Nocturnal Home Haemodialysis Therapy

Extended Treatment Options for Home Patients.

Home nocturnal haemodialysis is designed as a simple and practical extended
therapy option for patients.

Duration matters, even with more frequent therapy:
  • Improved survival
    • Performing more frequent nocturnal haemodialysis has shown similar 5-year survivability rates as deceased donor transplantation.1
  • Better cardiovascular outcomes
    • More frequent haemodialysis is associated with less dialysis-induced cardiac injury.2
  • Improved phosphorus control and middle molecule clearance
    • Compared to conventional thrice-weekly in-centre haemodialysis, nocturnal haemodialysis is associated with improved control of hyperphosphatemia, in addition to significantly higher total cleared volume both in phosphorus and β2 microglobulin.3,4
  • Improved energy and vitality
    • More frequent dialysis, during the day or overnight, may provide significant and wide-reaching therapeutic benefits.
      • Quicker time to post-dialysis recovery5,6
      • Less dietary restriction7
      • Better blood pressure control with fewer antihypertensive medications8,9
Risks and Responsibilities

Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. Home hemodialysis with the NxStage System One requires a patient and partner who are committed to being trained on and following the guidelines for proper system operation.

The reported benefits of home hemodialysis may not be experienced by all patients.

The NxStage System One is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set.

Certain risks are unique to the home. 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.

Certain risks associated with hemodialysis 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.

Patients should consult their doctor to understand the risks and responsibilities of performing these therapies using the NxStage System.

References:
  1. Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919.
  2. Jefferies et.al. Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (Myocardial stunning). Clin J Am Soc Neprhol. 2011;6(6):1326-1332.
  3. Raj DS, Ouwendyk M, Francoeur R, Pierratos A. ß2-Microglobulin kinetics in nocturnal haemodialysis. Nephrol Dial Transplant. 2000;15(1):58-64.
  4. Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012;23:727-738.
  5. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531-539.
  6. Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R, Daily Hemodialysis Study Group London Health Sciences Centre. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006;1(5):952-959.
  7. Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis. 2003;42(1 suppl):30-35.
  8. Jaber BL, Collins AJ, Finkelstein FO, et al. Daily hemodialysis (DHD) reduces the need for antihypertensive medications. Abstract presented at American Society of Nephrology Conference, October 29, 2009.
  9. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemo Int. 2015;19(3):386-401.
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