The reported benefits of home haemodialysis may not be experienced by all patients.
Despite the health benefits that more frequent home haemodialysis may provide to those with chronic kidney disease, this form of therapy is not for everyone. Please review this information carefully and discuss it with your patients as you evaluate their therapy options.
Personal and Partner Responsibility
Home haemodialysis with NxStage requires a patient and partner who are committed to being trained on and following the guidelines for proper system operation. If your patients choose to do more frequent home haemodialysis, they will be responsible for complying with their dialysis prescription, which may require treatments up to six days per week. Each treatment can take about 2½ to 3 hours or more including set-up and tear-down.
If your patients choose to do home haemodialysis, your patients and their care partners will need to take on the responsibility for tasks that would normally be taken care of by center staff when receiving treatment in-center. Patients will need to perform all aspects of the dialysis treatment from start to finish, including setting up the dialysis equipment, cannulation of their vascular access, responding to and resolving all system alarms, and system tear-down at the end of treatment.
In addition, patients must monitor their blood pressure, ensure that proper aseptic technique is followed, and follow all of the training material and instructions given to them by their training nurses. Your patients and their care partners will also be trained on and need to know how to respond to any health emergencies that might happen during treatment at home, including dizziness, nausea, hypotension (low blood pressure), and fluid or blood leaks.
To do home haemodialysis successfully, patients must take care to ensure that they have a clean and safe environment for their treatments. They will also need to set aside space in their home for the needed supplies.
Risks Associated with All Forms of Haemodialysis
All forms of haemodialysis, including treatments performed in-center and at home, involve some risks. These may include high blood pressure, fluid overload, low blood pressure, heart-related issues, vascular access complications, cramps, backache, headache, dizziness, nausea, an “off” taste in the mouth, fatigue, fever, chills, joint pain, itching, seizures or sinusitis.
All haemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their haemodialysis treatments.
Risks Associated with More Frequent Home Haemodialysis
Studies suggest that patients performing more frequent home haemodialysis may experience slightly fewer complications associated with their treatments, and actually may enjoy improved clinical outcomes. However, there are certain risks unique to treatment in the home environment. Treatments at home are done without the presence of medical personnel and on-site technical support. Patients and their partners must be trained on what to do and how to get medical or technical help if needed. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks.
With more frequent home haemodialysis, patients and their care partners would be taking on a great deal of responsibility, but many NxStage patients feel that the benefits of this therapy are worth taking on these responsibilities. Thousands of patients are performing more frequent home haemodialysis with the NxStage System One and are enjoying the health benefits, improved quality of life, and additional freedom it can provide.
When performed correctly under the direction and with the support of a medical care team, more frequent home haemodialysis with NxStage may offer tremendous health and quality of life benefits. Talk with your patients about the risks involved and how they might apply to them – and to determine if more frequent home haemodialysis is right for them.
Increased Risks Associated with Home Nocturnal Haemodialysis Therapy
The NxStage System One may be used at night while the patient and care partner are sleeping. Certain risks associated with haemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep.
Treatment with nocturnal therapy may require adjustments to medications, including but not limited to iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders. Talk with your patients about the risks and responsibilities associated with home nocturnal haemodialysis using the NxStage System One.