Dear Beth

I am a Dialysis patient at a Center but have been looking into the NxStage System I have been told that Medicare will only pay for this system if you are having problems doing in center Dialysis. I am not having problems persay but I am so tired and drained after dialysis that I usually end up sleeping the rest of the day because it gives me really bad headaches and makes me feel really drained and tired! I am a 34 year old female and have been on dialysis since I was 21 and it really decreases my quality of life. So I was just wondering what the ins. qualifications are to be able to do the nxstage treatments and what if anything there is that I can do to help with this process?

Medicare does NOT require someone to be doing poorly on in-center hemodialysis before he/she can choose to be trained for home hemodialysis. Perhaps what the person meant is that since most people who use the NxStage do dialysis 5 times a week, Medicare will only pay for the extra treatments if someone has problems like large weight gains between treatments, congestive heart failure or some other condition that makes it more difficult to maintain fluid balance and heart health. It’s also possible that the dialysis clinic that you go to is not certified by Medicare to train people for home hemodialysis and the staff have limited knowledge of treatments they don’t do.

Some facilities are dialyzing patients who have Medicare on the NxStage machine and accepting what Medicare pays especiallly if the patient also has a Medicare supplement (Medigap) plan. Some patients may be using the NxStage for longer treatments less than 5 times a week. Most clinics require that patients who do home hemodialysis have a dialysis partner with them when they are on dialysis. You may want to look at the “Find a clinic near you” database on Home Dialysis Central’s home page to see where daily dialysis – the type of dialysis that NxStage users do – is offered.

You might also want to check out the clinics that offer training for nocturnal hemodialysis at home 3 or more nights a week or look for clinics that offer nocturnal hemodialysis in-center which is typically done 3 nights a week. Patients who do this say they feel much better than they did when they were doing in-center hemodialysis 3 times a week and they often have a less restricted diet and better labs.

You might want to read about all the types of dialysis under the “5 types of home dialysis.” Patients who do PD do not generally need a partner and that might be another option to consider.


Not sure where the person is getting their information from who told you that you have to be sick and going downhill in order to transfer to home dialysis with NxStage. That couldnt be further from the truth.

Does your current center offer NxStage? Is there a center near you that offers NxStage? If there is, it would be well worth the switch. NxStage will give you the freedom and ccontrol you do not currently have in center. You should also feel much better as well as better lab results.
The headaches may be something called Dialysis Disequilibrium Syndrom (DDS) otherwise known as a “BUN Headache” which is very common on in-center dialysis. Your body toxins are going from a very high level at the beginning of the treatment to a low level towards the end of the treatment. This is harsh on the body. Its like a roller coaster ride every 3 days.
The only requirements for Home Hemo with NxStage is the will to learn home dialysis and you should have a partner. There is no education level required.
We should all have the option to do whatever modality we choose that is available to us.

Good Luck!!



The “Find a clinic near you” database has outdated information. I live in So Cal and used the tool on the Home Dialysis Central’s home page to search for nocturnal home hemodialysis. Both centers listed as having nocturnal home hemo program do not, I called them to verify. Some of them even said they have never heard of nocturnal home hemo!!! I’m beginning to wonder if home nocturnal hemo is being offered in So Cal, if so where??? I’m looking into alternative modality because PD may not be working well for my husband. I live about 45 miles west of L A in Ventura County. Where can i find information about who offers nocturnal home hemodialysis? Any suggestions or inputs from you would be appreciated.

When the database was initially set up, we had help from dialysis providers to keep it up-to-date. Lately, we haven’t received updates so some listings may be out-of-date or it’s possible that the person you spoke with doesn’t know what home services are offered. When I made calls to confirm services offered I found it was best to ask to speak to the home training nurse. S/he was the most well informed about the services the clinic offered.

In the meantime, here are some phone numbers to call to find out about clinics that offer nocturnal home HD in your area:

  • Fresenius - 1-866-434-2597
  • DaVita - 1-800-424-6589
  • Wellbound - 1-650-830-7954
  • US Renal Care - 1-800-692-9017

Also, you might want to call 1-866-697-8243 to talk with NxStage. It makes the machine most people use for home HD, including nocturnal home HD.

Keep in mind that some patients drive farther to get the type of home dialysis they want. Once trained, they don’t have to travel to the clinic very often…usually 1-2 times a month or less.