Treatment dependability at home in an age of instability

Joe Turk, President of Home and Critical Care Therapies at Fresenius Medical Care North America (FMCNA)

There is no question that the landscape for providing treatments to those with chronic illnesses has been drastically improving. The clinical advantages and dependability of home therapies is particularly evident in the case of patients who choose to receive life-sustaining dialysis treatment at home to manage kidney failure.

Proven solution

Research, government payment models, and new technology all indicate that home modalities are an important part of the future of dialysis therapy, with rates of adoption accelerating year over year.

Clinical evidence shows that the ability to individualize a patient’s prescription to optimize frequency and duration can have a significant impact on patient outcomes. In a collection of studies assessing greater than 10,000 patients across a dozen peer-reviewed publications, evidence demonstrates that more frequent home hemodialysis (HHD) leads to better outcomes as well as improved quality of life for patients.¹

On a national scale, the government has encouraged home dialysis adoption by enacting policies such as the Advancing American Kidney Health initiative², which aims to advance the number of ESRD patients receiving home dialysis and increase the number of kidneys available for transplant. Evolutions in these programs include new value-based payment models, including the ESRD Treatment Choices (ETC), which incentivizes home therapy from a policy level. Coupled with shifts by dialysis providers to educate and train internal teams on home dialysis, the industry has fully embraced this shift leading to record increases in home growth.

While efforts to prioritize technological advancements in home dialysis solutions from companies like Fresenius Medical Care North America (FMCNA) and NxStage predate these policies, subsequent inter-industry competition has organically prompted an innovation boom, inspiring development of the home dialysis modalities that we see today. FMCNA has been at the forefront of that evolution through efforts to prioritize a home-first approach to dialysis care, resulting in a staggering 37% growth in adoption of home hemodialysis for our patients in 2020.³

Care in all situations

For patients relying on life-sustaining treatment like HHD, care continuity is critical. An unanticipated crisis, natural disaster, or an unforeseen impact on treatment access can have serious consequences for a patient’s health. The function of filtering the blood and ridding the body of unwanted toxins and excess fluids with hemodialysis typically requires access to clean water to create dialysate. Should the water supply be compromised, by inclement weather or a routine water main break, a patient’s life could be at risk without proper preparedness or the proper machine. NxStage offers the only home hemodialysis system that creates ultrapure water from a home water source to make hemodialysis fluid as well as the option to use pre-mixed bagged dialysate so patients relying on the machine can continue their treatment even in the face of an unanticipated water crisis or inclement weather.

Beyond safety during a natural disaster, patients also want freedom and independence in their treatment choices. NxStage HHD machines provide a smart, simple solution with flexible treatment approaches including solo (without a care partner) and nocturnal dialysis options. Travel plans and social engagements are critical aspects of maintaining a balanced quality of life for patients and should not be sacrificed to maintain their physical health. A machine that is portable is essential, allowing patients to travel for vacation or work as desired.

While these technical elements are critical to providing sound care, the majority of patients do not have the luxury of time or training before they need to make a decision about their treatment options. Such anxieties around facing a new diagnosis and unfamiliar therapy regimens cannot be addressed by a machine alone. That is why the treatment success is equally defined by the myriad of patient education and training programs, reliable technology support, and connected health systems. Home patients must have confidence to manage on their own yet also have confidence in their support team. With better ways to stay connected with patients through systems like the Nx2me Connected Health platform, physicians can have confidence in prescribing this therapy. And if a machine has problems for any reason, it’s essential that a new machine arrives within a day.

Looking forward

As the technology of medical devices continues to evolve to meet the demands of an ever-changing treatment landscape, factors like security, flexibility, and reliability become increasingly crucial. We are dedicated to continued education, innovation, and advancements of strategies that will help accelerate the adoption of home dialysis and improve patient outcomes wherever you are.

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.Bonenkamp AA et al. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Med. Published online 2,2020. 2. Executive Office of the President. Advancing American Kidney Health. Executive Order 13879, July 2019. Retrieved from:  https://www.federalregister.gov/documents/2019/07/15/2019-15159/advancing-american-kidney-health. 3. NxStage Data On File, March 2021.

APM4258 Rev. A