What is On-Site Home Hemodialysis?
Opportunity For A More Patient-Centric Approach
Prevalence of End-Stage Renal Disease (ESRD) in Skilled Nursing Facilities
Challenges with the current dialysis care model at Skilled Nursing Facilities have supported the growing movement towards a more patient-centric approach.
Clinical Challenges
Dialysis patients may struggle with hemodynamic or cardiovascular instability associated with longer, conventional hemodialysis treatments.
Conventional hemodialysis in-center is also associated with longer recovery times and lower energy levels resulting in patients missing meals, rehabilitation, and social activities.3 This cyclical pattern makes it difficult for patients to obtain the rehabilitation and biochemical results needed for these patients to leave the facility and potentially return home.
Economic Challenges
Patients being treated in a dialysis center undergo the stresses of transportation 3 times a week to their clinic.
- $411 was the average roundtrip per diem cost of ambulance service for nursing home dialysis patients per patient-day, per Medicare claims data.4
- On average, $13,148 is spent annually per nursing home dialysis patient on transportation, per Medicare claims data.4
- Missed or delayed treatments, which can significantly impact the cost of care and resource planning.
Operational Challenges
Staffing and scheduling for both dialysis providers and skilled nursing facilities are already complex due to the care these patients require. By factoring in transportation to the mix, it becomes a daunting three-way communication challenge to organize and staff teams effectively.
- Patients often arrive late or miss treatments entirely resulting in lost revenue for dialysis providers, paying to staff empty seats
- Skilled Nursing Facilities are often challenged with missed rehabilitation sessions by their dialysis residents due to patient fatigue, losing billable sessions and potentially delaying patient recovery
- Delays or schedule changes could result in confusion around meals or medications
On-Site Home Hemodialysis - A Better Care Model
Benefits of On-Site Home Hemodialysis
For patients who may not be able to tolerate abrupt hemodynamic changes often associated with conventional hemodialysis three times per week, on-site home hemodialysis offers individualized treatment options, including more frequent therapy when medically necessary.
Benefits of More Frequent Hemodialysis
On-Site Home Hemodialysis enables individualized treatment options, including more frequent hemodialysis when medically justified.
The benefits of more frequent hemodialysis are widely recognized. The slower filtration rates used in more frequent hemodialysis provide a gentler treatment and are associated with lower mortality rates5,6 and reduced cardiovascular-related hospitalizations.7
Additional clinical benefits:
- Improved recovery time8
- Improved fluid management9
- Less stress on the heart10
- Enhanced sleep quality11
- Reduction in antihypertensive medications12,13
- Improves health-related quality of life14
Roles and Responsibilities
Sample Roles and Responsibilities
Effective on-site home hemodialysis programs rely on a strong partnership between dialysis providers and Skilled Nursing Facilities to manage everything from staff training, to equipment and care plans.
Dialysis Providers:
- Expertise with equipment
- Expertise with therapy delivery
- Billing and reimbursement
Skilled Nursing Facilities:
- Selecting areas for treatment
- Accepting supplies from courier services
- Provide speech, physical and occupational therapy
Shared:
- Communicating to discharge planners and prospective patients.
- Joint patient care plans
- Determine staffing model
Standard On-Site Set-Up
Standard On-Site Set-Up
NxStage is the most practical dialysis solution, with more than 8,000 worldwide patients in the home environment.15
NxStage provides individualized treatment options to meet the clinical needs of each patient, which additionally may allow patients to maintain rehabilitation, medication, meal and activity schedules.
The NxStage solution was designed specifically for home use and reduces the need for large, costly infrastructure changes. The small footprint of the NxStage solution provides flexibility to treat patients in either bedside or den setting.*
Simple interface, easy to learn & use. Dialyze when & where you want.
Integrated dialysate mixing using simple plumbing connections.
Disposable drop-in cartridge. Easy wipe-down disinfection.
*Treatment setting regulations vary by state.
Designed for Success
NxStage offers the following advantages compared to traditional in-center equipment:
- Compact design and small treatment space provide flexible treatment options in either bedside or den settings
- Simple user interface
- Minimal changes required to existing plumbing and electrical wiring
- Water purification system eliminates need for RO water treatment
- Most prescribed home hemodialysis machine in the US
Resource Center
Join the growing movement.
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.
The reported benefits of home hemodialysis may not be experienced by all patients.
The NxStage System One is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. Patients should consult with their doctor to understand the risks and responsibilities of home and/or more frequent hemodialysis using the NxStage System One.
Patients and providers are encouraged to contact their state regulators to discuss state-specific regulations that may impact dialysis in the Skilled Nursing Facility setting.
References:
- U.S. Renal Data System, USRDS 2016 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2016.
- DialysisData.org. FY2017 Dialysis Facility Report Data.
- Data on File. NxStage Medical, Inc. Health Advances Interviews. May 2013.
- Data on file. NxStage Medical, Inc. 2017 ADC Abstract on Medicare Payments for Transportation Between Nursing Institutions and Dialysis Facilities. March 2017.
- 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.
- Yang A, Lee WY, Hocking K, Xelay Acumen, Inc., Affiliated Dialysis. Survival comparison of daily home hemodialysis vs conventional dialysis in the nursing home setting. Nephrol News Issues. 2015;29(2):25-27, 30-31.
- Bednar B. Improving Kidney Care for Residents in Nursing Facilities: A National Model. Nephrol News Issues. 2016:30-34.
- 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) Stud. Am J Kidney Dis. 2010;56(3):531-539.
- 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.
- Jefferies et.al. Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (Myocardial stunning). Clin J Am Soc Neprhol. 2011 June, 6(6); 1326-1332.
- 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.
- FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24): 2287-2300.
- Jaber BL, Collins AJ, Finkelstein FO, et al. Daily hemodialysis (DHD) reduces the need for antihypertensive medications. Abstract presented at American Society of Nephrology Conference, October 29, 2009.
- Kraus M, Finkelstein FO, Daoui R, et al. Short Daily Hemodialysis (SDHD) improves overall Quality of Life (QOL) and physical intimacy: interim results from the FREEDOM study. Abstract presented at the American Society of Nephrology Conference, 2011.
- Data on file. NxStage Medical, Inc. 2017.