Published: August 18, 2008 6:00 a.m.
A Woodburn home companion
Kidney patient faring better with portable dialysis deviceMichael Schroeder
The Journal Gazette
At 46, Jerry Erpelding has endured three kidney transplants and spent about 10,000 hours – the equivalent of more than a full year – hooked up to a dialysis machine.
The most successful transplant lasted 18 years; the least successful, nine days. The most recent transplanted kidney worked for about 4 1/2 years. After that, from 1999 until early February, Erpelding, a Woodburn resident who has chronic kidney failure, went to a dialysis center in Fort Wayne for three four-hour treatments a week.
Kidney transplant has long been the goal for patients suffering chronic kidney failure (also called end-stage renal disease). But a shortage of donor organs and the finite life of transplanted kidneys mean that those who have kidney failure usually spend a significant amount of time hooked to a dialysis machine. The machines do what their kidneys can’t, filtering blood to remove toxins and excess waste, salt and water.
The problem is they do this work in a fraction of the time it takes a functioning kidney, taxing patients to the point of exhaustion.
Erpelding said it took him about five to six hours to regain his energy after thrice-weekly treatments at the dialysis center. He also takes medication for high blood pressure and anemia.
Since he began using a small-TV-sized dialysis machine in his home in February, he now needs less medication to control his blood pressure and anemia. He feels re-energized within 15 or 20 minutes of treatments. And the outdoor enthusiast can take the NxStage System One dialysis machine with him when he travels.
“I wanted to get it because it’s portable,” Erpelding said of the System One, which received expanded FDA clearance in June 2005. Having it at home allows some flexibility in his treatment schedule as well, he said. Along with “a little more freedom,” he says it gives him “a little more energy” and has improved his quality of life overall.
The machine is dubbed by its maker, Lawrence, Mass.-based NxStage Medical Inc., as the “first truly portable daily hemodialysis machine.” It’s decidedly smaller and easier to operate than anything Erpelding – who was the first patient in the area to use it – says he’s used before.
Erpelding and his wife, Alice, went through a three-week training session to learn to operate the system. He now gets treatments lasting, on average, 2 1/2 hours, six days a week. The more frequent treatments better simulate continuous work done by functioning kidneys and are easier on his body, Erpelding and his nephrologist say.
As of last week, six patients at DSI Central Fort Wayne Dialysis Center on Bluffton Road were using NxStage. (Although the patients get dialysis treatments at home, they still come in once a month to see a doctor, dietitian, social worker and nurse.) As a group, they reported feeling better, taking less medication and having fewer complications than they did when treated in-center, said Dr. Irfan Munir of Nephrology Associates.
Although less than 1 percent of hemodialysis patients get treatment at home, Munir is confident that more will have the option because of the NxStage machine.
“I’m very hopeful that it will improve the quality of life for dialysis (patients), which is not that great at this point,” he said.
Most dialysis patients undergo hemodialysis, which involves using a machine and dialyzer that acts as an artificial kidney. Typically, because of the complexity of most machines and their sheer size, this is done at a specially-staffed dialysis center.
A smaller fraction of kidney failure patients, less than 10 percent, use peritoneal dialysis. The catheter-based technique employs the patient’s own abdominal membrane, or peritoneum – instead of an outside machine – to extract toxins from the blood. Treatments can be done at home.
However, because peritoneal dialysis is limited to a smaller subset of patients and traditional hemodialysis machines aren’t easily portable, NxStage saw a niche market in home hemodialysis.
The System One consists of a small control unit, or cycler, which weighs 70 pounds and is about the size of a 13-inch TV. It comes with disposable daily cartridges and delivers a high-purity fluid called dialysate in prescribed doses. All components considered, it’s considerably smaller than its predecessors.
For two years when Erpelding was a teen, he was among a tiny fraction of dialysis patients who got treatment at home. It helped that his mother, Josephine, was a nurse. After six weeks of training, she was able to operate what Erpelding describes as a behemoth of a dialysis machine at their home.
“My old machine was the size of a very, very large upright freezer,” he said. The new one’s not just substantially smaller, he says, it’s also easier to operate and doesn’t require a medical background.
That’s not to say System One has been void of problems. NxStage reported in an August 2007 filing with the Securities and Exchange Commission it had voluntarily recalled cartridges because of an increased incidence of reported dialysate leaks. First it sent a letter to patients and customers about the problem. Customer dissatisfaction continued to increase when leakage problems didn’t decline. So the company recalled affected cartridges and replaced them with newer ones at no cost to customers and patients, the company said.
NxStage reported a loss of up to $2.5 million. It said the increased incidence of leaks had also been associated with increased cycler service requirements.
An official with the company said Wednesday that NxStage is continuing to improve the cartridge and rigorously tests its durability.
“The leaks have not been completely eliminated but they’re substantially below where they were last year,” said Joe Turk, senior vice president of commercial operations for NxStage. He said leaks occur in “one in thousands” of cartridges compared with “one in hundreds” of cartridges before the recall and subsequent improvements.
Erpelding said he had one cartridge leak a few months ago, but suffered no ill-effects. He sent it back to NxStage and has only positive things to say about the System One.
Dr. Munir, expects the system’s market share to grow significantly based on the experience of patients he’s seeing who have used it. He hopes that more patients will benefit from shorter, more frequent dialysis treatments at home.
Numerous studies show that survival rates and complication rates might improve with more regular home dialysis treatments, though researchers say larger, more comprehensive studies are needed. Based on its own registry information, NxStage reports that survival rates for patients using the NxStage system are more than 50 percent better than those on in-center dialysis.
Regardless of how well System One is ultimately received, “Not every patient is likely going to be a home dialysis patient,” Turk said.
Patients must be motivated to get trained on using the machine, have a support structure and be able to physically deliver treatments themselves or have someone who can, he said.
Those with compounding medical problems or disabilities would likely not be good candidates for home dialysis, according to Dr. Munir. There are also some people who feel more comfortable going into a dialysis center for treatment, Turk said.
Still, he believes the market potential is substantial.
In addition to medical results, there might be an economic case to be made for delivering treatments at home. The System One treatments cost about $1,500 to $1,600 a month, Turk said, less than what Medicare pays for in-center dialysis.
But that doesn’t mean Medicare and other insurers will start paying for more frequent in-center treatments for patients who can’t do it at home. Hurdles standing in the way of more regular treatments include personal convenience and economic constraints.
The cost alone of offering six treatments per week at the dialysis center would be “phenomenal,” Munir said. Still, he’s convinced NxStage’s home dialysis has improved the quality of life for his patients who have used it.
Erpelding, for one, is a believer.
mschroeder@jg.net
Chronic Kidney Disease
• 26 million Americans suffer chronic kidney disease, the precursor to kidney failure, and 20 million more are at increased risk.
• 485,000 Americans are currently being treated for kidney failure (of those, 341,000 are dialysis patients, and the rest are kidney transplant recipients).
• People with diabetes, hypertension and family history of kidney disease are at higher risk for kidney disease.
• Blacks, Hispanics, Pacific Islanders, American Indians and seniors are also at increased risk.
• Early detection can help prevent kidney disease from progressing to kidney failure. That includes checking blood pressure, testing urine for traces of albumin (a type of protein that can be an early sign of kidney disease) and checking levels of creatinine in the blood (higher levels indicate reduced kidney function).
• High blood pressure is one of the leading causes of kidney disease, and kidney disease can cause hypertension.
• Heart disease is the major cause of death for people with chronic kidney disease
http://www.journalgazette.net/apps/pbcs.dll/article?AID=/20080818/FEAT/808180377
I Hate Dialysis Message Board
Author
