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Home Hemodialysis

Individualized Therapies to Meet the Changing Needs of Patients With Kidney Disease

When patients feel better, they live better.

Help your patients get their lives back.

Home hemodialysis (HHD) offers clinicians an opportunity to provide treatments that are uniquely tailored to the individual needs of each patient, taking into consideration their specific clinical and lifestyle needs.

Studies suggest an association between more frequent HHD and improved clinical outcomes and quality of life in patients with end-stage kidney disease (ESKD). 1-3

Considerations to Treat the Person, Not Just the Disease

Clinical Outcomes

Frequency matters.
More frequent hemodialysis has been shown to be associated with improved cardiovascular outcomes and survival compared to patients treating 3 days per week.1-4

Read More

Health-related Quality of Life

Understand. Overcome. Thrive.
Performing more frequent hemodialysis treatments at home may improve your patients’ quality of life.3,8

Read More

Patient-centered Care

Dialysis is a family matter.
ESKD significantly impacts your patients' lives, not just their physical health.

Read More

Individualized Home Hemodialysis Treatment Options

Examples of Thriving HHD Patients and Their Prescriptions

Dialysis is a journey.

ESKD patients often experience multiple treatment modalities over the course of their disease, which is why it is important to monitor for signs that their current therapy is no longer meeting their clinical and lifestyle needs.

Actual patients not pictured. Patient profiles represent actual home hemodialysis patients. The reported benefits of home hemodialysis may not be experienced by all patients and their outcomes. All forms of hemodialysis involve some risks. See full risks and responsibilities below.

Featured Message

Cardiovascular Decline

74yo Taiwanese female. Experiencing cognitive decline and recurrent heart failure. Not happy with quality of life (QoL) and declining. Does not speak English, but their care partner does.

Prior Therapies / Symptoms    

  • Left Ventricular Hypertrophy (LVH)
  • Frequent symptomatic episodes of severe intradialytic hypotension requiring intravenous fluids and discontinuing ultrafiltration
  • Pre-dialysis BP frequently >200/110
  • Post-dialysis hypotension


Sample prescription

  • Initiated HHD @ 6x/week for 2 hrs/tx 
    • 15L of dialysate per treatment
  • Transitioned to 5x/week for 2.5 hrs/tx to decrease burden of therapy 
    • 20L of dialysate per treatment


Outcomes

  • Normotensive BP
  • No LVH
  • No depressive symptoms
  • Traveled to Taiwan twice

 

Patient has since passed due to causes
unrelated to dialysis.

Featured Message

PD No Longer Adequate

37yo African American male. Crashed into dialysis with CKD5, presumed from hypertension.
  

Prior Therapies / Symptoms

  • Initially prescribed in-center HD with tunneled dialysis catheter
  • Cardiac ischemia and hypotensive during dialysis
  • Severe post HD fatigue
  • Poor BP control
  • Unable to work
  • Noncompliant
  • Transitioned to Peritoneal Dialysis (PD)
  • 3.5 years after initiating PD, residual kidney function (RKF) abruptly declined
  • 2 peritonitis episodes within 6 months


Sample prescription

  • Initiated HHD @ 5x/week 
    • 30L of dialysate per treatment
  • Transitioned to solo HHD due to loss of care partner


Outcomes

  • Weight increased from 89kg to 98kg
  • Improved activity, sleep, anorexia, and cognitive function
Featured Message

Unhappy With In-center HD Outcomes

43yo white male with medullary cystic kidney disease.
  

Prior Therapies / Symptoms

  • Started ICHD in 1997
  • LVH
  • Intermittent atrial fibrillation (AFib)
  • Severe restless leg syndrome (RLS)
  • Post-dialysis fatigue
  • Reduced muscle mass
  • Severe hypertension controlled with 4 medications
  • Forced into retirement
  • Kidney matched, but clotted venous returns and pulmonary emboli
  • Transplant not placed, but inferior vena cava (IVC) filter was


Sample prescription

  • Initiated nocturnal HHD 5x/week for 8 hrs/tx 
    • 30L of dialysate per treatment


Outcomes

  • AFib resolved
  • No edema or fluid overload
  • No LVH
  • BP controlled without medication
  • Activity remarkably improved and travels as desired
     
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Individualize Your Patients’ Prescriptions to Meet Their Unique Clinical Needs

To support dialysis patient care teams in providing individualized prescriptions for their patients, NxStage has compiled a set of educational dosing resources, including:

3-Step Process for Patient-Centered HHD Prescriptions

Includes clinical considerations for determining frequency, treatment time and dialysate volume when prescribing HHD.

