NxStage System One Enhancements

The latest Nxstage Sytem One recieved an update which has improved and added more features…with an embedded computer and communications ports like USB jump drive, lan, and telephone connections makes remote managment and data collection part of this major update. The power supply is now embedded as well…another change are error reports and air removal management system making air removal and control alot easier for patients to manage on their own…I just wonder if I can connect my laptop computer to it and manage how it behaves and operate or perhaps be able to automatically record reports digitally… :smiley:

Very nice Gus! Is this a brand new machine or were they able to make adjustments the present machine?

This is a brand new machine…it was swapped over the old one. The old one is then sent in for re-manufacturing and placed in circulation…

Gus are you using the NxStage Dialysate Preparation Module that was recently approved by the FDA?


No, not yet…numerous updates and improvements are being made at this moment including a newly designed dialyser which should be fully in use by the end of the year.

Whats interesting for the Dialysate preparation module is that all those small white boxes with dialysate bags being shipped may be a thing of the past somtime soon…

Nah, all it means is that they will be replaced by boxes of acid and bicarb, and your space will be taken up by an r/o machine with all it’s testing and cleaning requirements. Stick to the bags!! I hate the r/o but know it is a necessary evil.[/quote]

Speaking of R/O’s, mine conked out on me just after I had setup my machine last night. It just totally died, and I had to miss that treatment. Luckily, they were at my house with another one in the morning. I was a little worried missing a treatment because I had gone a little overboard on the Tex-Mex food that day :slight_smile:


I don’t have the full information but I think this module is all newly designed…the patient will not do any mixing at all…its fully contained…not sure how long it needs maintenace but suppose to self operating…it must work similiar to Aksys PHP system…dunno, but I do know it will be quite cool… 8)

Sounds good Gus. I don’t have to do any mixing at all with my setup (and I think Cathy’s is similar, from the sounds of it). The acid and bicarb concentrates come premixed, in 4.5 and 7 liter jugs. No mixing whatsoever (except the addition of phosphorus and other electrolytes if necessary), but it does take up a lot of storage space. On the days when Baxter delivers the 20 or so boxes of concentrates for the month, that’s when I wouldn’t mind having a system like NxStage or Aksys :slight_smile:

Actually, although Pierre and I do use the same machine, the Fresenius 2008K, I do do a little mixing, I have to add a small carton of bicarb to a jug of r/o water, otherwise I just hook up the jugs of bicarb and acid to the machine and it does all the mixing. Do not be surprised if you find that you will have additional water testing to do to ensure the r/o is working properly and water is not contaminated (I check ph, hardness, free chlorine and total chlorine as well as double checking the conductivity), and that you will need supplies so that the machine can make the dialysate, there is a lot more to it than simply water.

The benefit of this is that my bicarb comes in two small boxes a month, so I generally only have around 13 boxes of supplies a month.

Hi Cathy

I guess we shouldn’t complain about supplies though. PD people have at least as many :slight_smile:

I only have to test the water from the carbon filters for chloramine, nothing else, except after the day I disinfect the R/O. Then, I have to test it for peroxide. Once a week, I do a chemical disinfect of the dialysis machine, and then the next day, I have to test it for chlorine.

It’s great though. The past 2 weeks, we had 3 birthdays in the family. I ate a lot of stuff I wouldn’t have when I was on 3/week dialysis, including a lot of chocolate cake and ice cream :slight_smile:

Last night, I decided to make macaroni and cheese for supper. It was the first time I had that in over 3 years, maybe 4. I’m still on short daily, not nocturnal, but it seems to be enough to keep my phosphorus totally normal. I guess a little residual kidney functions doesn’t hurt.

I’m not really complaining, Fresenius is great and delivers the supplies right to my closet, they do all the heavy lifting.

I was complaining about the water testing lol, and am extremely jealous that you don’t have to do all the daily testing I do, I have the same weekly and monthly disinfecting and testing.

I do think Gus will probably have my testing regime since we use the same company, different locations. If he doesn’t then I hope he posts so I can complain to my unit lol!!

More great news with NxStage…

I have now started using the new CAR-160 dialyzer for the 5th time and my labs showed even more improvement!

