[quote=Bill Peckham;14215]Gus I’m moving my reply to your comment from my boat travel thread to here to try keep things organized.
We’ve had this conversation before, often as part of other discussions but what is your ideal dialysis machine?
Maybe a question in three parts.
First don’t edit yourself: Putting aside what you think is possible engineering-wise what is your ideal machine?
Nano Home dialysis…
Second: What is your understanding of the design trade-offs and how do weigh the various trade-offs that you perceive?
The possibilities are limitless and it just takes a few great minds to come up with a unique home dialysis machine. For someone as myself that has been too long in-center one of the important aspects of home dialysis for me is freedom. The ability to freely move around with my home dialysis machine and the ability to travel with it. The current problems we have with the use of resources and/or disposing of plastics filling the landfill does pose some problem, but I do think those can be addresses with solutions. Nxstage has accomplished a BIG step with its System One but I don’t think that the System One will stay here for long. Nxstage Medical needs to move forward with new ideas that can take System One even further. Baxter already joined the race and I beleieve they’re doing their homework. Am sure Baxter will bring something unique in its own respect, but I don’t think theirs will be the perfect machine…there’s no such thing in a perfect home dialysis machine. However, I do think it may have features surpassing that of Nxstage’s System One unless Nxstage does something quick… size and features matter to me.
Third: What one thing would make your dialysis life easier today?
Nano Home Dialysis…perhaps the size of a blender…hehehe
I agree that BTS remains a great opportunity. Coceptually, suppose you had a separate BTS unit to which you could (for example) connect a NxStage PureFlow line (ultrapure water only) and cartridge saline, effluent, arterial and venous lines after completing a treatment without ever removing the cartridge from the machine. The BTS unit would be charged with an appropriate sterilant and after pushing a button the BTS unity would sterilize the cartridge and lines for reuse. When complete, connect to a new saline bag, reprime to replace the sterilant rinse water with saline and reconnect to the patient for the next treatment!
The water unit seems more difficult. Ideally, it should be continuous flow rather than batch (I offset the R/O waste by having it plumbed for topping off our pool or switching it to water the garden). I agree it should be 1:1. It seems inherently too risky to use random, untested water sources during travel so bags may be difficult to replace for that purpose for single pass dialysis. Multipass technology, like sorbent, is concepually appealing when it is fully proven.
Open source raises liability and risk issues, but I agree it would move the field of home dialysis along faster and at less ultimate cost than purely proprietary systems. Instinctively, companies are programmed in their DNA to resist it. Expousing open source might, however, be a potentially winning strategy for a large, but late entrant into the home market.
If you accept my view that a “swap out” philosophy is crucial, then it seems clear that modularity as you suggest is required to stay below the desirable single unit weight limit.
I’m not quite there yet Mel. It’s compelling but is it the only service model that could work? When I used the B Braun at home for a year it went the duration without needing service. If it’s up to me a clinically optimal, highly reliable machine could be the size of my refrigerator if it was as reliable as my refrigerator; even better if it was as easy to use.
Just think about, we need one size fits all, its economical for a dialysis machine company to create the most economical most effecient home dialysis machine for mainstream use.
I know you may have plenty of room for a refrigerator size dialysis machine in your home, but what about the majority of home patients that have limited space? Do you have the option to choose an in-center dialysis machine over Nxstage? If so, which in-center machine would you choose?
Anyone using the System One has room for a refrigerator sized machine if the supply footprint is included. My primary wish is for the highest clinical quality of treatment - provide that and I’ll find a way to accommodate the machine no matter what its size.
Sounds like you’re describing a transplant … I don’t prefer a large machine but to me the size is less important than clinical effectiveness. All else being equal then sure make it portable but in the real world all else is rarely equal.