I Hate Dialysis Message Board

Dialysis Discussion => Dialysis: Home Dialysis => Topic started by: Bill Peckham on January 15, 2007, 09:06:20 PM

Title: Aksys is dead. Long live Aksys.
Post by: Bill Peckham on January 15, 2007, 09:06:20 PM
My provider the Northwest Kidney Centers (NKC) informed all of their PHD dialyzors that Aksys would no longer support the PHDs currently in use at NKC and those machines would be withdrawn from service by February 2nd. Bottom line for me is I have to reevaluate my options. I have a number of choices to make: Which machine? I can choose between the B Braun and the NxStage. Incenter or home? Hemo or PD for that matter; not to mention frequency and duration. After a relationship ends badly I think it is a good idea to reexamine habits and assumptions.

And that is how it feels - like a relationship ending before I am ready for it to end. Sigh. I guess it is better to have loved and lost then to have never loved. I think tonight when I settle in with my PHD for 2 hours and 50 minutes of alone time, I will be getting the best dialysis minute for minute available. No other machine is offering the biocompatibility the Aksys offered or the other advantages of heat disinfecting and reusing the blood circuit. Advantages such as being able to use more robust materials for the blood circuit since the cost of the tubing could be spread across dozens of treatments.  If it was up to me I'd use the PHD until their new G2 machine came out. Ah, well. The point is moot.

And I canít say it is a total surprise. All the news lately has been bad and while I like what I heard during my visit last month (here is a post on HDC about the visit: http://forums.homedialysis.org/showthread.php?t=1300" target="_blank ), the G2 sounded great but I know that it is a long way from the lab to my house. I hope that their patents and approach will live on under some recalibrated business model. However, there will always be new machines, new approaches; I am in this for the long haul and maybe four and half years will seem like about how long on average it takes for the 'next thing' to come along. What ever machine or modality it is itíll come with new tradeoffs - clinical tradeoffs and logistical tradeoffs; tradeoffs between the clinical ideal and the logistical ideal, with the business calculus the measure of success.
Title: Re: Aksys is dead. Long live Aksys.
Post by: Zach on January 15, 2007, 09:34:30 PM
How about the Gambro AK 95?† Is it available for home?  Or is it the issue of needing a RO system?
Title: Re: Aksys is dead. Long live Aksys.
Post by: Epoman on January 15, 2007, 10:54:44 PM
There is always: "The Allientģ Sorbent Hemodialysis System"

http://www.renalsolutionsinc.com
Title: Re: Aksys is dead. Long live Aksys.
Post by: Treasure on January 24, 2007, 05:07:48 PM
I just got a call asking if I'd be interested in the Allient clinical trials...I'm reviewing the website, but does anyone know anything about this system? I'm planning to go and see one for myself...but I don't really know what questions to ask about the pros and cons. I kinda jumped at the chance for the NxStage before, because the system was portable and seemed pretty easy to use. But I don't know a thing 'bout birthing anything but a NxStage...

Title: Re: Aksys is dead. Long live Aksys.
Post by: Bill Peckham on August 13, 2011, 09:46:09 AM
I thought I would resurrect this thread to talk about the Aksys home dialysis machine in context - the company folded in 2007. I was the first person to use it post FDA approval, I switched to Aksys from a standard machine in September of 2002. The primary problem with the technology was that it kept breaking. You know you have problems when your Windows based computer is more reliable than your dialysis machine. Believe me it is not fun to have the 'my dialysis machine broke' conversation with your Mom every week or two.

My machine was actually one of the more reliable ones - the comment I heard was that mine was hand built by the guys who came up with the system - I cannot imagine having to deal with a less reliable machine, and some were lemons from the start. So for me the biggest difference between the Aksys and the NxStage is reliability. The NxStage just keeps on ticking, I've taken the cycler down the Rogue River, it is not a delicate contraption like the Aksys. And the NxStage has a business plan that works that may some day work.

Aksys required their own technician to come out when the machine went down ... that guy was busy. It would have had to have been orders of magnitude more reliable for that model to work. NxStage I think learned from this and came to the market with their swap out model, which seems to work well from what I've experienced and heard. All that said, the Aksys gave great dialysis.

