April 2006' Neph. News & Issues Article

Discussions for Patients, Family, and Friends HD For Patients
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[quote=“Bill Peckham”] Cathy, I think you have posted that take away FMC’s water treatment and they are about the same

.

No, I do think the set up and “clean up” of the NxStage is significantly easier and faster than the Fresenius.

[quote]What I find remarkable is the reaction that the article received. I worry that there is too much partisanship. That to admit a short coming is to admit failure. I worry about the schadenfreude I read between the lines of some posts in the cyber world and schadenfreudenistic actions in the real world.

Again, I will state that I am concerned more that the article made it sound as if the NxStage was very difficult to use and learn and am afraid it would scare people away. On a scale of 1-10 it probably isn’t that different, you took the same amount of time to learn, I was doing it myself (with supervision) on my second day of training). Sure the Aksys has a few fewer steps and may be better for people who aren’t very involved in their treatments, but, should those people be doing home hemo?? I think it is good that you really need to understand the numbers on the NxStage and what is happening. I have nothing against the Aksys, I just don’t want people thinking the NxStage is too complicated for them to try.

I’ve heard it speculated, from a number of sources, that an Aksys competitor alerted the FDA to the disparity between the PHD’s 510k and their move to longer treatments - including nocturnal - that resulted in the recent warning letter. If true I ask: was that done for the benefit of dialyzors? or was it the result of competitive business juices? I understand the requirements of business - stockholders and stakeholders - but this is not a case of competing espresso stands “let the best latte win“. This is about real people and their renal replacement needs. I think whoever dropped a dime on Aksys made life harder for many people without achieving any great or required business victory.

If that is true it is dispicable. Since NxStage is also allowing nocturnal I doubt it was them, sounds as if maybe a company that does nocturnal may be getting scared of all the competition, just speculation.

But that is not the path I have chosen. I choose to seek to understand how dialysis works and the compromises we dialyzors must make. It is a balance. I try to stick to posting my personal experience, as accurately as I can. I think I have done a pretty good job, I can think of only a handful of HDC posts I would retract or I wish I had not written or that I had written differently. Now I have to accurately write my clinical impression of the System One and I am a bit gun shy, I am not sure how to present my opinion. Is that good? Should we only write the positive?

I hope that my post didn’t appear in any way to be an attack, I am very curious about the differences, although would, for my own reasons (just like you) not change to the Aksys, if for some reason the NxStage was unavailable. We should absolutely be free to write our own opinions and experiences and especially someone like you who really has researched everything. I am NOT anti Aksys or any other home treatment, I think competition is good, I do not bash Aksys or Fresenius, I do promote NxStage, as my choice, and explain why, and try to correct any mistakes I read, or misunderstandings. Please, please I think these discussions are good and let new and potential users get a clearer idea of their options.

Part of my approach is that I strive to be humble and skeptical. I fully admit that what we take as fact today may well be proved incorrect tomorrow. I’d just like to see that same humility and skepticism in others. I may be wrong but what I write is what I think to be true.

I hope I don’t come across as believing the NxStage is the end all of dialysis machines. I am disappointed to say the least to see the “improvements” in dialysis over the last 30 years, I do however, find the NxStage to be the best choice for me out there. I am hoping better choices, and smaller more portable choices come available sooner rather than later, I do NOT believe that the perfect machine has yet been designed.

Cathy

42

Gus wrote:

I think you gave your personal opinion based on what you experienced, but am surprised how quick you learned in four days and hit the road for your great journey! Didn’t you take longer to train on Aksys?

From what I’ve read, both Aksys and NxStage say that it takes about 3 weeks to learn how to use their machines. Bill had already used two hemo machines so he was probably able to learn how to use the NxStage easily because he could transfer the transferable skills to that machine and just had to learn what the differences were between the B Braun and Aksys and the NxStage.

