We are preparing to initiate a home hemo program and would like to know what machines people are using and why.
Thank you.
Lynn Smith, RN
Hi Lynn,
That’s really good news that you’re starting a home hemo program. I hope you will edit your center’s listing on the Home Dialysis Central database. You might even consider becoming a center sponsor to describe your clinic to patients that are looking for a home hemo program (under support our efforts). Patients on our home hemo message board have moved (one from FL to WA) to get home hemo.
So far as home dialysis equipment, have you looked at the equipment section of Home Dialysis Central? It describes several of the machines that people are using. You might want to read threads on the HD-for patients message board where patients have shared information about the machines their clinics are using. I can remember reading patient perspectives on doing home hemodialysis using the Aksys PHD, B Braun, Fresenius 2008K and NxStage System One. The latter is still in clinical trials and not yet widely available. You might want to attend the Annual Dialysis Conference in Tampa (www.muhealth.org/~dialysis/). This is a great conference for learning what you need to know about home hemo programming plus you get to see home hemo machines.
I would recommend NxStage over Aksys for convenience, ease of training, and travel. I learned it in 2 wks.
I am interested in strarting a daily home HD program at a hospital based unit in a small New England town. I would be interested in learning about the reliability of Aksys PHD from a home clinic nurse and or a nephrologist or a clinic administrator, particularly from a clinic that runs more than 1 PHD.
Do most Aksys PHDs require a service visit several times a month? (clearly some do)
For a small institution with a HD unit at capacity fitting in patients while a technician is traveling acros the country to fix a PHD can be a stong disincentive to offering frequent home hemo.
One of the best ways I can think of to find out about machines is to call the machine companies that you’re considering. Ask for contact information for clinics that have had their machines for at least 6 months. In addition to cost to purchase and operate, some questions that you might want to ask include:
– What machines do they use for home hemodialysis?
– How reliable are each of the machines on average?
– When a specific machine breaks, how responsive is the company in getting the machine fixed?
– How long does it take to train a patient to use a specific machine?
– What company support is available?
– What do patients say about their satisfaction with the machine?
– Is there anything else (pro or con) they can share about the machine?
The Annual Dialysis Conference in Tampa February 28-March 2 will have machines in the display area. Hopefully you or one of the nurses at your clinic can make time to attend this meeting.
Where can I get conference itinery?
Here’s a link to the website that describes the meeting and provides the daily itinerary. The meeting is designed for renal professionals and doctors and nurses from the US and other countries are the ones that are best represented, although some dietitians, social workers, and technicians also attend.
www.hsc.missouri.edu/~dialysis/
as a patient I recommend the NxStage machine by far over the Aksys, which I have not used but am in contact with someone who is very unhappy with it. it runs constantly, using electricity and water in bulk.
the NxStage uses a dialysis solution which comes in bags and does not need water, or a water filtering device such as a reverse osmosis which takes up lots of space and wastes more water than it uses.
the NxStage is small and can be taken when traveling. it is easy to use and the treatments are short.
I did nocturnal dialysis with a Fresenius but I prefer the NxStage.
I like the savings in water and electricity and the peace of mind in doing dialysis while awake instead of sleeping and being wakened by alarms all night.
still nocturnal had its benefits in time saving.
New home hemo machines are in the pipeline and existing machines are being improved all the time. To stay in business dialysis machine manufacturers must listen to its customers. As patients experience problems, the patient and/or his/her nurse should report problems to the company so they can be resolved. It is my understanding that based on customer interest, machines that traditionally have been used for daily treatments are being modified to do nocturnal home hemodialysis treatments too.
So far as choosing a machine, in my opinion, the best way to find out about machines is to talk with customers that have bought the most recent versions of them and even their patients, if possible. Keep in mind that what is important to one patient may not be as important to another. This is why it would be great if dialysis clinics offered more than one machine for home hemodialysis.
I am concened about the limitation of patient size with NxStage. NxStage did not give me a straight answer regarding the maximum size patient I could put on their machine. Clearly there is a limit to the amount of bagged fluid per patient that can be used. Is 30 liters a practical amount to use for each Tx? Will NxStage take on a 250lb patient? I suspect that for a 6+foot tall, 200+lb patient Aksys may be the only daily option and actually QOD nocturanl, as offered by Fresenius in my area, may be the best option.
One of the issues with soliciting testimonial as suggested by Beth Whitten is the high level of patient satisfaction with frequent home Hemo. It is of course a good thing. However, clinical success makes nurses, doctors and clinic managers overlook the little anoyances like dialyzing Pts incenter while an Aksys techinician is on the way at some airport. Or being locked-in into a 5 year lease by Aksys or the demand by NxStage that you get 10 Pts onto thier machine during the first year.
As a patient on the Aksys PHD, I love it, it took less than two weeks to learn and I don’t have to mess with bags, the electricity and water are well worth the convinence. If it does go down the techs are here usually the same day or within 24 hours at the most, and I only need a small area for a months worth of supplies. I love it.
John L
So far as what the maximum patient size is for the NxStage, I’ve heard that in general patients should weight 100 kg. or less. I suspect this is exceeded sometimes.
One of the things I’ve heard is that Aksys PHDs break down less today than they used to. It’s my understanding that Aksys is working hard to listen to customers about things they can do to improve customer satisfaction. Also, I’ve heard from patients using the Aksys that when a technician is in the area and doesn’t have to fly in, it makes repairs easier and faster. I think Aksys is trying to focus on selling machines in areas where they have technicians nearby to provide the best customer service they can.
You might ask Aksys where the closest technician is to your clinic and what the average time for a repair might take.
I have been using the Aksys machine at home for over a year. I think it’s a great machine. It does have breakdowns occasionally but this is
improving all the time. It is extremely easy and convenient to use daily.
I’m getting ready to start using it nocturnally. I love it because it allows me to access daily dialysis which has allowed me to feel dramatically
better than I ever felt on conventional dialysis. I’m looking forward to feeling even better on nocturnal.
Karen L
Who provides the technical support for AKSYS and how are the txs paid for? How will the txs be paid for when you go nocturnal?
Hi Jane,
This question is best posted on the patient, not the professional board. 
Aksys provides technical support for its own machines. Treatments are paid for by Medicare, just as in-center treatments are paid. To learn more, read the patient FAQs on this site–they go into a lot of detail about payment methods. You can find them at:
www.homedialysis.org/v1/medicare/faqs-pat.shtml.