Home Dialysis Therapy FAQs:

In this section, you’ll find answers to frequently asked questions about home dialysis, including what it is, its benefits, challenges, and available options. If you have additional questions, reach out to your doctor or contact a Patient Consultant at 888-200-6456.

What is Home Dialysis?

Home dialysis is the option to receive dialysis treatments in the comfort of your home, rather than at a center.

What are the Types of Home Dialysis?

There are two types of home dialysis therapies to consider—peritoneal dialysis (PD) and home hemodialysis (HHD). Talk with your doctor and care team to determine if PD or HHD might be a good therapy option for your health and lifestyle needs.

What are the differences between peritoneal dialysis (PD), in-center hemodialysis (ICHD), and home hemodialysis (HHD)?

PD uses blood vessels in the lining of your abdomen to remove toxins and extra fluid from your blood. Typically, PD patients can perform therapy on their own at home. PD treatments are done daily, so waste and toxins in your blood don’t have a chance to build up as much between treatments, compared to in-center hemodialysis.

ICHD uses a machine to remove blood from your body, clean it, and return it to your body. Treatments are traditionally performed at a dialysis center 3 times a week, for about 4 hours per session.

HHD follows a similar treatment procedure as ICHD but is usually done in the comfort of your home, and more frequently, 5 or 6 days a week. More frequent hemodialysis may lead to improved health and quality-of-life outcomes¹. Your doctor may prescribe HHD to be performed during the day—with or without a care partner—or overnight while you and your care partner sleep, which is referred to as nocturnal HHD.

What are some potential benefits of more frequent home hemodialysis?

Studies have shown that there are several clinical and lifestyle benefits to more frequent home dialysis, including:

• Greater schedule flexibility
• Improved sleep quality²
• Improved post-dialysis recovery time³
• Improved appetite⁴
• Increased likelihood to be on the kidney transplant list⁵

Is Home Dialysis Safe?

There are some risks with all medical procedures and treatments. Serious adverse events in home dialysis are relatively rare*. Home dialysis equipment is safe to use with both procedural steps and system alarms in place to help prevent any adverse events from occurring. In addition, your home training nurse will review all the precautions and procedures needed to avoid and prevent any adverse events. Patient retraining and periodic technique checks may also help mitigate these risks. Please review full risks and responsibilities below.

*Tennankore KK, et al. Am J Kidney Dis. 2015;65(1):116-121.

What is the Cost of a Home Dialysis Machine?

For most patients, supplies and equipment are covered by their insurance or Medicare, but it is important to review coverage with your insurance provider to learn more about what options are available to you. Your social worker and insurance coordinator can also help you with this process and identify opportunities for reducing costs.

Who is Eligible for Home Dialysis?

Many patients may be candidates for home therapy, including patients with pre-existing conditions or disabilities. Interested patients should discuss this with their care team, who can review their specific needs and help determine what is best for them.

What am I Responsible for on Home Hemodialysis?

If you choose to do home dialysis, you and/or your care partner(s) will be responsible for all aspects of the dialysis treatment from start to finish, including but not limited to:

• Setting up the dialysis equipment
• Cannulation (inserting needles)
• Taking vitals
• Responding to and resolving all system alarms with the help of Technical Support, if needed
• Monitoring blood pressure
• Maintaining a clean and safe environment for treatment

Both you and your care partner(s) will be trained by your provider so you’re equipped to respond to any health emergencies that might occur during treatment at home, including dizziness, nausea, hypotension (low blood pressure), and fluid or blood leaks.

When Can I Begin Home Dialysis?

Your care and home training teams will work to train you as soon as possible. In some cases, training may begin in-center with an overview of each system and therapy, a review of the first few elements of training, and an opportunity to ask questions. You will go home after training is completed, and you and your care team feel you are ready.

How do I Get Started on Home Dialysis?

There is no recognition or nomination program required to go home. If you are interested, start by talking to your physician to determine if home dialysis is right for you. Once you have a prescription from your physician, the center can introduce you to your home training team, who will help you get started.

I’m Interested in Home Hemodialysis but Not Sure if I’m Ready to Commit. Do I Have Any Options?

Some in-center clinics have a program called Experience the Difference. Ask your care team if this is something they offer. The program offers in-center hemodialysis patients the opportunity to have more frequent hemodialysis treatments in your own center for 1-2 weeks without giving up your current in-center time slot. During this time, you will discover and potentially experience some of the benefits made possible by dialyzing more frequently.

Am I Required to Have a Care Partner for Home Dialysis?