I don’t think any company that makes a machine or any dialysis clinic would advocate sending a dialysis patient home in 4 days if he/she did not already know how to do needle sticks and basics of how to operate a dialysis machine unless perhaps he/she had a dialysis nurse or technician as a partner. Otherwise, it would be unsafe and the risk management people would be having a stroke.

43

Averages are made of extremes. The first time I trained to go home was on the B Braun and that took two weeks but my memory is that I could have gone home sooner but I had to wait for the supplies to be ready. The reason my System One training was four days v. five was that they were not ready for me on Monday. After thinking back I think the Aksys was 5 days M-F.

I am a quick study, and had 10 years of self-care experience on the Cobe Century III but the main thing is that it is very inconvenient to add daytime dialysis training to my schedule. To me learning the different machines is like learning to captain different vessels – where things are is different but in general there is a check list to follow and you take the same precautions.

44

I agree Cathy. I am glad you are doing so well using the System One and I have never found one of you posts offensive. I still maintain that the user interface on the NxStage is suboptimal - the retro LED display may be fashionable in some circles but a graphical user interface using touch screen technology offers many advantages.

As far as settings go it is the inability to directly set/change the treatment length on the System One that creates problems. When I wrote about the not being able to change the fluid removal target I forgot that you can toggle the main displays. Just to be clear - I didn’t write the article and when I read it (I’ve subscribed to NN&I for many years) it did not strike me as pro/anti either machine. The article talked about the drawbacks of the PHD too, all very even handed.

What struck me was the reaction Jane’s initial post here on Home Dialysis Central – I’ve tried both machines and those four items are manifestly true. However, as I’ve said I see them as having little consequence. A more legitimate beef against the initial post would be that it was out context.

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[quote=“Bill Peckham”]
I still maintain that the user interface on the NxStage is suboptimal - the retro LED display may be fashionable in some circles but a graphical user interface using touch screen technology offers many advantages.

I agree, however, for size and weight it is something I am happy to live without.

As far as settings go it is the inability to directly set/change the treatment length on the System One that creates problems
.

It isn’t necessarily easy, but they want you to get the optimal dialysis. You can always stop early if you choose and slow down with ff, dialysate rate and/or blood flow rate if you want longer dialysis. I just do the optimal amount they tell me to and live with it. If I am in a hurry I run a faster blood flow rate, if not a slightly lower one, just making sure my pressures are fine.

–

I’ve tried both machines and those four items are manifestly true. However, as I’ve said I see them as having little consequence. A more legitimate beef against the initial post would be that it was out context.

I think my beef is that it makes it sound like a NxStage is a 1 and an Aksys is a 10 in terms of ease of use, when in reality I’m guessing it is more like an 8 and a 10, for set up and clean up, and closer for reliability.

Cathy

46

I would agree with that.

47

I have never used the PHD however I am using the NxStage and I think it is the next best thing to sliced bread. :smiley: I love the freedom and the freedom to create my own schedule. As to the 100 steps I guess if you count taking off the little caps off of the bags and any other minute detail. Then maybe you can get to that 100 point mark, but seriously my 9 year old son sets up my machine BY HIMSELF that’s right I said 9 year old son ALL BY HIMSELF. And it takes him just a few minutes.

As for the display, I can see Bill Peckhams problem with it, I too would like to have the information static instead of scrolling. But I have learned nothing in life is perfect. But the way Nxstage has changed my life, to me it is perfection.

I will be posting a video soon of my son setting up the machine on my “fansite” ilovenxstage.com

48

Hi y’all,

Epoman wrote:

but seriously my 9 year old son sets up my machine BY HIMSELF that’s right I said 9 year old son ALL BY HIMSELF. And it takes him just a few minutes.

It’s so funny that you’d say this–the first time I ever saw the NxStage machine was at the American Society of Nephrology meeting in San Francisco, so, maybe 3 years ago? My very first thought was, “my 13 year old could work this!” :smiley:

49

NxStage already has an GUI interface, but at the moment its not part of the training for most of us NxStage users and I really don’t know why…

However, I do know that NxStage is constantly improving the machine and what not may have some nifty, cool ideas that we don’t know!

