When patients feel better, they live better.

Help your patients get their lives back.

Home hemodialysis (HHD) offers clinicians an opportunity to provide treatments that are uniquely tailored to the individual needs of each patient, taking into consideration their specific clinical and lifestyle needs.

A growing body of evidence supports prescribing more frequent home hemodialysis to improve the overall patient outcomes of the growing end-stage renal disease (ESRD) patient population, without the constraints of conventional in-center hemodialysis.

Considerations to Treat the Person, Not Just the Disease

Frequency and duration matter.
More frequent hemodialysis has been shown to significantly improve cardiovascular outcomes and survival compared to patients treating 3 days per week.1,2
Understand. Overcome. Thrive.

Performing more frequent hemodialysis treatments at home may improve your 
patients’ quality of life.3
Dialysis is a family matter.
ESRD significantly impacts your patients' lives, not just their physical health.

Individualized Home Hemodialysis Treatment Options

Examples of Thriving HHD Patients and Their Prescriptions

Dialysis is a journey for patients.

ESRD patients typically experience multiple modalities over the course of their disease, which is why it is important to monitor patients for signs that their current therapy is no longer meeting their clinical and lifestyle needs.

Actual patients not pictured. Patient profiles created from composite data of current NxStage patients.

Cardiovascular Decline
74yo Taiwanese female. Experiencing cognitive decline and Recurrent Heart Failure. Not happy with QoL and declining. Patient does not speak English, but their care partner does.
Prior Therapies / Symptoms
  • Frequent symptomatic episodes of severe intradialytic hypotension requiring IVF and d/c UF
  • Pre-dialysis BP frequently >200/110
  • Post-dialysis hypotension
Sample prescription
  • Initiated HHD @ 6x/week for 2 hrs/tx
  • 15L of dialysate per treatment
  • Transitioned to 5x/week for 2.5 hrs/tx to decrease burden of therapy
  • 20L of dialysate per treatment
Outcomes
  • Normotensive BP
  • No left ventricular hypertrophy
  • No depressive symptoms
  • Traveled to Taiwan twice
PD No Longer Adequate
37yo African American male. Crashed into dialysis with CKD5, presumed from hypertension.
Prior Therapies / Symptoms
  • Initially prescribed in-center HD with tunneled dialysis catheter
  • Cardiac ischemia and hypotensive during dialysis
  • Severe post HD fatigue
  • Poor BP control
  • Unable to work
  • Noncompliant
  • Transitioned to PD
  • 3.5 years after initiating PD, RRF abruptly declined
  • 2 peritonitis episodes within 6 months
Sample prescription
  • Initiated HHD @ 5x/week
  • 30L of dialysate per treatment
  • Transitioned to solo HHD due to loss of care partner
Outcomes
  • Afib resolved
  • Weight increased from 89kg to 98kg
  • Improved activity, sleep, anorexia, and cognitive function
Unhappy With In-center HD Outcomes
43yo white male with medullary cystic kidney disease.
Prior Therapies / Symptoms
  • Started ICHD in 1997
  • Left Ventricular Hypertrophy (LVH)
  • Intermittent AFib
  • Severe RLS
  • Post-dialysis fatigue
  • Reduced muscle mass
  • Severe hypertension controlled with 4 medications
  • Forced into retirement
  • Kidney matched, but clotted venous returns and pulmonary emboli
  • Transplant not placed, but IVC filter was
Sample prescription
  • Initiated nocturnal HHD 5x/week for 8hrs/tx
  • 30L of dialysate per treatment
Outcomes
  • No edema or fluid overload
  • No LVH
  • BP controlled without medication
  • Activity remarkably improved and travels as desired

Individualize Your Patients’ Prescriptions to Meet Their Unique Clinical Needs

Frequency

Studies of patients prescribed 5-6 treatments per week reported improvements in clinical outcomes and health-related quality of life.3,4

Ultrafiltration Rate

Evidence has shown that higher ultrafiltration rates are associated with higher risk of death.5,6

The mean ultrafiltration rates for more frequent HHD are 6-7mL/kg/hr during the day and 2-3mL/kg/hr for nocturnal treatments.

Dialysate Volume

For patients prescribed 5 treatments per week, their estimated per treatment dialysate volume is approximately 25% of their body weight.

To increase clearance, increase dialysate volume and/or time 
per treatment.

If adequate total treatment time, number of treatments, and volume are delivered, adequate clearance is easily achieved.7
For additional assistance with individualizing patient prescriptions based on unique clinical needs, see the NxStage Dosing Calculator.

Struggling to manage patients as they transition to hemodialysis?

Learn how transitional dialysis care can help ease patients into dialysis, while educating them on their modality choices.

