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Transitional Dialysis Care


Designed to provide clinical stabilization and modality education for new-to-dialysis patients and patients in transition

What is Transitional Dialysis Care?

Innovative model designed to gently transition patients into the dialysis modality best suited to their individual clinical and lifestyle needs.

Easing patients into hemodialysis and educating them on their modality choices can help them make informed decisions, that meet their clinical and quality of life goals. Using existing center staff and infrastructure, transitional care provides the opportunity of expanding home hemodialysis (HHD), in-center hemodialysis (ICHD), and peritoneal dialysis (PD) programs.1

Transitional Dialysis Care is designed to allow patients time to:

  • Recover medically
  • Adjust emotionally
  • Receive thorough education about all their treatment options – including both dialysis and transplant
  • Choose the modality that best fits their unique clinical and lifestyle needs

Crashing Into Dialysis

Patients who end up on dialysis often do so in a rapid change or crash from disease progression, PD or transplant failures, or emergency hospital treatments.

These patients may experience a range of emotions from fear to anxiety and depression. The uncertainty of their health may make it difficult to receive treatment modality education and make long-term decisions about kidney replacement therapy.

Did You Know?

Many patients are not presented with all treatment options.2


According to a survey of new dialysis patients:

  • 66% weren’t presented the option of PD
  • 88% weren’t presented the option of HHD
  • 74% weren’t presented the option of transplantation

 

Clinical stabilization is critical to incident dialysis patients.

Incident (or new) hemodialysis patients have the highest mortality rate in the first 6 months of therapy.3

Mortality risk is 80% higher in the first two months.

 

Impact On Patient Modality Decisions

The below results suggest that the Transitional Dialysis Care model can be an effective strategy for increasing patient selection of home dialysis modalities with better overall clinical outcomes.1

A survey of 60 patients who graduated from one of 10 participating US Transitional Dialysis Units between October 2018 and April 2019 found that:1
  • 70% of patients selected a home modality upon completion
    • 25% chose HHD
    • 45% chose PD
  • Some of the top reasons that patients selected a home modality were:
    • Control over treatment and schedule compared to in-center
    • They received education about health outcomes
    • They wanted less time driving to/from a dialysis center, and wanted the ability to travel with their dialysis system

Contact Us For More Information

For more information on starting Transitional Dialysis Care in your center, complete the form below and a NxStage representative will contact you to discuss your goals and provide helpful resources.

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:

  1. Blankenship D, Usvyat L, Kraus M, Chatoth D, Lasky R, Turk J, Maddux F. Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score-matched analysis. Hemodialysis International. 2023;27:165-173.
  2. Mehrota R, Marsh D, Vonesh E, Peters V, Nissenson A. Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kid Int. 2005;68(1): 378-90.
  3. Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Patterns and predictors of early mortality in incident hemodialysis patients: new insights. Am J Nephrol. 2012;35(6):548-558.

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