In-home, portable dialysis system gives patients freedom

In-home, portable dialysis system gives patients freedom

Portable, in-home dialysis gives patients freedom to travel and the energy to do so

By Shari Rudavsky
Posted: July 21, 2008

Rick Skiles has tried just about every type of dialysis. But none compares to the machine that's currently doing the work of his kidneys: a system he can use at home on his own schedule and take along when he travels.

Four years ago, Skiles was among the first people to test the NxStage System One as part of a study by an Indiana University doctor. Today, more than 2,400 people rely on NxStage, which in 2005 received Food and Drug Administration approval for home use.
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"It's the closest thing to having a kidney of any dialysis that I can imagine," Skiles said.

Dialysis -- which performs the work of the kidneys when they fail, often as a result of high blood pressure and/or diabetes -- typically requires a patient to visit a facility three times a week for about four hours to have blood withdrawn, cleansed and returned to the body.

Because this can be physically draining and requires a significant time commitment, many patients are unable to work and have difficulty taking extended overnight trips.

With the NxStage system, patients do dialysis almost every day for about two hours in their own homes at their convenience. Because the system is much smaller than a conventional machine, patients can travel with it.

Indiana University is the largest of the 300 centers in the nation using the technology, with 56 people on the system. And the device is slowly catching on throughout the dialysis population.

The company that makes the device, NxStage Medical, estimates that 10 percent to 15 percent of the more than 341,000 people on dialysis might one day benefit from the at-home therapy.

Patients who choose NxStage have fewer hospitalizations, decreased reliance on medicines and lower mortality than those on other forms of dialysis, said Dr. Michael A. Kraus, an Indiana University School of Medicine nephrologist who conducted early trials on the device.

About 42 percent of Kraus' patients on NxStage are employed, compared with 7.6 percent of in-center dialysis patients ages 18 to 54 in Indiana, he said.
Finding freedom

NxStage allowed Skiles, 54, to re-enter the work force. The Southside resident, who has been on dialysis for more than a decade, now feels well enough and has enough free hours to work part time.

"It's a life-changing machine," he said. "No one wants to be on dialysis, but if you were going to be a patient and had to be on a machine, this is the dialysis that I think someone would want to be on."

He should know. For the first six months he was on conventional dialysis, he visited a center three times a week. Then he signed up for at-home dialysis with a conventional machine, which requires patients to have access to purified water.

Four years later, contaminated well water ended his home dialysis. He tried another form of home dialysis that required having a catheter inserted in his stomach. Three infections later, he returned to in-center dialysis.

Then municipal water lines were installed in his neighborhood, so he could obtain the purified water necessary for dialysis at home. He went back to at-home dialysis with a conventional machine that was loud, large and not portable.

When he heard about NxStage, Skiles jumped at the opportunity to try it. Not only was the new device quieter and more compact, he could travel with it. Skiles and his NxStage have gone on a cruise and visited Virginia, Georgia and Florida.

In addition, he has been much healthier than he was on conventional dialysis. He's had no hospitalizations; on conventional dialysis, he was hospitalized a handful of times.

The system also leaves patients feeling much better, said Kraus, who serves on NxStage's scientific advisory board and holds about $5,000 stock in the company.

"This to me is the most rewarding thing that I do," he said. "It clearly returns patients back to a normal lifestyle."

But NxStage isn't right for everyone.

Patients have to be willing to run the machine and have someone there to help them set it up, said Brenda Dyson, past president of the American Association of Kidney Patients and the first person in the country to try the system.

Larger individuals may have to stay hooked up to the machine for longer than two hours, making the process more onerous. Seniors may find it too difficult to operate.

Dyson used the device until she had a kidney transplant about six years ago.
Catching on slowly

NxStage has been slow to spread.

Fewer than 1 percent of patients use NxStage, which like most other forms of dialysis is covered by Medicare and most private insurers. For patients with that coverage, the cost of NxStage is comparable to traditional dialysis.

"There's a chance for a lot more patients to benefit," said Joe Turk, senior vice president of the Lawrence, Mass.-based company.

Last year, NxStage had $60 million in sales. The first quarter of this year saw more than $30 million in sales, said Turk, an Indianapolis native and a 1985 graduate of Brebeuf Jesuit Preparatory School.

Doctors have been slow to embrace it as well. Of the 111 patients Kraus has treated, 52 had heard about NxStage through word of mouth rather than their doctors, he said.

The word is beginning to get out, though. DaVita, the largest independent provider of dialysis in the country, has chosen NxStage as its preferred home dialysis system.

And doctors such as Joel D. Glickman, director of home dialysis programs for the University of Pennsylvania School of Medicine, are becoming converts.

When Glickman first heard about NxStage, he said he was a doubter. The technology was new, his staff would have to be trained in it and learn how to train patients, and he feared the device would not work as well as the traditional machine.

"Then I saw how patients embraced it," Glickman said.

For most of the past two decades, the number of people doing home dialysis has stayed at about 2,000, he said. In the past few years, that number has more than doubled. And it's likely to continue to rise.

"There's a nursing shortage; with gas prices being what they are, I would think that home therapies are catching on," Dyson said. "And I hope that they do."

NxStage has caught on with James Coleman, 58. At first he balked at the idea of doing dialysis six days a week. He felt awful each time he went through dialysis and couldn't imagine doing it twice as often.

The Clermont resident decided to try NxStage for two weeks. After one week, he wasn't impressed. But after the next, he said, he felt like a new man. His skin color returned, and he felt more energy than he had in years.

On July 4, 2004, he brought home his own machine.

"That's been my independence day," he said. "I used to feel restricted, tied down, unable to do things. I feel I can do just about anything now."
Call Star reporter Shari Rudavsky at (317) 444-6354.

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