Its one of the reasons we should support this BIG little company because we the patients want more control and freedom in our lives… :roll:

50

That looks like it’d be worth its weight Gus. Last night on the PHD I had high venous pressure alarms, guess I did a bad stick. I ended up running at a 300 pump speed, that would have made for a long night on the System One. That new NxStage screen will be a help in a bad needle stick situation, to be able to adjust the needle and see the cause and effect on a continuous, rather than snapshot display.

One difference between the PHD and the System One that Jane’s initial post didn’t list was brought home tonight. I carried in two months worth of supplies for the PHD. 48 treatments, 9 boxes: 4 boxes of acid, 4 boxes of bi-carb and a box with two artificial kidneys and two blood tubing sets. Sometimes there is another box if I needed more pre-filters.

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Epoman I hope you know that you will be talked about for years and years at renal conventions. The journey you made from your posts in February to just five months later in July must put a smile on everyone’s face at HDC. I think your story will serve as a prime example of the impact of technology and information. I wonder if you’ve ever thought about what if ? What if the NxStage had been around when you started dialysis? What would you say to someone who is starting dialysis today? How do you explain why it is better to dialyze more than three days a week?

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Well if I am talked about, hopefully they will visit my sites. :wink:
Oh yeah I think of the “what if’s” a lot. If this machine was around back when I started 12+ years ago I may still be able to go for a walk with my son or go for a bike ride. Honestly though to me I value the FREEDOM more so than the actual “feeling better”. I literally am scared to death of the possibility of having to go back to in-center. I just want to help get as many people as I can informed of this wonderful machine, which is why I created ilovenxstage.com (yes I know shameless plug). But honestly from in-center to home the last month and a half I feel like I am on vacation. I just have to dialyize 5 times a week and my Kt/V is as good as if I were doing it 6 times a week. I only run an average of 2.5 hours and my 9 year old son sets up my machine. He just dislikes hanging the bags. And with the buttonholes all the anxiety is gone, all the worrys of finding a new spot. I have such passion for this machine as I mentioned before:

“Nxstage did NOT invent a new dialysis machine, they found a way to keep a father alive longer for his son.”

I can only imagine what the next 10 years hold. It’s an exciting time. Read this link to see what I am talking about: Stagnation

53

Bill ……….Me thinks you protest too much. You sound like a paid adviser for Aksys. Don’t know much about either machine but just following this thread and you’re a little defensive. Doing a little research on the subject and from the looks of things you won’t have to worry which is better soon Aksys is on the verge of going out of business and they are going to be desisted on the NASDAQ which is pretty hard to do so there is very little interest in there business model. Volume for 2005 2.67 million and a loss of 34.0 million stock price .88 average trading volume 1,300 shares per day almost laughable. Nxstage on the other hand is attracting investors 6.0 million in volume in 2005 also a staging loss however stock price $ 9.90 and climbing and trading volume in excess of 100.000 shares per day. The reason is Aksys has nothing new they are just another big unit in about the same mold where Nxstage is new small simple there are a lot more reason but money flow will determine the winner and right now it’s Nxstage it may not be perfect but the investment community likes it and that’s all that it will take MONEY.

54

I believe Dori has said that it is OK for people that post to share differences of opinion, but personal attacks are not OK on this board.

Bill is no more a paid advertiser for Aksys than Gus is a paid advertiser for NxStage. Both really like the machines that they use. Both machines have their advantages and their disadvantages. What is an advantage for one may be a disadvantage to another and vice versa.