Nxstage Dosing Calculator

Helps evaluate therapy options for new HHD patients and adjust prescriptions for current HHD patients as their needs change.
 

Downloadable Resources

Training videos, webinars and quick reference guides to help educate both HHD care teams and patients.
 

Struggling to manage patients as they transition to hemodialysis?

Learn about how transitional dialysis care can ease patients into dialysis, while educating them on their modality choices.

Learn About Transitional Dialysis Care

Working With Patients to Overcome Barriers to Better Outcomes

Whether it is a fear of needles or lack of a care partner, a patient’s care team plays a key role in helping each patient to overcome the barriers to getting the best possible treatment.

Dialysis is a journey and can involve multiple treatment modalities. Regular communication and education about appropriate treatment options is important. Proactively working with patients and educating them on potential future modalities, including more frequent HHD, may help support successful transitions and improved outcomes.

Download the “Open Connection” guide to learn about starting the home hemodialysis conversation before, during, and after training.

Home Hemodialysis with NxStage

A Practical Option for More Frequent Therapy

NxStage home hemodialysis products are designed to provide patients with simple, practical options for treatment at home.

NxStage HHD Products

From hemodialysis machines to cartridges, fluids, and a telehealth platform, NxStage's products provide healthcare professionals with complete HHD solutions.

A&G Fresenius July 2020


Versi®HD with GuideMe Software
  • Designed to enhance ease of use with a simple interface
  • Portable, dialyze when and where you want
  • 24/7 technical support
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PureFlow™ SL
  • On-site dialysate mixing
  • Simple plumbing connections


 

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Cartridge
  • Simple drop-in cartridge
  • Easy wipe-down disinfection
  • Disposable

 

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Nx2me Connected Health®
  • Automated flowsheets
  • Treatment data display
  • Context sensitive help

 

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Resources

NxStage is dedicated to supporting healthcare professionals

Tools

NxStage offers healthcare professionals a variety of tools to help with everything from patient selection to prescribing and training.

NxSTEPS2
Interactive Training Program

Dosing Calculator
Online Prescription Assistance

NxRx
Online prescription and ordering system

NxDocuments
Training and resource library

Training & Education

Supporting healthcare professionals with educational resources from NxStage and third parties, including in-person and online training.

Clinical Evidence

To get an understanding of how our products and therapies can help in your practice, take time to review our clinical evidence library. Our clinical evidence pieces include posters, presentations, and clinical summaries.

Download a copy of the Vascular Access Checklist for Catheter

Download a copy of the Vascular Access Checklist for Fistula/Graft

This video, presented by Dr. Allan Collins, Director of Chronic Disease Research Group (CDRG) and Professor of Medicine at the University of Minnesota, reviews the clinical outcomes of home hemodialysis as compared to other dialysis modalities and the potential barriers of prescribing home hemodialysis.
 

Risks and Responsibilities

The reported benefits of home hemodialysis (HHD) may not be experienced by all patients.

The NxStage System is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set.

Home hemodialysis with the NxStage System during waking hours may not require a care partner, provided a physician and a qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are required to have a care partner. Care partners are trained on proper operation and how to get medical or technical help if needed.

Certain risks associated with hemodialysis treatment are increased when performing solo HHD because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo HHD, they may lose consciousness or become physically unable to correct the health emergency. Losing consciousness or otherwise becoming impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo HHD.

Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow and/or increased treatment time, and delayed response to alarms when waking from sleep.

Patients should consult their doctor to understand the risks and responsibilities of performing these therapies using the NxStage System.

 

APM2146 Rev. B


Customer Service and Technical Support

24/7 technical support for patients and healthcare professionals
24-hour system swap
Dedicated customer service for inventory management
Nxpeditions patient travel support and delivery program

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Risks and Responsibilities

Patients should review the following information carefully and discuss it with their doctors to decide whether home hemodialysis with NxStage systems is right for them.

 

Users should weigh the risks and benefits of performing home hemodialysis with NxStage systems.

  • Medical staff will not be present to respond to health emergencies that might happen during home treatments, including, among other things, dizziness, nausea, low blood pressure, and fluid or blood leaks.  
  • Users may not experience the reported benefits of home, more frequent, or nocturnal hemodialysis with the NxStage systems.
  • The NxStage systems require a prescription for use.   

