Probably there has been a thread on this, previously, but I don’t have time to go back and look for it. Would like to review personal experiences of ppl who have used each machine as to which machine they feel was the most patient-friendly and offered the best tx options. The NxStage appears much more versatile than the AKSYS. What are your opinions? And please remind me, are both designed for daily dialysis only and what is the length of time they can run, dialysate flow rate, dialyzer used? How does the NxStage compensate for not having a sodium modeling feature…is it unnecessary on shorter runs?
[b]I haven’t used Aksys yet and almost did as it was my first and only choice but was introduced to NxStage by the WellBound clinic head nurse…I’ve dialyzed for many years now and I did my research between both machine features…I gathered data from my past dialysis exeperiences and analyzed the current features of both Aksys and NxStage…
Based on my findings, NxStage System One met all my expecatations…ease of use, flexible schedules, small & lightweight, no R.O. required…it doesn’t need sodium profiling as it already comes with pre-mixed Ultra Pure dialysate which already is balanced with the right sodium for you so you rarely will ever need saline during treatments…both machines are made for daily hemodialysis and both do their job right but both differ in size and the way they work…though NxStage is small it’s capable of long treatment hours and and volumetric control, just like the large in-center machines…you can travel with NxStage to…there’s many more things that can be said but really it boils down to patient preference…what are your expectations for a home dialysis machine…there several important factors to consider…ask yourself…will this machine keep utility costs down? Will this machine be easy to move around and fix? Is this machine too complex for me? Do I have anough space to accomodate the machine and supplies? Do I want less setup time? Do I want flexible schedules? …try to jot down all your questions about what you want and research and compare existing problems you may have with the options you have…then you can determine which machine best fits your needs…I also would recommend to call your nearest WellBound clinic and setup an appointment to go see both machines in person…that’s what I did before making a choice…being there and seeing the machines in person is not the same as virtually seeing it over the net…[/b]
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I haven’t talked to anyone who has used both machines. To me, as an Aksys PHD user, the NxStage’s biggest selling point is its portability. My ideal scenario would be if I could use the Aksys at home and borrow a NxStage when traveling. To me issues like water usage or storage are peripheral to clinical issues. Clinically both machines are too new to have enough published data to draw any conclusions.
On paper I like the features of the Aksys. The Aksys reuses the F-80 kidney and blood tubing set which allows a protein coat to develop on all the surfaces. There is not very much information on what role different aspects of the dialysis treatment play in chronic inflammation in dialysis patients but both machines try to impact chronic inflammation by using ultra pure dialysate. The PHD goes further but there is no data on the over all long term impact of lowering the body’s inflammation response and there is even less information on how much of the inflammation response is triggered by the blood’s contact with the blood tubing and/or kidney v. the impact of dialysate purity.
As far as treatment length I have dialyzed daily for 8+ hours on the PHD and experienced the same sort of impacts reported by people dialyzing on a standard machine daily, nocturnal. I was able to enjoy dairy products while at the same time not take any binders. As it is I no longer take blood pressure meds or need EPO on the PHD, so there was no change when I increased my treatment length. The one person I’ve talked to who used the NxStage for nocturnal switched back to her standard Fresenius machine because she says she was not getting enough of a dose nocturnally on the NxStage. So there is a question in my mind “How would 3 hours on each machine stack up against 3 hours on a standard machine?” and “How does 8 hours of dialysis on each machine stack up against 8 hours on a standard machine?” In other words how much bang does each machine give for each hour of dialysis? I think it will take time - years - to answer these questions, for instance I’d be interested in the EPO usage rates for users on the various machines and the impact of treatment regime on EPO use. Until we get more data I think only one thing is clear: that dialyzing more frequently on either machine is healthier than dialyzing 3x/week incenter.
It is hard for me to address the backup issue. I have not had many machine problems over the last year - none for months. I’ve had to dialyze incenter for iron but my PHD just chugs along. With the NxStage the swap out strategy sounds good, I guess you’d have to live in an area served by FEDex’s next day service but the swap out strategy would work in my area. With the PHD you’d want to have a local tech but then again progress requires people willing to be first so there is value in pushing the envelope, expanding the dialysis options for the other dialysis consumers in your community.
Both machines are new enough that today’s users will be advancing knowledge of dialysis. Good or bad it is the experience of today’s users that will inform tomorrow’s user. I think both companies are working hard to make the healthier alternative of more frequent dialysis available in the US given the constraints of reimbursement.
