To Gus Nxstage Questions

Gus, Is the nxstage transportable? Could you do night dialysis on the machine. Which machine appeared to be faster setting up Askys or Nxstage?
Is the Nxstage self cleaning like the Askys. What did you see as the biggest drawback to the machine?

Does the NxStage reuse its blood tubing set and/or kidney?

Is it true that the NxStage uses pre-bagged dialysate? If so how much dialysate is in each bag? and how long does each bag last (dialysate flow rate)?

Is the NxStage approved for home use or would you go home as part of a study?

Thanks for sharing.

Marty@ Yes, the NxStage system is very mobile…only weighs 70lbs and fits easily in the trunk of most cars…if you mean Nocturnal dialysis I doubt it as it has not been tested for that. NxStage is faster to setup than Aksys as it can be setup anytime you want whilst Aksys requires it’s cleaning cycle to complete its process…NxStage is not self-cleaning like the Aksys system…probably the the biggest drawback of having the NxStage system is having to deal with the supplies needed…for instance, it requires 5litre dialysate bags to have dialysis…some people may require more than just one 5litre bag…now how many do you need for a month’s supply? :roll:

The other drawback are the plates…(integrated dialyzer and lines) though they slide in quickly the number of plates needed per month for daily dialysis is amazing…my garbage can is gonna fill quickly… :roll:

Now if you wanna take a quick one week trip without hassle then you’ll prolly need enough room to carry the extra supplies.

The NxStage doesn’t require water and only requires electricity and drain…and of course a very energetic person… :smiley:

Bill Peckham@ The plates (integrated tubing and dialyzer) is onky used once. Each time you have dialysis you use a new plate…NxStage does use pre-bagged dialysate ready for use from the NxStage company…5litre per bag…the higher the flow the quicker it will empty…so in most cases a bigger guy needs 2 bags and if needs a higher flow to remove more waste then he’ll prolly need a 3rd bag…

NxStage is for dailyhome, However, training is required in center and for a more experienced patient it may probably take 2 1/2 weeks then they let you go home under te study… :slight_smile:

Gus, thanks for taking the time to answer my questions. When it comes to the actual work the patient has to do; do you see much difference between the 2.

Gus, in your opinion would a machine like this be a good deal for a pt. like myself who has their own well and septic? HOW energetic would I have to be lol Thanks, Lin.

Marty@ No problemo, that’s what this message board is all about…anyway, between the NxStage and Aksys the actual work needed to do for each differs…you will be doing more work with NxSTage than Aksys…

Aksys requires changing lines and dialyzer about once a month or when needed…whilst NxStage uses new plate (lines & Dialyzer) everytime you dialyze…the supplies needed for Aksys to operate is far less than NxStage…

Lin@ Well, I think it depends, as NxStage does not require water and only a drain/electricity is needed so I don’t see why you wouldn’t be a good candidate…when I say energetic I refer to a person on the go or wants to travel alot or even a person using a motorHome…traveling alot would require you to have good contacts with the company for your supplies and of course having backup storage on hand., but having NxStage just in home without traveling works well to…I kinda look at it as like having CAPD…it uses large bags and doesn’t require water…

Thanks for posting the info Gus.
I noticed that the NxStage is not listed on the Dialysis Central manufacturers’ machines list. Here is their URL:

and the link for info on the machine

I think this machine would be a good addition to the Northwest Kidney Centers’ home hemo program. I know that in the '70s NKC home patients could use one of two portable units - Ready machines. Maybe having the opportunity to borrow a personal, portable hemo machine would be a good incentive to get people to give home hemo a close look.

Bill, Gus, Do either of you know how the cost compares with other dialysis machines now being used in home? I know cost of providing programs is definatley a factor, and well guess I’m thinking ahead trying to overcome obstacles before they happen; if for instance they tell me I have to pay extra, or that it’s too expensive just wondering if it would be practical to pitch such a machine. The last unit was an FMC so had their own machines, but others have to purchase them from FMC so I’m sure it costs plenty. I was told by head tech in first unit what the in unit type of machines went for, and I all but went into cardiac arrest!
Bill, do you know why they stopped using the Redy machines? Thankyou. Lin.

As far as I know NxStage design is meant to cut costs down…whilst Aksys increases the patient’s costs up…all because it needs to be on 7/24 using water and electricity around the clock…

As for the clinic providing you the support services I am not sure about what kinda costs they will deal with…most likely alot less than in-center hemodialysis…but again this is daily home dialysis so medicare don’t pay daily dialysis yet…

Another nice thing I would like to know is whether NxStage is capable of being used every two days or even the 3x a week therapy at home…that way medicare will pay for those days…but again, the point here is to use it everyday.

Thanks guest. I too wondered about the per tx fees, reimbursment ect…
I wish the fees were a per week setup perhaps, or something whereby the centers would just get paid their rate and home pts. could do their own thing, daily if they wanted ect… Lin.

The thing I would keep in mind is that both NxStage and Aksys built and priced their machines to be used more frequently in the current reimbursement framework. My provider gets the same total monthly reimbursement whether I dialyze three times a week incenter or at home every night and there is no way my provider could do that if they lost money when I treated daily. So I guess I would have to say that I have confidence that both machines are economically viable (from the provider’s perspective) under CMS’ current 13 times a month reimbuirsement policy.

From the patient perspective no question the Aksys uses water - about 180 gallons a day near as I can tell from my water bill but I have the number of people in my household changing alot so that is just my best guess - and the NxStage uses no water. And the electric use I suppose but really I have not seen too big a jump in my bill - maybe 15 dollars a month. So I suppose it could be 10 less with a machine that was on only during treatment.

