What Responsibilities Should Patients Expect?
HHD can be performed during the day with or without a care partner or overnight while you and your care partner sleep (nocturnal home hemodialysis)*. A care partner is not a medical professional and can be a friend, spouse, colleague, or family member.
If patients choose to do home hemodialysis, either they and/or their care partners will need to take on the responsibility for tasks that would normally be taken care of by center staff when receiving treatment in-center. They 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, they must monitor their blood pressure, ensure that proper aseptic technique is followed, and follow all of the training material and instructions given to them by their training nurses. If a patient is using a care partner both the patient and care partner will be trained by their provider 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.
To do home hemodialysis successfully, patients must take care to ensure that they have a clean and safe environment for their treatments. They will also need to set aside space in their home for the needed supplies.
*Work with your doctor and care team to determine the best treatment option for you.
Is there is a waiting list to begin home dialysis?
Is there a nomination or recognition program needed to begin home dialysis?
Are you required to have a care partner for HHD?
Can I still have a flexible schedule while doing home dialysis?
What if I have a catheter?
How is NxStage therapy prescribed?
Patients are prescribed the dialysis therapy that is best for them. Based on their needs, their doctor will decide how frequently they will need to perform their therapy, how much and what kind of dialysate they will use, how long the treatment will last, and what their weight at the end of each treatment should be.
Treatment times will vary based upon your patient's body size and their prescription. A typical more frequent treatment uses 20 to 30 liters of dialysate and takes 2½ to 3 hours to complete.
Are you required to have a care partner for PD?
Am I able to do PD if I have had abdominal surgery?
Will I be required to perform treatment every day?
Every prescription is based on the individual’s particular needs. Patients can work with their doctor to determine what home modality option best fits their clinical and lifestyle needs and how often they will be required to treat. HHD and PD Dosing Calculators, available for healthcare professionals only, can help prescribers provide dosing considerations for both home therapies. Each calculator provides individualized therapy options based on the clinical information entered.
Will I be required to pay for equipment, home modifications, extra utilities supplies, etc. ?
Are you still able to dialyze at home if you have a disability?
Do I have to be a certain body type to dialyze at home?
Do I need to have residual kidney function?
Will home therapy be a burden to my family?
What are the chances I will experience a serious access event?
There are some risks with all medical procedures and treatments however, serious adverse events in home dialysis are relatively rare.1 HHD and PD equipment are designed for safety and there are both procedural steps and system alarms in place to help prevent any adverse events from occurring. The home training nurse will review all the precautions and procedures needed to avoid and prevent any adverse events. Patient retraining and periodic technique checks may also help to mitigate these risks.
- Tennankore KK, et al. Am J Kidney Dis. 2015;65(1):116-121.
How much space does NxStage’s Versi HD take up?
The NxStage Versi HD is just over a foot tall, measuring approximately 18 inches high by 15 inches wide by 16 inches deep. It easily fits into any room at home without any home modifications, and can also be packed into a car or checked (with the appropriate preliminary steps and protective case) for airplane travel. The system plugs into a standard 110V electrical outlet.
The PureFlow SL dialysate purification system is about the size of an end table, and the System One cycler sits on top of it. The PureFlow SL is not portable for travel.
Storage space is required for the disposable supplies, such as cartridges, sacks of concentrated dialysate, and bags of premixed dialysate (for back up and travel), as well as access-related supplies and saline bags.
What if I have well water at my house?
What is Versi HD?
NxStage's Versi HD is the first and only portable hemodialysis machine cleared specifically by the U.S. Food & Drug Administration (FDA) for home hemodialysis, solo home hemodialysis, and home nocturnal hemodialysis. Its simplicity and revolutionary size (just over a foot tall) are intended to allow convenient use in patients' homes and give patients the freedom to travel with their therapy.
When combined with the NxStage PureFlow SL Dialysis Preparation System, patients are able to further simplify the process by using ordinary tap water to create dialysis fluid. Unlike conventional hemodialysis systems, Versi HD requires no special infrastructure to operate. Under the guidance of their physician, patients can use Versi HD, with their trained partners, where, how and when it best meets their needs, including while they're sleeping - at home or on vacation and at a medically appropriate treatment frequency. Versi HD is also used to provide a range of flexible therapy options in more traditional care settings such as hospitals and dialysis centers. Its safety and efficacy have been demonstrated by experience with more than 21 million treatments with thousands of patients around the world1.
- Data on file. NxStage Medical, Inc. 2020.
How does NxStage's Versi HD Work?
Versi HD is designed to deliver hemodialysis therapy in a home setting. It consists of the following elements:
- A small control unit containing a fluid pump and a touch screen user interface (referred to as the cycler).