I believe there is plenty of room in the “market” for both companies. Given the home hemo experience of New Zealand and Australia I think the big issue is increasing the number people doing more frequent home dialysis. I believe completely that if people were given all the information available, had it explained clearly AND had all the dialysis options available in their area, that our home population - PD and home hemo - would be much greater. I think that we could get to the point where at least to 30% of all patients starting dialysis in the US start on a form of home dialysis - PD or hemo. And over all there should be at least 10% of all patients on more frequent home hemodialysis. Until the numbers are much higher I will assume that there is a problem in the US with access: either access to information or access to the actual treatments options.
I do think that. That - yes, it is unnecessary for people dialyzing more frequently. I think sodium modeling is helpfull for people with large fluid gains between treatments which should not be an issue for people on more frequent dialysis. And yes both machines are ment to be used for more frequent dialysis.
How long can each machine run at a time?
I use sodium modeling in-center and do not have large gains, so I think there is more of an answer to the question about why NxStage does not have sodium modeling feature.
[b]I use to use Sodium modeling in-center 3x a week and the dosage is rather high…it’s something that should rarely be used but should only be used in serious hypotension…
As previously mentioned, NxStage uses pre-mixed dialysate which already has the balanced nutrients your body needs…this includes potassium, sodium and others…now if you remove too much fluid then you will probably need some fluid replacement so you use saline which also has the right amount of sodium concentrate…
Doing daily hemo, you will really feel the difference…no more weight gains like before, no more high blood pressure, no more dragn down and dirty feeling…har har har… :lol:
Your in constant loop with keeping fluids down everyday…you’ll never know till you go for it! …
Today, you see these machines side by side…tomorrow you will see incredible gadgets as never imagined before…
How about HomeHemo on the wrist of your hand? Perhaps Homehemo inside of you? Or…maybe homehemo while you excercise…[/b]
I went to the NxStage website and it does say that it can be used for long, frequent txs. Supposedly it offers the flexibility to get a tx started whenever the user is ready for it which is another plus.
I think I see what Bill is saying about the protein coat, but from what I heard somewhere, the NxStage uses ultra pure dialysate that is a level purer than what AKSYS uses. It would seem that there should be a way to compare the clincial issues of the machines and that this info should be readily available to prospective customers.
Does anyone know what the customer’s committment is to staying with a machine if offered a home program opportunity? It seems some of you have been able to try different machines due to trials or companies that offer more than one model. But I am concerned about being locked into a model. It seems there should be a clause that if the customer finds he doesn’t like the model, he should be able to go to another model. Anyone know how this works?
Re getting off bp meds with more frequent txs, I was able to get off bp meds with short 3x week in-enter dialysis. My first doctor kept me on bp meds, but my next doctor said I did not need them and could of gotten off much sooner.
Re EPO, it seems that stats on EPO usage on the home program machines should be available. Think I saw a chart re patients in the Lynchburg program, for example.
Gus writes:
use to use Sodium modeling in-center 3x a week and the dosage is rather high…it’s something that should rarely be used but should only be used in serious hypotension…
As previously mentioned, NxStage uses pre-mixed dialysate which already has the balanced nutrients your body needs…this includes potassium, sodium and others…now if you remove too much fluid then you will probably need some fluid replacement so you use saline which also has the right amount of sodium concentrate…
I am on sodium modeling every tx in-center. If the bicarb mix produced a higher conductivity, I would not need sodium modeling at all. But since the tech who mixes bicarb mixes it at different rates every tx, I must use sodium modeling every tx to keep from being deprived of sodium, thus put in a crampy state. Why do you say that sodium modeling should be rarely used? My understanding re the ultra pure dialysate is it comes in different mixtures and it is possible to find the exact mixture the patient needs. Can someone give a more technical explanation why sodium modeling is unnecessary when the patient gets the correct dialysate solution?
Gus, Patients that aren’t connected with a home program that uses more than one machine are locked into the machine the center offers. Or go back in-center. Trust me California is about the only state I have heard of where
there are so many choices for patients. The Vast Majority of Patients can’t even get into home programs as no home programs are offered. I agree with Bill I think the percentage rate of home patients would go up should home hemo become more available. I also think the rate may go up over Bill’s 30%. I think the NxStage has the potential to attract more caregivers into dialyzing the persons they are caring for at home. They could bring the patient to their home for dialyzing or they could go to the patients house which ever was convenient. In our corner of the world, most caregivers spend as much time driving patients to the centers as they would doing the treatment. It also seems like the NxStage has an advantage in that you probably can dialyze in any room you choose; just move the machine. Or am I wrong?
Does NxStage program require a helper?
The NxStage site states that the machine can run short or long. But read somewhere that NxStage is not approved for nocturnal. Can someone clarify?
