Thanks Dori, that WAS the one.
This post originally appeared in the more ‘modern’ Facebook version of the HDC Message Boards, and there are a couple of references within it to ‘Ian’ and Peter’ who had posted prior comments, to which I was responding. These, and a couple of unfixable typos aside (I can’t re-edit the answer I gave (above) that Dori has very kindly copied in for you) - and the post still stands, as I think it should.
In essence, the NxStage is a nice machine. It does offer portability - though that portability is still not simple and easy for many - and it is undeniable that the NxStage ans its (now three) delivery systems has transformed home care in the US.
But, any machine can do home dialysis. Any. Home care is not machine-specific (as you, in India, and we, in ANZ, well know). However, as a result of a great little machine and some very smart and largely unopposed marketting, many in the US seem to almost equate home dialysis with one single machine option - the NxStage - and, to be fair, this is not the case. There are sacrifices … especially to optimum middle molecular clearance and also, potentially, to fistula integrity … that I believe that a person who uses the NxStage must accept as the ‘down-sides’ of its use. To be equally fair, there are just as key a set of down-sides to the use of single pass systems like the Gambro or Fresenius systems - lack of mobility/portability and, as you rightly point out, the difficulty of holidays … and to some users, these deficits may well outweigh the NxStage deficiencies.
Fair enough, I say, fair enough. But, no system delivers all optimums. Not one. What you gain from some, you lose with others. That’s my point. My whole point. Know what you gain - yes - but also understand what you might lose … then make your decision about what is important to you.
Here in Australia, broadly - but not exclusively - most services have chosen to stay as we are and have been … for the main part, for the reasons I have given. But, I believe, we would also be very unwise to exclude the NxStage here, as some may make the choice for mobility (like Trevor and Maz … the original ‘posters’ of the thread at the Facebook site I commented on … who were Australian, and who were strongly supporting the mobility aspect of their NxStage system).
I think all systems have their place, have their strengths, and have their weaknesses, and all should be ‘available’, I simple seek to ensure that all home patients understand - and should be educated to understand - that no one machine does it all.
If mobility is your absolute ‘key’ requirement … fine. But, understand what you may lose.
If optimum dialysis and fistula longevity is your absolute ‘key’ must-have … also, fine. But, understand what you may lose.
Sadly, at least at the moment, I fear no system caters yet for the extremes on both sides of the coin.
While we ought, as providers of your care and as a profession, should be in a position to offer all choices, we, too, are entitled to have opinions, biases, and beliefs. And, these opinions, biases and beliefs should and do carry weight with, and influence the direction that home care has taken in different parts of this weird and variable world we live in.
It is the interface between all these sometimes competing variables that we must manage and negotiate, as best we can, till even greater choices unfold, choices that will hopefully solve some of the current apparent impasses that like me prattle on about.