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The reuse of dialyzers has been a concern of nephrobogists for almost two decades (1-3), since its development more than 35 years ago (4). Early, small studies, often but not universally based within one unit, suggested that reuse of dialyzers was safe, but that treatment and patient characteristics such as clearance, biocompatibility, and host responses had to be monitored (5-8). The potential harmful role of hemolysis (9) and the possibility that patients would develop maladaptive immune responses associated with reuse had been raised (10,1 1). Clinical concern was rather centered on the “first-use” phenomenon associated with the use of Cuprophan dialyzers: leukopenia, hypoxemia, and complement activation that were occasionally associated with severe hemodynamic instability and anaphylactic manifestations (12). Indeed, some studies suggested that the reuse of dialyzers might be advantageous (13), perhaps by diminishing the leukopenia associated with the initial phase of hemodiabytic treatment (14-17). As dialysis programs expanded and were included in nationab for-profit chains and fiscal efficiency was sought, reuse of diabyzers became increasingly economically attractive and a fiscal necessity. In 1996 only 19.5% of dialysis units did not reuse dialyzers, compared with 31.7% in 1989 (18). This trend has occurred pan passu with the advent of the widespread use of erythropoietin to treat the anemia of renal disease (19), the disappearance of acetate-based dialysate, the increased use of synthetic dialyzers, and a decrease in mortality in the U.S. ESRD program (20). More recently, evidence has accumulated suggesting that the use of synthetic dialyzers is associated with improved outcome in patients with ESRD treated with hemodialysis (21,22). The higher cost of these dialyzers, especially when used in innovative techniques such as double high-flux hemodiafiltration (23,24), has mandated reuse of dialyzers, given the level of fixed reimbursements for hemodialytic treatments in the United States. As the use of synthetic diabyzers has increased dramatically in the United States, so has the prevalence of reuse ( 18). Reuse patterns, tracked in the Dialysis Morbidity and Mortality Study, differ across the country ( I 8), and centers reusing have a higher proportion of patients treated with synthetic diabyzers, with higher serum albumin concentrations and a tendency to |