It was the first device that offered ultra pure dialysate. It used high end materials for the blood circuit, silicon instead of pvc. The backflush process increased UFR by 800ml/hour which, when coupled with the treatment UFR, increased the UFR to > 1000ml/hr which is when convective diffusion comes into play. Convective clearance increases the movement across the membrane of protein bound solutes - like β2 microglobulins. In general the Aksys was designed to minimize 'compartment activation' - which is the term for the chronic inflammation that comes with exposing the blood to synthetic surfaces - such as the artificial kidney and blood tubing - and from less than ultra pure dialysate.

The Aksys was the first hemodialysis machine to address the compartment activation issue directly in a comprehensive way but this aspect of the device: its ability to manufacture ultra pure dialysate and disinfect its own blood circuit was also the machine's downfall. Including those features made it clinically ideal but it also made it three different machines crammed into one very complicated device. So when I think of an ideal home dialysis machine it has all the features of the Aksys, with the reliability and transportability of the NxStage but I also want a device that has a viable business model. That last one is a real kicker because the US dialysis market is a tough one to compete in considering it is a duopoly with one of the dominate providers being a vertically integrated manufacturer/provider and the other an entity that will take full advantage of their market position and squeeze your margins to the bone. And at this point one has to question the potential size of the market.

Thus, when I imagine what machine I'll be using in 2014, I think it will be an update on the current NxStage cycler. I've long said that the cycler could be lighter very easily (http://www.billpeckham.com/from_the_sharp_end_of_the/2010/01/nxstage-wonkery-on-the-freedom-cruise.html). That would be a great improvement. Display technology gets cheaper by the day so one hopes that its LED snapshot display would evolve into a conversational touchscreen. The big thing would be if there was a innovation in dialysate technology so that a future PureFlow could deliver ultra pure dialysate on demand, up to 500 or 800ml/min, for an extended period. Then future NxStage could use traditional dialysate flow rates.

Not sure if compartment activation gets comprehensively addressed again any time soon.
Title: Re: Aksys is dead. Long live Aksys.
Post by: boswife on August 13, 2011, 01:21:21 PM
Loved that this re-serfaced....  So interesting and hearing of the stuff you went through with other machines sure makes it extra GREAT to have our NxStage... Now i cant wait for updates...  Lighter would be nice, and , well all that other stuff you said will be great too :)
Title: Re: Aksys is dead. Long live Aksys.
Post by: Bill Peckham on October 20, 2017, 03:37:13 PM
Came across this thread in a Google search. The record shows I expected to be using a different device by 2014 ... as we enter 2018 I am still using the same device I first used in 2006. There has been a few tweaks e.g high flow rates possible, can use a heparin pump but really it's the same 75lb machine.


Question: How will you be treating your kidney disease in 2021?
Title: Re: Aksys is dead. Long live Aksys.
Post by: kickingandscreaming on October 20, 2017, 04:20:26 PM
I'm guessing I'll be dead by then.  I have more than enough "conditions" to do me in.
Title: Re: Aksys is dead. Long live Aksys.
Post by: Simon Dog on October 21, 2017, 09:21:30 AM
NxStage has a new version out with a touch screen.  From what I have seen, it looks like the duplicated the existing interface rather than design one optimized for the touch screen technology.
Title: Re: Aksys is dead. Long live Aksys.
Post by: Bill Peckham on April 23, 2018, 11:49:50 AM
I am guessing from the CVS announcement (https://cvshealth.com/newsroom/press-releases/cvs-health-announces-plans-focus-kidney-care-and-dialysis-treatment) that the new HHD machine they plan to bring to market is based on the Aksys/Baxter/DEKA tech.


I am not sure how CVS can do it but I am all for a new HHD machine, and some market competition.
Title: Re: Aksys is dead. Long live Aksys.
Post by: Blake nighsonger on April 25, 2018, 09:15:25 AM
NxStage has a new version out with a touch screen.  From what I have seen, it looks like the duplicated the existing interface rather than design one optimized for the touch screen technology.
Do they have in office Monitoring system capabilities from home hooked up yet ?    Minute to minute live while doing a treatment sole or is the blood leak Sensor closest we get to that while doing sole? Thanks
Title: Re: Aksys is dead. Long live Aksys.
Post by: Simon Dog on April 26, 2018, 10:37:18 AM
NxStage has the Nx2Me Ipad based system, but it transmits info to the server at the conclusion of a treatment, not real time.   I know when I have funny humbers, high pressure, low BP etc. I get an email from the home care RN the next day.