My KTV jumped to almost .6 !!! from about .4 …

Cathy@ Low blood pressure has been solved for me…I now only dialyze about 2 hours, sometimes 2:15 …not 2:30 anymore, simply was getting too much dialysis…


When i used the new kidney my time also went down… I struggle now to do two hours… They keep having me lower the filtration fraction. I run now about 1:55…with me “playing with the numbers”

I have been very impressed with nxsatge. Remember how I said that I was getting those red 90’s during prime? It turns out there was a problem with the machine. The cool thing was is that I connected my machine in the back with the phone line and the nxsatge tecs were able to download my machines activities… while I was on the machine… Cool huh? Long story short I had a very nice tech from Nxstage come to my house and try to fix the problem…although he was not able to. I was given a new machine the same day. So far no more red 90s… Let’s hope never again.


1:55 ?? No way!! :shock: …barely last night I did 2:10 … 8)

Certainly I remember about the red 90… :roll: …I really think that update of adding a phone connector and LAN was quite a really nice move for Nxstage…what’s that mean for us and them? No Delays!…woohooo :stuck_out_tongue:

Am really glad it all went all well for you…nice ending… :wink:

I thought the minimum KT/V was suppose to be 1.2. Is NxStage Users figured differently?

The higher the number the better…everybodies varies…

I worry about people having their time on dialysis cut too much – whether you’re on dialysis 3 times a week or longer. I’ve worked in dialysis since the late 1970’s. People dialysis on 3 dialysis treatments a week in the 1980s had their time on dialysis cut to <2 to 3 hours with better equipment and more efficient dialyzers. They believed they were getting a break and loved not having to sit in a dialysis chair 4-5 hours.

Around the same time Medicare started paying a bundled payment for dialysis and dialysis clinics needed to fit more patients into a routine dialysis day and they started reusing dialyzers to make ends meet. Once Kt/V was measured, it was obvious that patients were not getting enough dialysis and they didn’t do as well. Then there were guidelines that said that the delivered Kt/V needed to be at least 1.2. What people seem to forget is that this number is the floor, not the ceiling. I’ve heard doctors say that you can never get “too much dialysis.” If the kidneys work 24/7, how could anyone get enough dialysis in 9-12 hours a week whether it is done 3 times a week or 5? Personally, I think we put too much faith into Kt/V. Kt/V is the best measure we have of dialysis adequacy today. In the future I bet they will come up with something that will provide a more precise measure of dialysis adequacy.

Although you should be able to tell what the coefficient of the dialyzer (K) is since the manufacturer provides that…at least when it’s new…and you should know the number of minutes (t) that you did dialysis on the dialysis treatment you’re measuring, but how the heck does anyone really know what a patient’s actual body volume is (V)…as far as I know this is a guesstimate. Even assuming that all the figures are right, Kt/V is only measured for one treatment. There is no measure of dialysis adequacy over a longer period of time, like the Hgb A1c measures a diabetic’s blood sugar control over a few months. If there was, it would mean no one could “game the system” by making sure that dialysis time on the day that labs are drawn is what it’s supposed to be.

Bottom line…the better the dialysis adequacy, the better your chances are of staying healthy, out of the hospital, and living a long and full life. We’ve heard on this board and I’ve heard it from people in my area who do nocturnal dialysis 5 nights or more nights a week that they have few if any dietary restrictions and they take fewer medicines. I suspect this is because they get more hours of dialysis weekly–closer to normal kidney function.

Now if they could just perfect nanotechnology so a small artificial kidney could be implanted in your body and filter the wastes into your bladder just like your normal kidney 24/7 without needing to be replaced or replaced very often…

At the risk of highjacking someone else’s thread, or being accused of horning in on someone else’s private discussion (come on guys, lighten up! - I think you guys may be getting too much dialysis, or maybe not enough), but in response to Dori’s message…

As you know, I’ve gone from 3 times per week, to short daily, to daily nocturnal - in that order, and without interruption. In my humble opinion, there is no, absolutely no substitute for time on dialysis. Frequency is good, but it is no substitute for time.

Short daily hemo

More often is better. I found short daily was better than 3 times per week, but not dramatically so. I did short daily for 3 months. During that time, my TUMS were reduced from 3 times per day to just one once a day. My BP did not normalize without meds. My diet liberalized, but I still had to keep on eye on fluid. You can only remove so much fluid in a 2 hour treatment. I felt better, but it was a real pain in the you know where doing dialysis 6 days a week during the daytime or evening. It felt overwhelming. At the time, I thought it was better, but I still hadn’t experience daily nocturnal hemo.

Daily nocturnal hemo

Daily nocturnal is very much like having a kidney transplant, but without the anti-rejection meds. I’m not exaggerating when I say my BP is better than normalized without any medication (for the first time in 20 years). I need no phosphorus binder at all - none. I can eat and drink whatever I want. Instead of limitations, I have reverse limitations. By that, I mean that instead, I have to ensure I eat enough of various things, including sodium and phosphorus. And, if I just left it to thirst, some nights, I could easily end up with not enough fluid to remove (it has happened).

