Risks and Responsibilities

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

Despite the health benefits more frequent home hemodialysis can provide to those with chronic kidney disease, this form of therapy is not for everyone. To help you make a decision, please review this information below carefully and discuss it with your doctor as you evaluate your therapy options.

Personal and Partner Responsibility

Home hemodialysis with NxStage requires a patient and a care partner who must both be trained to operate System One. 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 disassembly.

If you choose to do home hemodialysis, you and your partner will need to take on the responsibility for tasks that would normally be taken care of by 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 disassembly 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 and your partner will also be trained on, and need to know how to respond to, any health emergencies that may happen during treatment at home, including dizziness, nausea, hypotension (low blood pressure), and fluid or blood leaks.

A Suitable 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 some 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 leaks, 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 partners must 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 and your partner would be 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.

Increased Risks Associated with Home Nocturnal Hemodialysis Therapy

NxStage’s System One may be used at night while the patient and their 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.