Aksys/water softener

With the PHD it is necessary for the consumer to bear the cost of a water softener. Do other model machines for home programs require a water softener?

I don’t know about the Aksys, but for my machine (a baby K Fresenius), I don’t have a water softener in my installation, but I live right in the city. The techs who installed it told me some people do need a water softener, depending on how hard the water is where they live (usually people who live out in the country).

The need for a water softener depends on the level of hardness, or calcium carbonate in the water. Softeners simply exchange sodium for calcium as it passes through the device.

The RO is actually very effective at removing the calcium so it is not so much a safety issue. The problem is that the calcium causes “scaling” on the RO membrane, and greatly reduces the life of the membrane. The softener is there to protect the RO.

In my experience, in most places that have hard enough water to cause RO problem, people usually have softeners installed in their homes to reduce water spots on dishes, etc. Whether or not the dialysis facility pays for the softener is intermitent. Some do, and some don’t. I am not sure it is required, but it is probably cheaper for them to in the long run, as they will have to pay for new RO membranes.


Aksys donated money to the American Kidney Fund to help home hemodialysis patients with limited income/assets to pay for home modifications. AKF has guidelines for how the money is to be awarded. The maximum grant is $500. If you want to find out more, look for information on the Rountree Fund.

The r/o and water softeners, dealkanizer etc. are all included with the machine and paid for (except for the salt) by your insurance. These are not full house softeners but just for the dialysis machine.

self home hemo 9/04

I’m glad to hear that your insurance paid for home modification for home hemodialysis. It would be interesting to know how many commercial insurances pay for this.

Medicare says it will pay for minor modifications to the home to install a dialysis machine and water system. This is vaguely defined as hooking into existing wiring and plumbing. Medicare pay for the water treatment system (RO or DI) and the dialysis machine over months under the clinic’s per treatment allowed rate. Patients may have to bear the burden for home modifications when they have Medicare. A desire to remove this barrier is one reason why Aksys donated the money to the American Kidney Fund.

There’s a big push in the kidney community for “fistula first” since research shows that fistulas have the fewest complications. This effort made me think that there should be an equal effort to promote “home dialysis” (either PD or HHD) first. Encouraging people with failing kidneys to consider home dialysis might allow more to keep their jobs and their commercial health insurance. If Cathy’s experience is representative of other commercial payers, it could mean that patients that choose home hemo would not have to pay as much out-of-pocket to get their homes ready for home hemo.

I believe that Medicare insurance paid for my modifications. They were done by my clinic. I very luckily have had absolutely no out of pocket expenses other than co-pays for meds and for my neph since starting dialysis nearly a year ago. For the Fresenius machine all I needed was dedicated electrical outlets with fault interruptors and for water to be run into my bedroom from the shared wall with the bathroom. The modifications took maybe 3 hours of a contractors time and maybe $50 of supplies.

self home hemo 9/04

Hi all,
Our center paid/or medicare paid for the water softer. We pay for the salt.
We are in the process of moving to another location and we need to get the plumbing created to accept the dialysis machine that includes the pressure guage as well as the mixing valvue for the water. We paid for them on the original setup and they will be moved to the new location.
The center will do the actual move of the machine/RO/Carb tank/softner and the salt holder.
We just pay the plumber to do the electric and the the plumbing.
We use about a 40lb bag of salt a month.

Where do you purchase 40 lb bags of salt?

You do not need a water softner with NxStage. They have prepackaged bags of solution.

Re Jane,
Where do you purchase 40 lb bags of salt?

Home Depot, Lowes, Feed Stores,