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What is On-Site Home Hemodialysis?

On-Site Home Hemodialysis (HHD) is a growing care model involving partnerships between Skilled Nursing Facilities (SNFs) and dialysis providers to offer in-house treatments at the SNF for residents requiring dialysis.

Watch the videos below to learn more.

Learn how more frequent home hemodialysis has been associated with improved mortality rates for patients receiving treatments in a nursing home setting.¹

Submit the form to either download this clinical evidence brochure or have a NxStage representative contact you.

A Growing Opportunity

End-Stage Kidney Disease (ESKD) Patient Population in Nursing Homes

There are over 540,000 dialysis patients in the United States and approximately 17% of them utilized nursing home care annually.^2,3

Challenges with the current dialysis care model at Skilled Nursing Facilities have supported the growing movement towards a more patient-centric approach.

Clinical Challenges

On-Site HHD - A Care Model for Success

On-Site HHD offers SNF patients requiring dialysis the opportunity to receive treatments on-site at the SNF where they reside.

Effective Care Partnerships

Effective programs rely on strong partnerships between dialysis providers and SNFs. Below are some roles and responsibilities to consider.

Considerations for Implementing
a Program

With over 14,000 patients worldwide in the home environment,¹² the NxStage HHD system is the practical dialysis solution for the SNF environment.

Resource Center

Additional information on the benefits and considerations of Skilled Nursing Facility on-site home hemodialysis.

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.
Users and their care partners will be responsible for all aspects of their hemodialysis treatments from start to finish.
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.

Certain forms of home hemodialysis have additional risks.

If a doctor prescribes more frequent home hemodialysis, 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 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 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 users and their care partners 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.

References:

Yang A, Lee WY, Hocking K, Xelay Acumen, Inc., Affiliated Dialysis. Survival comparison of daily home hemodialysis vs conventional dialysis in the nursing home setting. Nephrology News & Issues. February 17 2015.
United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2023.
Chen S, Slowey M, Ashby VB, Barnes L, Pearson A, Kang J*, Messana JM* Nursing Home Status Adjustment for Standardized Mortality and Hospitalization in Dialysis Facility Reports. Kidney Med. 5(2):100580. Published online December 8, 2022. doi: 10.1016/ j.xkme.2022.100580
⁠FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24);2287-2300.
⁠Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and post dialysis recovery time; interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3);531-539.
Yang A, Lee A, Hocking K. Nursing home care. Daily HHD vs conventional dialysis: A survival comparison. Nephrol News Issues. 2017 Feb;31(2):21-26.
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;65(1):98-108.
Finkelstein FO, Schiller B, Daoul R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5);561-569.
Weinhandl ED, Liu J, Gilbertson DT, Ameson 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.dol:10.1681/ASN.2011080761.
Data on File. NxStage Medical, Inc. Health Advances Interviews. March 2020. Based on interviews with 9 facilities.
Data on file. NxStage Medical, Inc. Healthcare Advances Interviews. May 2013. Based on interviews with 5 facilities.
Data on File. NxStage Medical, Inc. September 2024.
In-center water calculations based on 500 mL/min DFR, 220 minute treatment, 109 L of dialysate per treatment, 3 treatments per week. This simulation uses a 3:1 ratio for RO systems
Home hemodialysis calculations based on 190 mL/min DFR, 30 L, 158 minute treatment, 30L of dialysate per treatment, 5 treatments per week. This simulation uses a 1:1 ratio for DI systems

APM3857 Rev. D

Clinical Challenges

Dialysis nursing home residents that receive traditional off-site in-center hemodialysis treatments may struggle with hemodynamic or cardiovascular instability associated with longer, conventional hemodialysis treatments.⁴

Conventional 3x/wk. dialysis in-center may keep residents away from their facility, resulting in missed meals, rehabilitation, and social activities.⁵

Economic Challenges

Residents being treated at a dialysis center will likely require round-trip transportation three times a week to their clinic. This can be stressful for them and costly for SNFs. Economic challenges to consider when managing dialysis residents include:

Average roundtrip cost of transportation
Hours spent scheduling, coordinating, and transporting

SNFs are looking for unique competitive differentiator services to potentially improve occupancy and referrals.

Operational Challenges

The complex care required by SNF dialysis residents can result in organizational, staffing, scheduling, and communication difficulties between the SNF and the dialysis clinic. When transportation is added to the equation, a three-way communication challenge presents itself, increasing the possibility for confusion, delays, and/or schedule changes. When a dialysis resident’s schedule is compromised, they may miss meals or scheduled medications, which is detrimental to their health and wellbeing.

Benefits of On-Site Home Hemodialysis (HHD)

Residents performing more frequent HHD on-site in a SNF have shown improvements in survival.⁶ In addition, more frequent hemodialysis in the general population is associated with:

Less risk of cardiovascular hospitalizations⁷
Improved post-dialysis recovery time⁵
More energy & vitality⁸
Reduced antihypertensive medications⁴
Improved survival⁹

A SNF On-Site HHD program allows a SNF the potential to increase referrals as well as decrease dialysis-related transportation expenses.^10,11

Effective Care Partnerships¹⁰

Effective on-site HHD programs rely on strong partnerships between dialysis providers and SNFs. Below are some roles and responsibilities to consider.

Skilled Nursing Facilities

Identify treatment space for dialysis
Cover expenses for basic utilities (water and electricity)
Determine dedicated secure areas for equipment, supplies, and medications
Cover labor costs for staff-assisted dialysis (care-giver fee)
Receive and handle supplies delivered by courier

Dialysis Providers

Oversight of the home dialysis program (Medical Director, Nurse Manager, etc.)
Manage dialysis equipment and supplies
Administer medications and labs associated with dialysis
Handle billing and reimbursement associated with dialysis treatments

Shared Responsibilities (between SNF and dialysis provider):

Policies and procedures – e.g. emergency planning, infection control
Coordinated patient care plans
Caregiver and staffing

Centers for Medicare & Medicaid Services (CMS) requires a formal coordination of care agreement between the SNF and the dialysis provider when ESKD patients are residents in the SNF.

Considerations for Implementing a Program

With over 14,000 HHD patients, worldwide in the home environment,¹² the NxStage HHD system is a practical dialysis therapy for the SNF environment.

NxStage provides individualized treatment options to meet the clinical needs of patients, which may translate to success maintaining rehabilitation, medication, meal, and activity schedules.

On-Site Home Hemodialysis With NxStage® For Skilled Nursing Facilities