Clinicians and patients alike recognize the limitations of traditional, three times per week, in-center therapy. Home and more frequent therapies offer many potential benefits, including the promise of a more normal lifestyle. Making daily and home therapies a practical reality, however, demands a new approach to renal care. NxStage is leading the way.

The Chronic Renal Care Challenge

Chronic renal failure, or end stage renal disease (ESRD), impacts more than 1.7 million patients worldwide —including 485,000 in the U.S. (in 2005)1—a number growing by 4% annually2. Annual care costs in the U.S. approach $70,000 per patient, for a total cost of care exceeding $30 billion in the U.S. alone3. Yet the dialysis treatment itself represents less than 1/3 of this cost.

Chronic patients are currently treated with one of three standard therapy options:

• Transplant – A minority (less than 30% and shrinking) receives kidney transplants.
• Hemodialysis – Approximately 90% of patients not treated with a transplant receive therapy performed in dialysis clinics three times weekly.
• Peritoneal dialysis – Nearly all other renal patients – approximately 9% of those not treated with a transplant – have peritoneal dialysis administered daily in the patient's home.

The status quo for chronic renal care has reached a critical juncture:

• ESRD patient mortality in the U.S. is not improving.
• Recent randomized trials suggest modifications to traditional in-center hemodialysis4 and home peritoneal dialysis5 therapies are unlikely to lead to improved outcomes.
• Costs continue to rise, yet reimbursement has changed little over 30 years.
• Nursing shortages have led to understaffed, overcrowded clinics that are beginning to turn patients away6,7.
• Patient numbers could potentially double over the next 10-15 years.

The Promise of Daily and Home Therapies

There is hope. In recent years, hundreds of peer-reviewed articles have reported on the clinical and quality of life benefits experienced by patients on more frequent and/or home therapies—whether in a short or long daily format. The majority of studies on which these articles were based were conducted before NxStage's products were available, but the literature strongly supports the meaningful benefits associated with more frequent and home therapies.

As shown in the chart below, numerous clinical benefits have been attributed to daily, or more frequent, hemodialysis. In addition to these relative benefits, home therapy also reduces reliance on healthcare providers’ staff and overhead, directly addressing existing resource challenges.

Relative Patient Benefits of Daily Therapy

SOURCE: Review of 89 original publications. References provided on request.

Key:
+ Moderate Benefit
++ Strong Benefit
+++ Very Strong Benefit

Despite the evidence of these benefits, less than 1% of ESRD patients receive hemodialysis at home, and even fewer receive home daily therapy. 8 This is due in part to conventional equipment design, which is optimized for in-center use by professional staff. Its bulk, complexity and infrastructure requirements limit its effectiveness for home daily therapy. Many believe the use of home therapies could increase by a substantial amount with the right technology and incentives.9,10,11

The NxStage Approach to Chronic Renal Care

At NxStage, we are working to realize the promise of daily home therapy. Our approach to renal therapy represents a departure from the status quo—one that offers the simplicity, portability, and flexibility that can make home daily hemodialysis more accessible to patients.

Patients should not treat themselves alone. Home therapies should be administered with the help of a trained partner.