Working With Patients to Overcome Barriers to Better Outcomes

Working With Patients to Overcome Barriers to Better Outcomes

Whether it is a fear of needles or lack of a care partner, a patient’s care team plays a key role in helping each patient to overcome the barriers to getting the best possible treatment.

Dialysis is a journey and can involve multiple modalities. Regular communication and education about appropriate treatment options is important. Being proactive in working with patients and educating them on potential future modalities, including more frequent HHD, may help ensure successful transitions and improved outcomes.

Download the “Open Connection” guide to learn about starting the home hemodialysis conversation before, during, and after training.

Home Hemodialysis with NxStage

A Practical Option for More Frequent Therapy

The NxStage suite of home hemodialysis products are designed as simple and practical options for patients to perform treatment at home.

NxStage HHD Products

From hemodialysis machines, to cartridges, fluids, and telehealth platform, NxStage's 
products provide healthcare professionals with complete hemodialysis solutions.
System One Cycler

Simple interface, designed 
to be easy to use

Portable, dialyze when and where you want

24/7 technical support

PureFlow SL

On-site dialysate mixing

Simple plumbing connections

Cartridge

Simple drop-in cartridge

Easy wipe-down disinfection

Disposable

Nx2me Connected Health

Automated flowsheets

Cycler heads-up display

Context sensitive help

Resources

NxStage is dedicated to supporting healthcare professionals
Tools

NxStage offers healthcare professionals with a variety of tools to help with everything from patient selection to prescribing and training.

Training & Education

Supporting healthcare professionals with educational resources from NxStage and third parties, including in-person and online training.

Clinical Evidence

To get an understanding of how our products and therapies can help in your practice, take time to review our clinical evidence library. Our clinical evidence pieces include posters, presentations, and clinical summaries.

Customer Service and Technical Support

24/7 technical support for patients and healthcare professionals

24-hour system swap

Dedicated customer service for inventory management

Nxpeditions patient travel support and delivery program

Contact Us

  • Learn more about how NxStage can help you and your patients

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References
  1. 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.
  2. Weinhandl ED, Lie J, Gilbertson DT, Arneson 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.
  3. Kraus M, Finkelstein FO, Daoui R, et al. Short Daily Hemodialysis (SDHD) improves overall Quality of Life (QOL) and physicial intimacy: interim results from the FREEDOM study. Abstract presented at the American Society of Nephrology Conference, 2011.
  4. Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol. 2012;7(5):782-794.
  5. Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular mobidity and mortality. Kidney Int. 2011;27:250-257.
  6. Chazot C, Vo-Van C, Lorriaux C. Even a moderate fluid removal rate during individualised haemodialysis session times is associated with decreased patient survival. Blood Purif. 2017;44(2):89-97.
  7. Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. Philidelphia, PA: Lippincott, Williams, and Wilkins; 2007.
  8. 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. U.S. Renal Data System, USRDS 2015 Annual Data Report: Table 6.3. Adjusted survival (%) by (a) treatment modality and incident cohort year (year of ESRD onset), and (b) age, sex, race, and primary cause of ESRD, for ESRD patients in the 2008 incident cohort (initiating ESRD treatment in 2008) Abbreviation: ESRD, end-stage renal disease.
  11. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis 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.
  12. Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis. 2003;42(1 suppl):30-35.
  13. Finkelstein FO, Schiller B, Daoui R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5):561-569.
  14. Heidenheim PA, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(S1)(S1):S36-S41.
  15. Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis. 2003;42(5):1020-1035.
  16. Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N, Kutner NG, Cheung AK. A crossover study of short daily haemodialysis. Nephrol Dial Transplant. 2006;21:166-175.
  17. Pinciaroli AR. Restuls of daily hemodialysis in Catanzaro: 12-year experience with 22 patients treated for more than one year. Hemodial Int. 1998;2(1):12-17.
  18. Jaber BL, Schiller B, Burkart JM, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6(5):1049-1056.
  19. Kraus MA, Cox CG, Summitt CL, et al. Work and travel in a large Short Daily Hemodialysis (SDHD) program. Abstract presented at American Society of Nephrology Annual Conference, 2007.
  20. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life. JAMA. 2007;298(11):1291–1299.
  21. Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919.
  22. Ayus JC, Achinger SG, Mizani MR, et al. Phosphorus balance and mineral metabolism with 3 h daily hemodialysis. Kidney Int. 2007;71(4):336-342.
  23. Eloot S, Van Biesen W, Dhondt A, et al. Impact of hemodialysis duration on the removal of uremic retention solutes. Kidney Int. 2008;73:765-770.
  24. NxStage Medical, Inc. 2018. Quantitative Research Report. Hawk Partners 2017. Assessing Patient Threshold for Solo HHD Risk Tolerance.