Healthy Kidneys Help Maintain Balance
Healthy kidneys are constantly working to remove excess fluids and toxins, maintaining balance in your body.
When your kidneys are healthy, they work 24/7 to balance fluid and salt in the body and remove toxins.
When your kidneys aren’t working properly, dialysis is used to try to achieve balance by imitating the fluid and toxin removal functions of healthy kidneys. But for many kidney patients, treating three times per week may not be enough dialysis, and this can hurt their heart.
Even a hemodialysis patient who follows their diet restrictions and limits fluid intake can build up an average of an extra three liters of fluid in the two day skip with standard in-center treatments, which has a direct impact on heart health.1
For example, hemodialysis patients who treat three times per week are more likely to experience abnormal heart rhythms during their first treatment of the week, when the total fluid in their body is typically at its highest.2
Large Changes In Fluid Volume Is A Common Concern with 3x/week Dialysis
More Frequent Hemodialysis May Reduce Common Symptoms3,4
Fluid Overload Symptoms3,4
- Swelling (edema)
- High blood pressure
- Shortness of breath
- Weight Gain
Aggressive Fluid Removal Symptoms3,4
- Low blood pressure
- Long Recovery Time
If you experience these symptoms, it may be a sign that you are not getting enough dialysis and your heart health is at risk.
Get The Facts:
More Frequent Dialysis May Be Better For Your Heart
- 40% of patients with end-stage renal disease (ESRD) die from heart-related complications5
- Up to 75% of patients with chronic kidney disease (CKD) suffer from a heart complication called left ventricular hypertrophy (LVH), a thickening of the heart6,7
- LVH can develop as a result of the heart having to work harder, and puts you at a higher risk of a heart attack or stroke
- Hemodialysis patients who treat more frequently experience 17% fewer heart-related hospitalizations compared to those who treat 3x/week8
- Hemodialysis patients who treat more frequently have a 17% lower risk of cardiovascular-related death compared to those who treat 3x/week9
The reported benefits of home hemodialysis may not be experienced by all patients.
Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are 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 the NxStage System during the day may not require a care partner, provided a physician and a qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are required to have a care partner. Care partners are trained on and follow 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.
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 staff when in-center. You will need to perform all aspects of dialysis treatment from start to finish, including equipment setup, needle insertions, responding to and resolving system alarms, and system tear-down after treatment. In addition, you must monitor your blood pressure, ensure proper aseptic technique is followed, and follow all 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 health emergencies that might happen during treatment at home, including dizziness, nausea, low blood pressure, and fluid or blood leaks.
You must ensure that you have a clean and safe environment for your treatments. You also need to set aside space in your home for the needed supplies.
Risks Associated with All Forms of Hemodialysis
All forms of hemodialysis 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 may experience 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 required), 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.
Risks Associated with Solo Home Hemodialysis Therapy
A 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 become physically unable to correct the health emergency. Losing consciousness or otherwise becoming 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.
Increased Risks Associated with Home Nocturnal Hemodialysis Therapy
The NxStage System 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.
- Kjellstrand CM. Ing T. Daily hemodialysis history and revival of a superior dialysis method. ASAIO J. 1998;44(3): 117-122
- Roy-Chaudhury, P, et al. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Int. 2018:93:941- 951.
- Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26(8):2656-2663. doi:10.1093/ndt/gfq763.
- Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250-257. doi:10.1038/ki.2010.383.
- Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015:66(1 Suppl 1):Svii, 51 -305. doi: 10.1053/j.ajkd.2015.05.001.
- London GM. Pannier B, Guerin AP. et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12(12):2759-2767
- Cheung AK. Sarnak MJ, Yan GF, Berkoben M, Heyka R, Kaufman A, et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int. 2004:65(6): 2380-2389.
- 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. 20 15:65(1):98-108.
- 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.