I believe everyone on this board can agree that:
– getting more dialysis whether done short time daily or overnight is better because patients feel better and can eat a less restricted (and sometimes close to normal) diet and more clinics should offer this;
– home hemo machines that are smaller and lighter are better because small machines take up less room in the home and light machines are more portable for relocating within the home and for travel;
– requiring as few supplies as possible is better because supplies should not keep people from doing home dialysis and some have limited space and some aren’t strong enough to lift lots of boxes or bags;
– whether someone is mechanical or not should not limit people from doing home hemo and machines that are user friendly are better because even people that are not mechanical should be able to operate them;
– finances should not limit people from doing home hemo and machines that require fewer home modifications are better because people who want to do home dialysis may not have a lot of money to pay for modifications (by the way, if someone does need to do home modifications, social workers should have American Kidney Fund applications to help);
– doing dialysis should not cause problems like resistance to EPO, amyloidosis, and heart problems so having sterile or ultapure dialysate is better because it reduces endotoxin levels that can lead to inflammation that can be a factor in these dialysis complications.

I suspect there are other things that people can agree on. I’d much prefer read these things that will push the machine makers to make even better machines instead of reading any more postings comparing these two machines. I think I’ve read everything possible to say about either machine more than once. And I’d really like to see people stop making personal attacks because someone disagrees with their point of view. Finally, if you’re going to attack someone personally on this board, have enough guts to register and post who you are!

55

“(I) don’t know much about either machines but”, you have got to be kidding. Your knowledge is based on the stock price and then you come on here to flame me? As I wrote previously “It must be tempting to conflate the business model of the PHD with its usability or clinical effectiveness.” I know it must be tempting because so many are so quick to do it.

“The reason is Aksys has nothing new they are just another big unit in about the same mold” that’s the whole point, the PHD is not another standard dialysis machine. Listen if you’re just cruising the board to glean some information to help you make an investment decision then just lurk.

If you are an actual dialyzor or family member then you tell me which piece of information I’ve posted that you’d rather not know. The usability of the PHD has no impact on the usability of the System One. The clinical effectiveness of the PHD has no impact on the System One. The stock price of the PHD has no impact on the System One. The machines are independent of each other.

Anonymous posts and emails questioning my motivations are a joke. I am proud of my 11 and half years in the carpenters union, writing to message boards is done on my own time. If I start questioning Teamsters in my posts, then you can point out my paid bias.

56

Hi

The only reason I pick nxstage was the waterless and takeing it on the road. If the only one they had was a water base one I would have taken it. I just wanted to come home. Some day down the road someone will come out the best of all the systems. Maybe 50 yrs or 100 yrs down the road the medical world can take a part of you and clone a kidney???

bobeleanor :smiley:

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medical device company that develops, manufactures and markets innovative systems for the treatment of end-stage renal disease (ESRD) and acute kidney failure, announced today that The Wall Street Journal recognized the company’s System One® Portable Dialysis Machine in the Medical Device category of the publication’s global 2006 Technology Innovation Awards. The annual awards recognize technological breakthroughs by individuals, companies and organizations around the world in a wide range of areas, including medicine.
“We are honored that The Wall Street Journal recognized our portable dialysis technology as one of the top innovations of the year,” said Jeff Burbank, President and CEO of NxStage Medical, Inc. He adds, “This award adds to the body of evidence supporting daily home hemodialysis. Our System One has made the life-saving dialysis process more accessible to chronic kidney failure patients, allowing patients and their families to have more freedom and improved quality of life.”
In selecting the winners, an independent panel of judges considered whether the technology truly represents a break with conventional methods rather than just an incremental improvement. The Wall Street Journal received more than 600 applications from nearly two-dozen countries for the awards event.
The NxStage System One is the smallest, commercially-available hemodialysis system. It is portable, allowing patients to travel, and is easy to use by patients with their trained partners. Unlike traditional dialysis equipment, the NxStage system plugs into standard electrical outlets and requires no special infrastructure to operate, allowing patients to use it in their own homes. The personal freedom that NxStage therapy offers patients makes it an attractive alternative for many of the estimated 300,000 people in the United States who live with chronic kidney failure and are treated with dialysis.