- A disposable dialyzer and tubing set (referred to as the cartridge).
- PureFlow SL dialysate preparation system or in premixed dialysate bags for travel.
- PureFlow is the only system designed, tested, and validated to produce ultrapure water from tap water, accommodating most home water sources.
For each treatment, a new cartridge is inserted into the cycler, where it is prepared for use or primed prior to treatment. The dialysate is generally prepared in advance, in batches, by the PureFlow SL, and is then connected to the cartridge.
During treatment, the cartridge tubing is attached to the patient's blood access. Blood and dialysate pass through the filter to clean the blood. Used dialysate, wastes known as effluent and excess fluids removed from the blood are routed through a waste line on the cartridge and into a drain.
Therapy is complete when the prescribed dialysate volume has been delivered. Daily supplies are thrown away, and the cycler is simply wiped down after use.
What are the differences between the NxStage Cyclers?
Does my house need to constantly be clean to do home dialysis?
Does my center need to offer home dialysis to be able to begin training?
Can I still do home dialysis if I am afraid of needles?
When do you need to decide whether or not you want to try home dialysis?
How are patients trained?
Is learning how to do home therapy difficult?
How long does training last?
Can I still enjoy swimming or water activities?
Can I still take a shower or bath on home dialysis?
What help is available?
Patient have access to Fresenius Technical Support and Customer Service for PD equipment questions and NxStage Technical Support and Customer Service for HHD equipment questions.
Fresenius Medical Care Product Training and Technical Support
Fresenius Customer Service
Fresenius Medical Care Technical Support
Opt. 1 Technical Support
Opt. 2 Customer Service
Patient Consultants: 1-888-200-6456
Do I need a large amount of available storage space?
Is it true I can not have carpeted floors to do home dialysis?
Can I have pets?
Do I need a certain level of education to be on home dialysis?
What resources are available once I begin to dialyze at home?
A patient's center, care team, technical support, and customer service are all available resources that a patient can access while dialyzing at home.
If a patient is experiencing a medical emergency during a treatment they should contact 911. For equipment concerns, or issues patients can contact technical support, available 24/7, 365 days a year. Customer service is available Monday–Friday during normal business hours to answer questions regarding deliveries, inventory, or travel.
Are home modifications required to be able to dialyze at home?
Will I be able to try home dialysis even if I haven’t been 100% compliant in-center?
Can I still keep my candidacy for a transplant if I decide to do home therapy?
Many people who select a home therapy report feeling better physically when performing more frequent treatments1,2 and studies confirm there is a higher likelihood of being added to the kidney transplant waiting list on HHD and receiving a transplant on PD.3-5
- 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.
- FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
- Sinnakirouchenan R, Holley JL. Peritoneal Dialysis Versus Hemodialysis: Risks, Benefits, and Access Issues. Adv Chronic Kidney Dis. 2011;18(6):428-32.
- Bonenkamp AA, van Eck van der Sluijs A, Hoekstra T, et al. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Med. Published online Feb. 11, 2020.
- Weinhandl ED, Liu 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.
Are care partners required to have a medical background or medical training?
Risks and Responsibilities - HHD
The reported benefits of home hemodialysis (HHD) may not be experienced by all patients.
The NxStage System 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. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. 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.
Home hemodialysis with the NxStage System during waking hours 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 proper operation and how to get medical or technical help if needed.
Certain risks associated with hemodialysis treatment are increased when performing solo HHD 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 HHD, 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 HHD.
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 and/or increased treatment time, and delayed response to alarms when waking from sleep.
Patients should consult their doctor to understand the risks and responsibilities of performing these therapies using the NxStage System.
Risks and Responsibilities - PD
The reported benefits of peritoneal dialysis may not be experienced by all patients.
Peritoneal dialysis does involve some risks that may be related to the patient, center, or equipment These include, but are not limited to, infectious complications. Examples of infectious complications include peritonitis, and exit-site and tunnel infections. Non-infectious complications include catheter complication such as migration and obstruction, peritoneal leaks, constipation, hemoperitoneum , hydrothorax, increased intraperitoneal volume, respiratory, and gastric issues. It is important for healthcare providers to monitor patient prescriptions and achievement of adequacy and fluid management goals.
Patients should consult their doctor to understand the risks and responsibilities of performing peritoneal dialysis.
The Liberty® Select peritoneal dialysis cycler is indicated for acute and chronic peritoneal dialysis. The stay-safe® PIN connectors are intended for use with a peritoneal cycler for drainage and infusion of PD solution during peritoneal dialysis exchanges. The stay•safe PIN connectors are indicated for acute and chronic peritoneal dialysis.