The one cost not mentioned so far is waste disposal but my understanding is that in most places whether you have one or two garbage cans it is the same price. Here in Seattle there is a significant difference in garbage rates depending on how many cans you use.

Good question - can the NxStage be used as a three day a week home system? For the Aksys the answer I have heard is no.

Lin that was before my time but what I heard was that the Redy did not do a great job removing waste it did an okay job with fluid but this was also before the technology to control fluid removal was advanced so I heard the Redy was kinda touchy. I know the home patients with access to the Redy at NKC loved having the option but in the end not many programs used the technology (I think one proposed use was post disaster which never really came up) so not enough were sold for the company to keep producing and servicing them. The patients I’ve talked to who used it - Mike Matson used it on a five day Snake River raft trip in combination with a generator - were happy with it figuring even if it did not do that great a job it would be fine for a week or two.

I hope the NxStage can fill the role that the Redy filled.

Oh Bill, me too! As always thanks for the information. Not sure I would like to go rafting, but would like to be able to visit son and dil in Baltimore perhaps for a long weekend, without the hassles of finding a center ect… Would like to check out Johns Hopkins; son is grad. student there. I don’t travel much, but the travels you’ve posted about sure do get me thinking it might be fun to do. I’m hoping for a machine that I could perhaps put in a backpack or carpet bag lol I’m hoping that if the companies are again making these types of machines, that perhaps they have info. we don’t, perhaps that home hemo needs to be both accesible and financially possible! Lin. (I’ve got front teeth, so all I want for Christmas is home hemo and to be free to travel like Bill)

Anyone know if there is a reason this machine wouldn’t be good for in-center use. From the outside looking in; seems like a machine using no water, and so small would be a benefit to centers more space and less cost.

I am starting training for home hemo next month. When I read about this machine on this website I went to their website and clicked on contact us. I emailed them a quick question about whether the machine was suitable for slow nocturnal and when they expected to be approved. Imagine my surprise when, within an hour or so I had a CALL from a representative who was able to answer many of my questions. I would suggest anyone who has questions do the same.

Right now they have what I believe is “off-label” approval for home dialysis IF your doctor prescribes it. They do require that you have a partner which left me out, although that might change in the future. They do not have a heparin pump but he said they have been trying slow dialysis with the machine using different protocols in the hospital or in center, can’t remember for sure, and they hope that it will work for that.

Since I haven’t yet started I’m not completely sure about the supplies, but it does sound as if it would be a similar amount as the Fresenius machine uses. The cartridges do not sound as if they are very large. Pump speed goes up to 600 so I’m guessing that it could easily be used for 3x a week dialysis as well as daily short, but not easily daily slow as of yet.

Please contact them for more complete information, they are very willing to answer questions!!

Great info Cathy. I too am always surprised when I get promptly called back (or emailed) by a real live human. When you wrote “that might change in the future” did you mean your situation or the company’s requirement?

Wow, they’re up! That was quicky…

As far as I know the company can’t promote self-use…it is recommended that you have a partner but if your capable enough to do it yourself it is very important that there’s people where you live or available each time you dialyze…it’s a matter of security and assurance that you will be okay…

No company nor the clinic cannot take responsibility of any death caused by misuse…

On the other hand, I am glad NxStage site finally sent live! I read that they have 2 options for the cartridges…with dialyzer embedded or without, which I assume we have the option of using a brand name dialyzer like Fresenius…

To me this machine looks very capable of doing 3x a week therapies, so it looks like there’s enough options to go around? :smiley:

No company nor the clinic cannot take responsibility of any death caused by misuse…

Actually my center is allowing me to do home hemo without a partner. They are only requiring that I do slow nocturnal as they say in their experience there are more negative side affects (blood pressure flucuations and cramping for example) with the fast daily.

I also know that there are many people doing home hemo without a partner in other areas of the country, some are doing short daily, so it is up to your center’s discretion.

With regard to my comment about it maybe changing in the future, I am assuming that possibly after the Nxstage machine gets more users and more history and my facility becomes used to the machine they may change their minds and allow me to use it without a partner or if it becomes available for slow nocturnal.

Two years ago when I was first told to be ready for dialysis within months my neph looked at me like I was crazy when I asked to do slow nocturnal home dialysis, now I am starting dialysis with this option, so I prefer to keep positive and live with the options that I have currently, but keep trying to optimize the options to best fit what I want. I don’t talk no for an answer without questioning it and researching it thorougly.

Actually my center is allowing me to do home hemo without a partner.

The center where I am located also says the same…BUT they also say it is important that there’s people around you while you dialyze…

2 weeks later it would be horribly sad to hear news of patient found dead near a NxStage machine because he/she didn’t have people supervising…

Unless, they add the rule of requiring “LifeSaver communications” for self-care users…or even a monitoring system via GPS… :stuck_out_tongue:

Actually I could be found dead 10 days later whether or not I am on a dialysis machine. The question is how much risk is there to dialyze alone, and I personally have determined that it isn’t that high and my health will actually be better doing daily dialysis than it would be if I were to do just 3 short treatments a week.

FWIW it doesn’t matter which machine I use. Fresenius has the ability to monitor the machine remotely, but mine won’t be hooked up to any monitoring. I believe there are special alarms that will go off if they detect moisture (bleeding) which would wake me if asleep. I apparently will have no higher a chance of a heart attack on the machine than off. I don’t think they have found the monitoring to be worth the cost. I won’t be using the Nxstage although I am looking forward to it hopefully being available in the future to allow for easier travel.

I don’t mean to sound argumentative, however, there are many single people suffering with ESRD, and I want them to know that as long as they are in generally good health, home hemo can be an option for them too. Sure I wish I had a partner to help with this, but ya can’t have everything. Be thankful and appreciative of your partner!!