National Surveillance of Dialysis Associated Diseases in the United States, 1991

To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention in collaboration with the Health Care Financing Administration performed a mail survey of chronic hemodialysis centers in the United States in 1991. Of 2,123 centers surveyed, 2,046 (96%), representing 155,877 patients and 40,298 staff members, responded. The 1991 survey found that certain hemodialysis practices are increasing in frequency, including use of bicarbonate dialysate and highflux dialysis and reuse of disposable dialyzers (in 1991,71% of centers reused dialyzers). Hepatitis B surface antigen (HBsAg) was present at low frequency in patients (incidence=0.2%, prevalence=1.3%) and staff (incidence=0.04%, prevalence=0.3%). Among centers that had ≥ HBsAg positive patient, the incidence of hepatitis B virus (HBV) infection was lower in those centers that used a separate room for dialysis of HBsAg positive patients. Reuse of dialyzers, bloodlines, transducer filters, or dialyzer caps was not associated with an increased risk of acquiring HBV infection among either patients or staff. Antibody to HBsAg was present in 2 1% of patients and 53% of staff, and was significantly related to levels of hepatitis B vaccine coverage. Pyrogenic reactions in the absence of septicemia were reported by 20% of centers and associated with the reuse of dialyzers. Human immunodeficiency virus (HIV) was known to be present in 1.2% of patients; 29% of centers reported providing hemodialysis to one or more HIV infected patients.