New smaller dialysis machine purifies water, creates dialysate

[Zach]

http://www.nephrologynews.com/articles/110931-new-smaller-dialysis-machine-purifies-water-creates-dialysate

New smaller dialysis machine purifies water, creates dialysate

JUNE 09, 2015
Nephrology News & Issues

Outset Medical has secured $91 million in equity and debt funding for its Tablo dialysis machine. The machine, which is just 35 inches, includes wireless connectivity and real-time integrated water purification. The machine alsoproduces dialysate, takes blood pressure and delivers medication. The machine is designed to reduce the set up and management time of performing dialysis, the company said. 

The company will use proceeds from the financing to begin a controlled commercial introduction this year and to pursue expanded FDA clearance to allow patients to use Tablo at home. The FDA recently approved an investigational device exemption (IDE) trial to evaluate the safety and efficacy of Tablo in this setting.

“Dialysis is a life-sustaining therapy that has changed very little in the last few decades,” said Glenn M. Chertow, M.D, Norman S. Coplon/Satellite Healthcare Professor of Medicine and Chief of the Division of Nephrology at Stanford University School of Medicine. “I am excited about the ways Tablo can offer expanded choices for dialysis patients. Many patients who receive dialysis want more control over the experience and want to live fuller, more independent lives. These patients are extremely capable, and with improved technology, could take the lead in their own dialysis care with minimal assistance. Other areas of medicine suggest that when people are directly engaged in their care, they live longer and feel better.”

The equity and debt funding came from Fidelity Research and Management Company, Warburg Pincus, The Vertical Group, Partner Fund Management LP, Perceptive Advisors, and CRG.

“We are gratified by the strong showing of support from existing and new investors who share our vision of expanding where, how and who can perform hemodialysis,” said Leslie Trigg, Outset Medical’s CEO. “Today, hemodialysis is labor-intensive and expensive to provide, and many patients lack flexibility and control over the experience. Tablo uniquely enables new care delivery models that may offer significant cost reduction opportunities for providers while substantially improving the experience for patients.”

Company web site:  http://outsetmedical.com/tablo/

[Whamo]

  Is this new machine for hemo or perio use?

[kickingandscreaming]

I think the machine referred to is Hemo.  There is a new cycler--Amia-- for PD that will be coming soonish from Baxter.  It makes its own dialysate.

[Simon Dog]

Unfortunately, Tablo has shifted the emphasis for the new hemo machine from home to in-center self care use.

[Charlie B53]

Making the dialysate for either machine is HUGE.  The capability of doing this at home is almost unimaginable.  And small enough to be portable, one could concievably take it along and go anywhere.

I did PD for 3 1/2 years, the amount of product make long trips awkward. I had to take so many boxes along.  It adds up quickly.  I imagine pretty much the same thing for the dialysate necessary to operate any Hemo machine.  This pretty much keeps most of us tied to home or our clinic unless prior arrangements are made for supplies.  Awkward.  No 'spur-of-the-moment' trips much longer than a day, or maybe a weekk end.  No way any of us are taking off camping in the woods for a week or two, out of touch with 'society'.

Machines such as these may make that possible.  As long as we have power and water, we be good.   I can deal with that!

[Michael Murphy]

What this thread brought home is how much Zach contributed and how much he is missed. Now for my comment, these systems in center will make a difference there too.  Since they will require 6liters of potable water they will kill the need for the huge RO systems used in center, and the problems they cause when they are feeling cranky.

[Charlie B53]

I should have noticed this was posted by Zach, almost two years ago.

He is greatly missed.

[iolaire]

Internationally the newer dialysis machines they use always have bicarbonate power bags on the machine - is that used in the dialysate making process?  Something like this: http://www.fmcna-bibag.com/

also searching for "bicarbonate bag dialysis" found this
https://books.google.com/books?id=IGV4boOFjZYC&pg=PA230&lpg=PA230&dq=bicarbonate+bag+dialysis&source=bl&ots=ebplzycYpl&sig=yBoTWKi7VgVFTi9gJ6lrXd2YzLc&hl=en&sa=X&ved=0ahUKEwi2-7v0gPzTAhWGRiYKHXrRC44Q6AEIYDAO#v=onepage&q=bicarbonate%20bag%20dialysis&f=false
Handbook of Dialysis, Volume 236
edited by John T. Daugirdas, Peter Gerard Blake, Todd S. Ing

it looks like you can almost read the entire $69 ebook in the browser...

[Simon Dog]

Internationally the newer dialysis machines they use always have bicarbonate power bags on the machine - is that used in the dialysate making process?

Traditional dialysis machines use two solutions - bicarbonate and acid.  Settings on the machine control the mix of filtered water; acid and bicarb to dynamically create the dialysate (note the Bicarb setting on the machine)  Clinics already make the bicarb solution from powder (home users on the FMC 2008 series BabyK get pre-mixed bicarb).    You will notice two lines running into the machine - bicarb (blue) and acid (red).  Clinics generally have the water room in the back and mix up their bicarb in bulk.  Sometimes if you have a non-standard acid bath concentration, you will have a bottle of acid at the machine.

It looks like the bi-bag is an alternative FMC is offering for clinics that don't have a water room.   It would also be useful in hospital settings that use a roving dialysis machine.  When I had an in-hospital treatment with the rolling machine (2008K) the RN mixed up the bicarb from powder.

The NxStage machine makes a single solution which is lactate, not bicab, based.

[Michael Murphy]

My understanding is all the machines in development are lactate based yes tap water and filter the dialysate and reuse it which is why they only need 6 liters of tap water.

[Simon Dog]

My understanding is all the machines in development are lactate based yes tap water and filter the dialysate and reuse it which is why they only need 6 liters of tap water.

The Fresenius PAK (Portable Artificial Kidney), which has been "about to hit the market" for years works this way.

I don't think the Tablo uses only 6L, but I am not certain.  I also think it is a "reuse" machine - when dedicated to a single patient, filter & tubing changed every few treatments.

Although NxStage does not blend Acid + Bicarb, the concentrate is available in two lactate concentrations, with the patient's bicarb level used to decide (the liver converts lactate to bicarb)

[Geiser100]

I know this is old, but I saw this and was interested. My dialysis center uses the new Tablo machines and I believe we might be an "experimental" clinic lol. There's always people coming in to tour the facility and a "maintenance man" on duty in case one machine fails which seems to happen more ofton than it should. Im on PD now but these machines seemed very gentle on my body and I never felt exhausted.

[Simon Dog]

Tablo originally stated they were targeting the home market, but it appears that they have shifted to more of an emphasis on in-center at least for now.

The machine uses HP inkjet technology to mix the dialysate on the fly.