Yesterday I had the opportunity to visit Aksys corporate headquarters (the last time I visited was in July 2004). This week after Christmas is the quietest time of the year at most (non-retail) companies and Aksys is no exception, still I met with a couple of the folks working on the next generation machine and was able to say in person the same things I have written here, re: what I like about the PHD; what improvements I would wish for.
Transportability of course is a feature I could speak to directly. I shared how I was looking forward to taking a bare bones yacht charter this summer for a week in the beautiful protected waters north of Seattle. Until the NxStage became an option that sort of vacation was not an option. I also hope to go skiing up at Whistler in February another vacation not practical without transportable dialysis.
However, I pointed out that while this new vacation option was an exciting development what really mattered to me was getting the most dialysis per minute during my normal work a day life. And of course I wanted a machine that would allow me total flexibility in regard to schedule and frequency. I would very much like to try dialyzing for eight hours over night on Friday and Saturday and then 2 hours after work during the week - I would like a machine that would support this sort of flexibility.
I also do not want to give up the features the current version of the PHD offers. I like the conversational interface but I did suggest that these days we are use to being able to customize the way our software programs display. The example I gave was how message boards can display in a simplified, summary or expanded format, I thought the interface on a dialysis machine could offer something along the same line for people who needed/wanted more or less information. These days it seems like you should have the entire manual at your fingertips through a touch screen.
But beyond the look and interface of the machine I of course want a machine that offers all the same clinical benefit the current PHD offers. I said that having a bio-compatible blood circuit was important to me. I don’t have a study showing that it is better but it sure makes sense and so I said that I really hoped the second generation of the PHD would keep that feature. I also said that I still believe in the value of having dialysate flow rates (Qd) greater than blood flow rates (Qb). I brought this up because I am sure Aksys has to solve this issue, just as any manufacturer committed to injectable quality dialysate has to solve - can you make/provide enough dialysate to optimize each minute on the machine?
The current PHD reuses the dialysate - a process called multi-pass - in order to provide a Qd=800. I will be interested to see if the next generation Aksys still goes this route or if they’ll be able to figure out a way to deliver enough dialysate to allow single pass at standard dialysate flow rates. But I did say that I think getting the most dialysis per minute requires Qd greater than Qb. I also said that I believe in the value of the backflush. Or rather not so much the backflush as the process of artificially increasing the ultra filtration rate above 1 kg/hour in order to benefit from convection.
The other hope that I related was that Aksys and DEKA (the design firm) come up with a machine that is quieter then the current machine and of course a machine that is as reliable as a PD Cycler, which it’s my understanding that a cycler is very reliable. The PD Cycler came up as a suggested reliability benchmark because DEKA was involved in its creation.
It was an inspiring visit and I look forward to testing their next generation machine as soon as it is ready. On the downside I felt bad seeing the empty desks and moth balled space, remembering all the people I saw the first time I visited their facility. But I know they have learned hard lessons from their painful missteps and I was heartened that the company is still dedicated to providing optimal dialysis; to continue to deliver the best dialysis - minute for minute. The challenge will be to be to do it in a way that the accountants are happy with.
I hope the business end all works out and I’m testing a new machine in 2008.