Better Outcomes with NxStage

[David13]

NxStage Medical, Inc., announced positive interim four month results of select health-related quality-of-life (HR-QOL) measures from its ongoing FREEDOM Study, the largest study of its kind to measure the clinical and economic benefits of daily home hemodialysis (DHD) treatment, as compared to conventional, thrice-weekly in-center hemodialysis treatment (CHD), in Medicare patients requiring dialysis therapy. These findings show NxStage's DHD therapy significantly improves patients' HR-QOL as measured by several validated instruments measuring recovery time, depressive symptoms, and overall health-related quality-of-life. Improvements identified in this a priori planned interim analysis included:

A reduction in the average time required to resume normal activity from nearly 8 hours after CHD to just over 1 hour after DHD treatment (change of 6.6 hours, p < 0.0001).  In an average week, this translates into an additional 17 hours in which normal activities are possible for the patient.

A 27% reduction in the Beck Depression Inventory (BDI-II), a score reflecting depressive symptoms (improving the score from 11.4 to 8.3, p
< 0.0001).  Importantly, the average score for DHD patients fell below 10, which is often viewed as the threshold above which mild depressive symptoms exist.

Improvement in both the physical composite score (from 36.2 to 38.4, p=0.04) and mental composite score (from 48.2 to 50.7, p=0.03) of an international standard for health-related quality-of-life assessment (SF-36v2).

Scores for all eight specific health domains improved, and after just four months, four domains - physical ability to complete daily work or activities, general health, vitality, and both emotional and physical ability to participate in social activities - have achieved statistically significant improvements.

Researchers will present these four month data and other quality of life data on Nov. 7 during the American Society of Nephrology's annual meeting in Philadelphia.

[Wallyz]

I am one of the data points pulling this survey .  My health and sence of well being has improved dramatically since goign home with the NxStage.  My diet has normalized, and I am no longer on Binders, while my Phosphorus, Potassium, and calcium is all good.

I am healthy enought o go back to work.

[Zach]

There's No Place Like Home.

[cherpep]

Amen!! There is no place like home. 

I'm just wondering, though, about my access.  Has there been any research done on the impact on the access, doing dialysis more frequently?  I had a fistula for under a year, doctor said it was too weak.

I've been using a graft since April.  I try not to poke in the same spot, but honestly - there is not much real estate to work with there.  I can't do buttonholes on a graft, so I just have to keep moving around.  Has there been any study on the impact of poking a graft more frequently to do home dialysis?  Does this drastically reduce the life of the graft?

[jbeany]

My surgeon tried to lecture me about going back to regular hemo because I've got a graft, and I have problems with it.  Is it possible to politely tell someone they are an idiot?  Well, I tried.  I do 5 days a week with the home hemo.  That's only 2 more times a week than I would do with in-center. I figure my mental and physical health is worth more than the chance I might lose the graft at some point.  With home hemo, I also have a consistent person sticking the needle, which certainly has helped with infiltrating and bruising.  Besides, I had just as many problems with it when I was in-center as I do on home.

[skyedogrocks]

Rob feels 100% better since he started NxStage over 18 mos ago.  His labs are better, he feels "normal" and loves the flexibility that home hemo offers. 

[Zach]

I'm just wondering, though, about my access.  Has there been any research done on the impact on the access, doing dialysis more frequently?

There isn't much research, yet.

[petey]

Rob feels 100% better since he started NxStage over 18 mos ago. His labs are better, he feels "normal" and loves the flexibility that home hemo offers.

Marvin agrees with all of the above -- especially the "normal" part of it.  (Home hemo for the past 16 months for us).  We are having some issues, however.  Marvin's appetite has returned now that he's on home hemo -- oh my, has it ever returned!   He is the heaviest he's been since he was on dialysis; the only times he ate as much and weighed as much were years before he started dialysis and during his transplant.  "Everything tastes so good now," he'll say.  We're having to watch his weight again (don't want to get too fat for another transplant), and that's something we haven't done since the transplant (right after the transplant he ate and ate and ate -- within a year, he had put on about 75 pounds).  Marvin is also much, much more physically active now that he's on home hemo.  You'd think that with the increased activity he'd burn off more calories.  It's not working that way for Marvin.  Of all the "issues" to have, this is the one we want.     

[skyedogrocks]

Rob feels 100% better since he started NxStage over 18 mos ago. His labs are better, he feels "normal" and loves the flexibility that home hemo offers.

Marvin agrees with all of the above -- especially the "normal" part of it.  (Home hemo for the past 16 months for us).  We are having some issues, however.  Marvin's appetite has returned now that he's on home hemo -- oh my, has it ever returned!   He is the heaviest he's been since he was on dialysis; the only times he ate as much and weighed as much were years before he started dialysis and during his transplant.  "Everything tastes so good now," he'll say.  We're having to watch his weight again (don't want to get too fat for another transplant), and that's something we haven't done since the transplant (right after the transplant he ate and ate and ate -- within a year, he had put on about 75 pounds).  Marvin is also much, much more physically active now that he's on home hemo.  You'd think that with the increased activity he'd burn off more calories.  It's not working that way for Marvin.  Of all the "issues" to have, this is the one we want.     

Petey - Rob's appetite is also doing well.  When he was in-center he could never eat on the machine and now he can.  He was out of work for 3 months due to knee surgery and he gained about 20lbs @  because he wasn't active.  Now that he is back to work it's coming off.  He also needs to watch his weight if wants a transplant and a pancreas transplant after that!  Silly men!

[Adam_W]

Regarding the comments about doing NxStage with a graft, I've heard of several centres that won't allow a patient to do home hemo at all if they have a graft. Something about both the graft getting used more often, and not "trusting" patients with sharp needles and no buttonholes. I think that's retarded because one, we're not stupid and we're trained well. We can handle sticking a graft just as well (often times better) then most dialysis techs. And two, for some of us we don't have a choice as to what access we use. My surgeon tried twice to get a fistula going but both of them failed because I have small veins. Literally, if I had to go to one of those centres, I would be denied home hemo simply because my veins are too small for a fistula! I'm glad I have my current centre.

Adam

[skyedogrocks]

Rob has upper arm fistula that had to be re-mapped to a graft.  He had no problems with it at all.