I believe the reason NxStage cannot be used for nocturnal is that it does not have a heparin pump, I guess if you are awake you can inject heparin every few hours to do longer runs.
With regard to “helpers”, it isn’t machine dependent it is clinic dependent, many do not require helpers if you are healthy, compliant and they feel you can handle it on your own. Both Bill and I do home hemo without a helper using different machines, I’m on the Fresenius and Bill is on Aksys.
spiderwomen are you out there? spiderwomen posted that she was switching from daily nocturnal to short daily, it would be great to hear her report. How she felt under both treatments. Daily nocturnal on a standard machine, with a standard dialysate flow rate and blood pump speed, is probably the yard stick we should measure all treatments against, since it seems daily nocturnal is the next healthiest thing to a transplant (maybe better).
Jane I think some of the constraints are center dependent. I agreed to a one year commitment when I first started daily home hemo on the B Braun and then 50 weeks later I started training to use the Aksys. My center generally lets patients make the decision (in consultation with their Doc) about how often, and how long to run but as Cathy said there is a constraint on nocturnal runs with both machines due to the heparin issue.
I think the reason there are not allot of published clinical results is the newness of the machines. And remember, there isn’t even a full blown, double blind study that looks at frequency and length generally. The NIH has a study in the works (I haven’t heard a recent update) that is looking at short daily and nocturnal but really most of the conclusions I’ve drawn are based on my own experience and anecdotal information. My faith in “More dialysis is better; More often is best” is reinforced every time I hear the story of someone who’s life has been turned around because they switched from incenter to home; 3x week to daily. And I also note how few people switch back after trying more frequent treatments - to me that says it all.
Gus which machines does your center offer? Does your center offer a standard machine option?
Jane if I understand correctly you are usiong sodium modeling to trick the incenter machines into having a decent conductivity. I would most likely do the same thing if I had to use machines that ran at a low conductivity. With the PHD my conductivity runs between 14 and 14.2, it is not adjustable. The PHD uses a range of mixes as far as dialysate potasium and calcium so as your labs change you can use different flavors of dialysate. But as far as conductivity I believe that is an internal (or factory) setting.
In regard to the purity of the dialysate my understanding is that “ultra pure” is not a marketing term, it has a specific scientific meaning. So since both machines use that specific term I believe both machine’s dialysate meet the same standard.
The conductivity is a result of the mix of the chemicals and will change depending on sodium, potassium, bicarb etc. The machine can get out of whack and not mix everything completely properly which will affect the conductivity.
On my machine, the Fresenius, on the dialysate screen there is an ideal conductivity based on the mixture shown. Mine with a 142 sodium and 40 bicarb and 3K general bath, should be 13.9 but runs at 14.1 which I like. I felt awful with a conductivity of 13.3 so am very careful never to run that low again.
It is possible that the machine she is running on needs to be recalibrated to get the conductivity up. I have no adverse affects from running at a 142 sodium and my blood sodium is always near the low side and I am not thirsty all the time.
With regard to daily. I have just this month lowered my treatment time down to 4 hours a day from 5 hours, I will get my blood work back in a few weeks and will report if there was any change from my earlier numbers. My pre dialysis, after one day off, at 6 hours a day was creatinine 6.1/BUN 40 and post dialysis creatinine 2.4/BUN 14. Don’t know how that compares to those of you running shorter times. I run at bfr300/dfr600 (now that I am down to 4 hours - had to run at dfr of 500 for 5 hours or would run out of bicarb).
Bill writes:
On paper I like the features of the Aksys. The Aksys reuses the F-80 kidney and blood tubing set which allows a protein coat to develop on all the surfaces.
Other than this feature, is there anything else the AKSYS offers, clinically, that the NxStage does not?
guest writes:
Epo dosage is dropping for me…I’ve started with 10k 2 times weekly to 7k 2 times weeky…once you start on a home hemo program you will start at a decent dosage and gradually will be reduced along the way…that’s if you show improvements in your labs…iron is another thing you’ll be needing, maybe more than the dosage you had for 3x a week
What IV meds are still required with daily dialysis and who administers? I am reading that some no longer need EPO, but what about heparin, iron and vit. D?
I don’t take IV meds except for heparin. If I need Vitamin D it is back to Calcitriol or Hecteral. I did need some iron in the very beginning and they gave me IV iron on 2 of my monthly visits and I took a large dose of oral iron. My iron and sats finally got into a normal range and we have cut way back since I don’t need any epo anymore. With regard to epo I take it (when I qualify) IM which is a better way to take EPO anyway (works better). You use a tiny needle and it doesn’t hurt.