following results were found. 1) During the last 14 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.1% among patients, and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of hepatitis B surface antigen (HBsAg) positivity declined from 7.8 to 1.4% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 92% of the centers. By the end of 1989, 19% of susceptible patients and 55% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1989, as a result of receiving vaccine, the prevalence of antibody to HBsAg (anti-HBs) increased from 12 to 19% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1989 was reported to be 0.7% among patients and 0.1% among staff members. 2) Twenty-two percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients, and 51% reported septicemia. 3) The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 23%. 4) In 1989, 68% of centers reported that they reused disposable dialyzers; these centers treated 73% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 1 to 50 (mean, 12) and the maximum number of times a disposable dialyzer was ever reused ranged from 3 to 150 (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 reported more frequently in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was associated only with centers that used Renalin or glutaraldehyde for reprocessing (not formaldehyde) and occurred with both automated and manual reprocessing systems.(ABSTRACT TRUNCATED AT 400 WORDS)