Healthy Kidneys Help Maintain Balance

When your kidneys are healthy, they work 24/7 to balance fluid and salt in the body and remove toxins.

When your kidneys aren’t working properly, dialysis is used to try to achieve balance by imitating the fluid and toxin removal functions of healthy kidneys. But for many kidney patients, treating three times per week may not be enough dialysis, and this can hurt their heart.

Even a hemodialysis patient who follows their diet restrictions and limits fluid intake can build up an average of three extra liters of fluid in the two-day skip with standard in-center treatments, which has a direct impact on heart health.¹

For example, hemodialysis patients who treat three times per week are more likely to experience abnormal heart rhythms during their first treatment of the week, when the total fluid in their body is typically at its highest.²

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. Kjellstrand CM. Ing T. Daily hemodialysis history and revival of a superior dialysis method. ASAIO J. 1998;44(3): 117-122
2. Roy-Chaudhury, P, et al. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Int. 2018:93:941- 951.
3. Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26(8):2656-2663. doi:10.1093/ndt/gfq763.
4. Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250-257. doi:10.1038/ki.2010.383.
5. Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R, Daily Hemodialysis Study Group London Health Sciences Centre. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. CJASN. 2006;1(5):952-959.
6. Foley, R. N., Gilbertson, D. T., Murray, T., Collins, A. J. Long interdialytic interval and mortality among patients receiving hemodialysis. NEJM. 2011;365(12):1099-1107.
7. Fotheringham, J., Smith, M.T., Froissart, M. et al. Hospitalization and mortality following non-attendance for hemodialysis according to dialysis day of the week: a European cohort study. BMC Nephrol 21, 218 (2020). https://doi. org/10.1186/s12882-020-01874-x.
8. The FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
9. Rocco MV, Lockridge RS, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80(10):1080-1091.
10. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386-401.
11. Weinhandl, E.D., Liu, J., Gilbertson, D.T., Arneson, T.J., Collins, A.J. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23:895–904.
12. 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.
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14. Heidenheim AP, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(1 Suppl):36-41. doi:10.1016/s0272-6386(03)00536-5.
15. Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015:66(1 Suppl 1):Svii, 51 -305. doi: 10.1053/j.ajkd.2015.05.001.
16. London GM. Pannier B, Guerin AP. et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12(12):2759-2767
17. Cheung AK. Sarnak MJ, Yan GF, Berkoben M, Heyka R, Kaufman A, et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int. 2004:65(6): 2380-2389.
18. 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. 20 15:65(1):98-108.

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