I think the idea that when the machine breaks down and they can just ship you another one overnight definitely has its merits for both patient and companies. The patient wouldn’t get held up waiting for service to arrive and I would think it would be a lot less expensive for the company not having a staff of field service personnel. Travel can get very costly.
It will be interesting to hear how this works out Marty. I’m trying to imagine the way it would work…
It is 7 PM on a Monday night. I finish dinner and go to get ready for dialysis. Hmmm… there is an issue and I can’t get on so I call service. Tuesday morning a new machine is shipped from headquarters. Wednesday it arrives and Wednesday night I am ready to go.
I think I would still try and back up incenter on Tuesday because what if the replacement machine is damaged during shipping? Especially if I took Sunday off. This model also assumes that the issue was because of a problem with the machine. What if the issue was because I was doing something incorrectly? With the Aksys I’ve caused the machine to require service because I did something incorrectly then because of technician feedback I’m doubly careful the next time. I think technician/patient interaction is very helpful.
Marty the merits of the “service swap” model may out weigh the drawbacks but my experience with the Aksys tells me that when things move from paper to reality there are always trade offs, unexpected consequences and ol’ Murphy shows up at every turn. It will mostly depend on how often service is required.
Bill, I see your points. I hadn’t thought of the patient doing something to screw up the machine if they can this would be a problem as you would never learn what not to do. To my knowledge there isn’t anything I can do to actually screw up the Fresenius Machine so I have to call for a repair. As far as your scenario at being down and a new machine arriving being also unuseable I don’t think Murphys Law changes much from having a down Fresenius or Aksys Machine and the service rep coming and not being able to fix it that trip. I know our serviceman came and had to change a spring because the machine was giving me flow errors.
He left and when I went to set up that night the machine wouldn’t turn on and he had to come right back the next day to change a computer part. I think having a machine that could be replaced via overnight service would allow for more patients to do home hemo as service wouldn’t be another issue for centers to deal with. We soon will have 38 patients in our program that is a lot of traveling for quarterly and yearly maintenance along with breakdowns.
Aksys sent out a press release announcing its 100th patient. This means that they’ve grown from 1 patient in December 2002 to 100 patients in less than 2 years. I’m not sure how many patients are currently on home hemodialysis, but considering that only 1,243 patients were on home hemodialysis nationwide in December 2002 (USRDS, 2004), this is quite an accomplishment and great for patients!
From what I’ve seen and read, NxStage has a great machine. However, I’ve heard that the System One is not yet widely available because it still has some patient testing to do to complete the final FDA approval process.
I hope that as time goes by more patients learn about home dialysis (tell your friends about Home Dialysis Central) and will closely examine the pros and cons of all home hemodialysis machines. You may like the NxStage machine, but someone else might like the Aksys. Still others may like a totally different machine. Patients need to understand that clinics may have contracts with a limited number of companies for home hemodialysis equipment. At this time, considering the number of clinics that offer home hemodialysis, much less daily home hemodialysis, patients who want a specific machine may not be able to get it without changing clinics, doctors, and traveling some distance. We need to keep promoting home dialysis so patients that want it can do it anywhere.
Beth: I agree with everything you say. I think you’ll agree that companies need to turn a profit to stay in business, even if they are producing products which are helpful to those with ESRD.
I hope Aksys can produce and sell thousands of PHDs. If Aksys is successful, it may be able to afford local service in my area. It’s also important to recognize that some patients cease using their PHDs – sometimes due to death or illness, a return to in-center HD, or to use another modality.
The nephrology community is aware of Aksys and the service record of the PHD. This awareness is reflected in the number of PHD users. I wish Aksys luck in their marketing efforts.
In the meantime, I’m happy when my PHD makes it through the day. Instead of becoming aggravated with the PHD, I find it’s healthier to focus on the benefits of the NxStage System One, which could be available for home use in January. I’m encouraging my clinic to sign a contract with NxStage so System One can be used by home patients.
I hope patients are free to post their experiences and opinions on this website without someone trying to discredit them. Knowledge will evolve through the free exchange of information, whether perceived as positive or negative. Patients who love their PHDs can post here too.
It’s also important to limit the number of posts by nonpatients and to identify posts by individuals who have a financial, promotional, or other interest in Aksys or any other manufacturer.
I’m not on dialysis myself, but my brother had acute kidney failure and was on hemodialysis for 3 months as a result of 30+ years of diabetes. I consider myself to be at risk for kidney disease and hope if my kidneys fail I will have many options for treatment.
I worked as a renal social worker from 1978-1996. In 1996 I began working with Medical Education Institute because I wanted to be part of an effort devoted to promoting rehabilitation and helping patients take a more active role in their care. I’ve seen the many benefits of PD and home hemodialysis and many changes in technology in the last quarter century (boy does that sound like a long time!). I am thrilled that technological improvements seem to be re-igniting interest in home hemodialysis, a treatment that has been underutilized for years.
So far as home hemo machines, I’ve seen a number of new ones and talked with company representatives at meetings. I am anxious for these machines to come to market because each has its advantages. I hope that more of patients that have participated in clinical trials using these machines post messages on this website.
I am extremely grateful to the pioneers in nephrology (patients and professionals) who have offered advice to companies that are designing new home hemodialysis machines. Most of them, even those with a financial interest in one or more of these machines, hope that as more options become available clinics will individualize care and offer choices to their home hemodialysis patients.
Finally, our challenge is to get more clinics to start home hemodialysis training programs so more patients have the option to do home hemodialysis. Success breeds success. I believe that as patients have positive experiences and talk up home hemodialysis to their kidney and other doctors, healthcare staff, in-center hemo patients, people not yet on dialysis, etc., as more research confirms improved outcomes, and as payers pay appropriately for home hemo, more clinics will offer it.