Haemodialysis, in the conventional form, means making the journey to a hospital or clinic every other day, apart from Sundays. This is the main disadvantage for the patients with this form of renal replacement therapy. In some cases the point of care is so far away from where the patients live, that on days where dialysis is required, the entire day can be taken up with travelling.
While peritoneal dialysis can provide good therapy outcomes, some patients may feel uncomfortable about continuously having dialysis solution filling their abdomen. Yet there are many end stage renal disease patients who undergo conventional haemodialysis who would, given the choice, opt to carry out their dialysis at home.
However, the number of patients involved in home haemodialysis in Europe is extremely low. This in many cases is because due to financial restrictions they have not been offered this treatment option.
Until recently there was no unique haemodialysis machine which fully addressed the specific needs of the home user. The major companies within the European market, Fresenius Medical Care, Gambro and Bellco all have product offerings that can be used, in a home located set-up. However, these machines are simply basic versions of the haemodialysis machines used by dialysis specialists in hospitals and clinics. On one hand this could be seen as a bonus, because the patients may trust what they are used to and have experienced the results of, yet conversely, there are disadvantages to using more conventional type machines. They tend to be quite large and bulky, require water purification equipment to produce the solutions from the dialysate concentrates, and in some cases may mean plumbing and electrical modifications to the patients’ home.
NxStage Medical, Inc. an American based company have developed what should be considered as the first haemodialysis system to offer significant patient freedom. The System One, which interestingly can also be used in a renal intensive care (ICU) situation, is independent of specialist power and water requirements. This means that it can easily be used in a non-clinical location, even allowing people with hectic lifestyles to travel without the hassle of arranging “holiday dialysis” as they can simply take their machine and supplies with them.
The NxStage System One has addressed another discouraging issue for potential home haemodialysis patients. They have stripped the therapy procedure back to the bare minimum, ensuring that patients no longer have to face a complex set-up process every session.
The filter simply drops into the machine, automatically engaging the systems safety features. Blood or fluid leaks are kept to an absolute minimum by using filters, which are pre-connected. Isolating the cycler within the machine from the cartridge ensures that sterilisation and upkeep are also minimised.
In conventional haemodialysis, dialysis fluids have to be mixed from purified water and concentrations. This process simply adds to the time that dialysis nurses have to spend getting the dialysis systems ready for use. NxStage have overcome this obstacle by pre-packaging the fluids, meaning that clinical errors in mixing are reduced and dosage is simplified to a number of bags per treatment.
The real advantages come though when considering the portability aspect of the machine. This is what gives the patients the level of freedom that they desire and deserve.
This is the first portable haemodialysis machine to be developed and there is the possibility that NxStage could monopolise the home haemodialysis market. The proof with however come from the patients, is this the dream machine they have been longing for? Only time can tell. Still, one thing is for sure – If patient quality of life increases, and costs are kept down, there will definitely be an increase in the size and associated revenues of the home haemodialysis products market.
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