Can you imagine being called by your renal dietician a few days after your latest labs specifically to be told to eat more phosphorus, with suggestions of eating more cheese, ice cream and drinking more cola? This is exactly what happened to me after a single week on nocturnal. While I’m still on the smallest possible dose of Eprex, I could probably do without it. My hemoglobin is the highest it has been since before I had more advanced chronic renal insufficiency. My doctor was even going to increase my weekly dosage interval to 2 weeks, but decided against it for the time being. I think she wants me to enjoy the extra hematocrit for the rest of the summer :slight_smile:

All across the board, my pre-dialysis numbers look much like they would have 5 years before I was on dialysis. It’s that good. So far, I’ve pretty much found it impossible to out-eat the daily, long dialysis.

Now, there still are limitations to some extent. Dietwise, while I haven’t been told to do so, I find that I still keep a mental count of my potassium intake. I don’t think I could eat too much potassium in one day from the end of one nocturnal treatment in the morning to the beginning of the next in the late evening, unless I made a real effort to do so. But, since potassium is the one immediate threat for any dialysis patient, I still, perhaps from force of habit, don’t go overboard with potassium.

In terms of fluid, I have no limits. So far, I’ve found even 4 litres easy to remove on nocturnal. I mean, with 7-8 hours of treatment, you’re still looking at removing less than 600ml per hour. There is a practical limit though. If I end up having to miss a treatment, for whatever reason, and I’m already more than 2 litres overweight, the next day, I have to limit my fluid more. This is because, while the dialysis itself can remove the extra fluid without any problem at all, my body doesn’t really feel well with fluid beyond 2 litres or so over.


The only disadvantage of daily nocturnal hemo is that you have to keep doing it. It’s not like you can take a vacation from it. And even if you could, say by reverting to 3/week hemo, you wouldn’t want to. Let’s face it, it’s a bitch to have to setup and get on treatment by yourself at 10pm or so, when you’re starting to feel sleepy. You don’t want to get on much earlier than that, because if you do, you will have to get up too early in order to take yourself off (but since you’re doing it, you do have that flexibility if you want to make use of it). So far, when I’ve been feeling too sleepy to start, I’ve been able to give myself a boost with a good strong dark roast coffee. I only like strong dark coffee anyway, so, to be honest, it’s not exactly a sacrifice.

It did take me and my body a couple of weeks to get used to it though. You can’t toss and turn on nocturnal. You have a variety of available sleeping positions, but if you toss and turn too much, you will definitely be wakened by pressure or TMP alarms. It is surprising how our bodies adapt to things though. I have no problems with this at all now. People ask me constantly how I manage to sleep hooked up to a machine like that. Well, I just do. I even have somehow gotten into the habit of waking up with just 1 minute left in the treatment. Sleeping through a whole treatment seems a lot shorter than even a 2 hour daytime treatment.

Dori talked about kt/V. You know, some nephrologists who have experience with daily nocturnal hemo feel that, while kt/V is great, it’s not that meaningful. Nobody really knows what kt/V means in terms of daily nocturnal hemo. Daily nocturnal is almost like having functioning kidneys for a third of the day, in many respects.

I do think a person can get too much dialysis. True, native kidneys work continuously, but what they also do is to constantly adjust what they do to what the body needs at any given time. With dialysis, you only get what you get. With the long, slow daily nocturnal treatments, you’re mimicking as much as possible the slow shifting of various things from cells to bloodstream. This is something that short treatments cannot do. With daily nocturnal as it’s currently done, you run your dialysate at 300, and your blood pump at 200-300. Plus, many people run with a bicarb of 32, and, a potassium of K3. This makes a world of difference. You get up in the morning and you don’t feel like you’ve even been on dialysis at all. Gentle is the operative word here.

Another thing I would not dismiss entirely is the matter of risks. We have discussed the risks of home hemo ad nauseum on here. Basically, I know there are some added risks, but I feel they are minor in comparison to the benefits of daily nocturnal, and besides, they aren’t much different than the risks at the dialysis centre - except that you do dialysis so much more often and longer.

As I said at the beginning, there is just no substitute for time on dialysis. But long dialysis sessions can be very hard on the patient. I mean, I even found it unbearably long to sit there for 3-1/2 hours. Daily nocturnal solves this by having the patient sleep through it.


Oops! That was me as guest above. I thought I was logged in, but I guess I wasn’t.