Users will be responsible for all aspects of their hemodialysis treatment from start to finish.

  • Medical staff will not be present to perform home treatments.  Users will be responsible for, among other things, equipment setup, needle insertions, responding to and resolving system alarms, system tear-down after treatment, monitoring blood pressure, ensuring proper aseptic technique is followed, and following all the training material and instructions that nurses provide.

Users will need additional resources to perform home hemodialysis.

  • Users will need a trained care partner to be present during your treatment at home (unless their doctor prescribes “solo/independent” home hemodialysis, described below).
  • Users must have a clean and safe environment for their home treatments.
  • Users will need space in their home for boxes of supplies necessary to perform home hemodialysis with NxStage systems.

Certain forms of home hemodialysis have additional risks.

  • If a doctor prescribes home hemodialysis more than 3 times a week, vascular access is exposed to more frequent use which may lead to access related complications, including infection of the site.  Doctors should evaluate the medical necessity of more frequent treatments and discuss the risks and benefits of more frequent therapy with users.
  • If a doctor prescribes “solo/independent” home hemodialysis without a care partner during waking hours, risks of significant injury or death increase because no one is present to help users respond to health emergencies.  If users experience needles coming out, blood loss, or very low blood pressure during solo/independent home hemodialysis, they may lose consciousness or become physically unable to correct the health emergency. Users will need additional ancillary devices and training to perform solo/independent home hemodialysis.
  • If a doctor prescribes “nocturnal” home hemodialysis at night while the user and a care partner are sleeping, risks increase due to the length of treatment time and because therapy is performed while the user and a care partner are sleeping. These risks include, among other things, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep. A doctor may need to adjust users’ medications for nocturnal home hemodialysis, including, among other things, iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.

References

  1. Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients. Am J Kidney Dis. 2015 Jan;65(1):98–108.
  2. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5):895–904.
  3. Miller BW, Himmele R, Sawin DA, Kim J, Kossmann RJ. Choosing Home Hemodialysis: A Critical Review of Patient Outcomes. Blood Purif. 2018;45(1–3):224–9.
  4. FHN Trial Group. In-Center Hemodialysis Six Times per Week versus Three Times per Week. N Engl J Med. 2010 Dec 9;363(24):2287–300.
  5. Kotanko P, Garg AX, Depner T, Pierratos A, Chan CT, Levin NW, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386–401.
  6. U.S. Renal Data System, USRDS Annual Data Report, vol 2, Table 6.3. 2015.
  7. U.S. Renal Data System, USRDS Annual Data Report, vol 2, Table 6.3.; 2015 & Matched NxStage patient data on file.
  8. Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: benefits and barriers. Nat Rev Nephrol. 2012 Sep 24;8(9):515–22.
  9. Jaber BL, Lee Y, Collins AJ, Hull AR, Kraus MA, McCarthy J, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: Interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531–9.
  10. Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis. 2003;42(1 SUPPL. 1):30–5.
  11. Masterson R, The advantages and disadvantages of home hemodialysis. Hemodial Int. 2008 Jul 8;12(s1):16–20.
  12. Finkelstein FO, Schiller B, Daoui R, Gehr TW, Kraus MA, Lea J, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5):561–9.
  13. Heidenheim AP, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(1 SUPPL. 1):36–41.
  14. Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-Term Study of High-Comorbidity ESRD Patients Converted From Conventional to Short Daily Hemodialysis. Am J Kidney Dis. 2003;42(5):1020–35.
  15. Jaber BL, Schiller B, Burkart JM, Daoui R, Kraus MA, Lee Y, et al. Impact of Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances. Clin J Am Soc Nephrol. 2011 May;6(5):1049–56.
  16. Lee A, Gudex C, Povlsen J V., Bonnevie B, Nielsen CP. Patients’ views regarding choice of dialysis modality. Nephrol Dial Transplant. 2008;23(12):3953–9.
  17. Culleton B, Walsh M, Quinn R, Donnelly S, Friedrich M, Kumar  a. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis. J Am Med Assoc. 2007;298(11):1291–9.
  18. Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, Pierratos A, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24(9):2915–9.
  19. Rocco M V., Lockridge RS, Beck GJ, Eggers PW, Gassman JJ, Greene T, et al. The effects of frequent nocturnal home hemodialysis: The Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80(10):1080–91.
  20. Raj DSC, Ouwendyk M, Francoeur R, Pierratos A. Β2-Microglobulin Kinetics in Nocturnal Haemodialysis. Nephrol Dial Transplant. 2000;15(1):58–64.
  21. NxStage data on file. NxStage patient survey with 330 respondents conducted in March 2016. 

