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Author Topic: New smaller dialysis machine purifies water, creates dialysate  (Read 1147 times)
Zach
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"Still crazy after all these years."

« on: June 11, 2015, 05:37:50 AM »

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/
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Uninterrupted in-center (self-care) hemodialysis since 1982 -- 34 YEARS on March 3, 2016 !!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
No transplant.  Not yet, anyway.  Only decided to be listed on 11/9/06. Inactive at the moment.  ;)
I make films.

Just the facts: 70.0 kgs. (about 154 lbs.)
Treatment: Tue-Thur-Sat   5.5 hours, 2x/wk, 6 hours, 1x/wk
Dialysate flow (Qd)=600;  Blood pump speed(Qb)=315
Fresenius Optiflux-180 filter--without reuse
Fresenius 2008T dialysis machine
My KDOQI Nutrition (+/ -):  2,450 Calories, 84 grams Protein/day.

"Living a life, not an apology."
Whamo
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« Reply #1 on: May 17, 2017, 07:22:21 AM »

 :pics; Is this new machine for hemo or perio use?
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kickingandscreaming
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« Reply #2 on: May 17, 2017, 08:05:22 AM »

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.
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Diagnosed with Stage 2 ESRD 2009
Pneumonia 11/15
Began Hemo 11/15 @6%
Began PD 1/16 (manual)
Began PD (Cycler) 5/16
Simon Dog
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« Reply #3 on: May 17, 2017, 10:09:37 AM »

Unfortunately, Tablo has shifted the emphasis for the new hemo machine from home to in-center self care use.
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Charlie B53
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« Reply #4 on: May 18, 2017, 03:41:21 AM »


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!
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Michael Murphy
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« Reply #5 on: May 18, 2017, 08:53:50 AM »

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.
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Charlie B53
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« Reply #6 on: May 19, 2017, 05:29:52 AM »


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

He is greatly missed.
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iolaire
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« Reply #7 on: May 19, 2017, 05:57:32 AM »

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...
« Last Edit: May 19, 2017, 06:02:16 AM by iolaire » Logged

Transplant July 2017 from out of state deceased donor, waited tree weeks the creatine to fall into expected range, dialysis December 2013 - July 2017.

Well on dialysis I traveled a lot and posted about international trips in the Dialysis: Traveling Tips and Stories section.
Simon Dog
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« Reply #8 on: May 19, 2017, 08:16:47 AM »

Quote
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.
« Last Edit: May 19, 2017, 08:18:28 AM by Simon Dog » Logged
Michael Murphy
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« Reply #9 on: May 19, 2017, 01:31:40 PM »

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.
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Simon Dog
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« Reply #10 on: May 19, 2017, 10:17:52 PM »

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)
« Last Edit: May 19, 2017, 10:19:02 PM by Simon Dog » Logged
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