Risks and Responsibilities

The reported benefits of home hemodialysis may not be experienced by all patients.

Despite the health benefits that more frequent home hemodialysis may provide to those with chronic kidney disease, this form of therapy is not for everyone. Please review this information carefully and discuss it with your doctor as you evaluate your therapy options.

Personal and Partner Responsibility

Home hemodialysis with NxStage during the day may not require a care partner, provided a physician and a trained and qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are still required to have a trained care partner. Care partners are trained on and follow system guidelines for proper operation. If you choose to do more frequent home hemodialysis, you will be responsible for complying with your dialysis prescription, which may require treatments up to six days per week. Each treatment can take about 2½ to 3 hours or more including set-up and tear-down.

If you choose to do home hemodialysis alone during the day, you will need to take on the responsibility for tasks that would normally be taken care of by center staff when receiving treatment in-center. You will need to perform all aspects of the dialysis treatment from start to finish, including setting up the dialysis equipment, needle sticks, responding to and resolving all system alarms, and system tear-down at the end of treatment. In addition, you must monitor your blood pressure, ensure that proper aseptic technique is followed, and follow all of the training material and instructions given to you by your training nurses. You will also be trained on and need to know how to respond to any health emergencies that might happen during treatment at home, including dizziness, nausea, hypotension (low blood pressure), and fluid or blood leaks.

Similarly, for patients treating nocturnally, or who wish to have a trained care partner, you and your care partner will both be responsible for understanding and performing the above tasks.

Treatment Environment

To do home hemodialysis successfully, you must take care to ensure that you have a clean and safe environment for your treatments. You will also need to set aside space in your home for the needed supplies.

Risks Associated with All Forms of Hemodialysis

All forms of hemodialysis, including treatments performed in-center and at home, involve some risks. These may include high blood pressure, fluid overload, low blood pressure, heart-related issues, vascular access complications, cramps, backache, headache, dizziness, nausea, an “off” taste in the mouth, fatigue, fever, chills, joint pain, itching, seizures or sinusitis.

All hemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their hemodialysis treatments.

Risks associated with More Frequent Home Hemodialysis

Studies suggest that patients performing more frequent home hemodialysis may experience slightly fewer complications associated with their treatments, and actually may enjoy improved clinical outcomes.  However, there are certain risks unique to treatment in the home environment.  Treatments at home are done without the presence of medical personnel and on-site technical support. Patients and their care partners, if performing nocturnal treatments, must both be trained on what to do and how to get medical or technical help if needed.  When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks.

With more frequent home hemodialysis, you are taking on a great deal of responsibility, but many NxStage patients feel that the benefits of this therapy are worth taking on these responsibilities. Thousands of patients are performing more frequent home hemodialysis with the NxStage System One and are enjoying the health benefits, improved quality of life, and additional freedom it can provide.

When performed correctly under the direction and with the support of your medical care team, more frequent home hemodialysis with NxStage may offer tremendous health and quality of life benefits. You should talk to your doctor to better understand the risks involved and how they might apply to you – and to determine if more frequent home hemodialysis is right for you.

Risks Associated with Solo Home Hemodialysis Therapy

A trained and qualified patient may dialyze alone, without a care partner present (solo home hemodialysis), provided the patient and physician agree that solo home hemodialysis is appropriate. Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo home hemodialysis, they may lose consciousness or otherwise become impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo home hemodialysis. Patients should consult their physician to understand the risks and responsibilities associated with solo home hemodialysis using the NxStage System One.

Increased Risks Associated with Home Nocturnal Hemodialysis Therapy

The NxStage System One may be used at night while the patient and care partner are sleeping. Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, 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.

Treatment with nocturnal therapy may require adjustments to medications, including but not limited to iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.

Patients should consult with their physician to understand the risks and responsibilities associated with home nocturnal hemodialysis using the NxStage System One.