APM2076 Rev. F

Clinical Outcomes

Frequency matters

If hemodialysis patients currently treating three days per week are experiencing large fluid gains, impaired cardiovascular function, hemodynamic instability, or are otherwise not tolerating their current therapy, they may want to consider more frequent hemodialysis.

More frequent home hemodialysis is associated with:

Significant Cardiovascular Benefits:
  • 12% reduction in left ventricular mass4
  • 20% fewer hypotensive episodes4
  • 7% decrease in systolic blood pressure4
  • 36% less antihypertensives consumed5
  • 11% fewer cardiovascular-related hospitalizations.1
Improved 5-Year Survival:
  • In-center HD – 40%6
  • Peritoneal Dialysis – 50%6
  • More Frequent HHD – 58%7

Health-related Quality of Life

Understand. Overcome. Thrive.

Performing more frequent hemodialysis treatments at home may improve your patients’ quality of life in addition to providing clinical benefits.

HHD patients who treat more frequently report:

  • 87% improved post-dialysis recovery time9
  • Improved appetite10
  • Fewer fluid and diet restrictions11
  • More energy and vitality12-14
  • Improved sleep15
  • Reduction in the incidence and severity of Restless Legs Syndrome15
  • Fewer depressive symptoms9
  • Improved ability to work or attend school11,16

Patient-centered Care

What matters to the patient

ESKD has a significant impact on patients’ entire lives, not just their physical health. That is why it is important to consider a patient’s individual lifestyle needs when discussing home hemodialysis as a potential therapy option, including:

  • Need to work/travel11,16
    • Performing more frequent home hemodialysis may enable you to keep working or go back to work.11,16
  • Care partner status
  • Therapy compliance
  • SNF residence

More Frequent Home Hemodialysis

Home hemodialysis allows clinicians to individualize prescriptions to meet each patient’s unique clinical and lifestyle needs, including: treating during the day, with or without a care partner, nocturnally, while both the patient and care partner sleep, or in the skilled nursing facility where the patient resides.

By educating ESKD patients about all treatment modalities and therapy options available, clinicians can provide individualized care that may improve clinical outcomes for the growing number of dialysis patients today.

Nocturnal Home Hemodialysis

Home nocturnal hemodialysis is performed overnight while the patient and care partner are sleeping. It is a longer treatment that is associated with improved left ventricular mass, a lower need for blood pressure medications, and reduced phosphate levels, even with reduced phosphate binder dose, compared to standard three-times weekly dialysis.17

Nocturnal hemodialysis is associated with improved quality of life and patient outcomes — including improved survival.13 Performing nocturnal hemodialysis has shown similar 5-year survival as deceased donor transplantation.18

Treating with nocturnal HHD may provide significantly improved phosphorus and ß2-m clearance.19,20

In addition, patients that dialyze at night while they are sleeping are able to have more time during the day potentially to work, for childcare, and travel. Nocturnal HHD may also relieve scheduling concerns for care partners.

Solo Home Hemodialysis

Historically, home hemodialysis has only been available to patients with a trained care partner. This has prevented some patients from being able to experience more frequent HHD treatments. NxStage hemodialysis cyclers received an added indication for solo HHD during waking hours in August 2017.

This represented, and remains a big win for patients, enabling more hemodialysis patients to experience hemodialysis treatments at home. It also provides an opportunity for greater control, ownership of self-care, increased independence, and flexibility in treatment scheduling.

The solo HHD clearance was supported by a patient preference study, which provided the following findings:21

  • 61% of HHD patients would choose solo HHD over in-center HD
  • More than 15% of HHD patients are already safely performing their treatments without a care partner
  • Of the 85% of patients that perform HHD with a care partner, 16% dialyze solo at least part of the time

On-Site HHD at Skilled Nursing Facilities

On-site home hemodialysis is a growing practice in which dialysis providers and Skilled Nursing Facilities (SNF) are partnering to offer SNF patients requiring dialysis with on-site treatments in the SNF where they reside.
 

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