No. It may be an option for you to perform home dialysis without a care partner. PD, for example, is typically performed without the help of a care partner. Solo HHD during waking hours with a NxStage system is possible for many patients with additional training from their care team. Your care team will work with you to determine what is the best approach for you.

Can I Have a Flexible Schedule While Doing Home Dialysis?

Yes. Home dialysis offers much greater schedule and lifestyle flexibility, as you are not tied to a specific time slot on your treatment days. You can work with your doctor to determine the treatment schedule that works best for you.

How Often do I Need to Perform Home Dialysis Treatment?

Every prescription is based on the individual’s particular health and lifestyle needs. Work with your doctor to determine what home modality option best fits your clinical and lifestyle needs and how often you will be required to treat.

What Type of Access do I Need to Perform Home Dialysis?

When starting dialysis, there are different types of dialysis access to consider. PD uses one type of access – a PD catheter. This is a flexible tube placed in your abdomen, with a small piece of tubing left outside of the body. People on HD typically use an arteriovenous (AV) fistula or graft. There is some flexibility for patients with special health requirements. Talk to your doctor about which access type is best for you.

How is Home Dialysis Therapy Prescribed?

You and your doctor will discuss your specific health and lifestyle needs, and what is important to you. Based on those needs, your doctor will determine the specifics of your prescription. It is important to have regular conversations with your doctor about your treatments and any negative symptoms you experience as your prescription should be updated based on how you are feeling.

Am I Able to do Peritoneal Dialysis (PD) if I Have Had Abdominal Surgery?

Past abdominal surgery doesn’t automatically disqualify a patient from doing PD. Interested patients who have had a prior surgery can work with their doctor to assess their ability to do PD treatments.

Do I Need to Have Residual Kidney Function to Start Home Dialysis?

Patients start home dialysis with a wide range of residual kidney function. Talk to your doctor to see what treatment option is right for you.

Does my House Need to Constantly be Clean to do Home Dialysis?

It is important that the treatment area remain clean to help avoid the risk of an infection. Most often, people choose to designate one room or area as their treatment space and keep it clean. This does not mean the entire house or dwelling needs to be spotless at all times. If you choose to perform home dialysis, your home training care team will provide education around how to properly care for your designated treatment area.

Can I Still Enjoy Swimming or Water Activities?

Many patients on home therapies participate in water activities. Follow the guidance of your doctor regarding what water activities can be enjoyed safely.

Is it True I Cannot Have Carpeted Floors to do Home Dialysis?

There are no home decor restrictions to home therapy, including carpet.

Do I Need a Certain Level of Education to be on Home Dialysis?

There is no education requirement to be on a home modality, and both HHD and PD patients have a wide range of education backgrounds. Your care team will provide training and support so that you are well prepared to perform home dialysis.

Are Home Modifications Required to Dialyze at Home?

Typically, no physical home modifications, such as plumbing or electrical, are needed for HHD with a NxStage system or for PD.

Can I Still Keep My Candidacy for a Transplant if I Decide to do Home Therapy?

Many people who select a home therapy report feeling better physically when performing more frequent treatments, ¹ and studies have shown that there is a higher likelihood of receiving a transplant for both PD and HHD.^6,7

NxStage Equipment FAQs:

In this section, you’ll find answers to frequently asked questions about NxStage equipment. If you don’t find the answers to your questions or need additional support, contact our customers

How do I Get a NxStage Cycler?

When you talk with your doctor and care team about starting home dialysis, you will be entered into a home training program and given a prescription and dialysis machine that you keep in your home.

What are the NxStage Home Hemodialysis (HHD) Systems?

NxStage Versi™HD and NxStage System One are home hemodialysis machines designed with patients in mind, to be simple, flexible, and portable. Training on our machines is intended to be fast and easy with intuitive self-guiding features. Both cyclers support a variety of treatment options, including more frequent, solo (during waking hours), and nocturnal (while you and your care partner sleep) hemodialysis. Treatments can be prescribed based on your health and lifestyle needs.

How do the NxStage Home Hemodialysis (HHD) Systems Work?

The NxStage System One functions similar to traditional in-center hemodialysis machines. It removes blood from the body, filters it, and returns the cleaned blood back to your body. The System One cycler and the VersiHD cycler contain the system controls that help you make adjustments before and during treatment. The steps in the treatment process will also be tailored specifically to you and your needs by your doctor and care team.

Can you Travel with a NxStage System?

Yes! Travel is one of the many possibilities you can explore when you use the NxStage systems. With a little extra planning to make sure you can continue dialysis treatment while you’re away, you may be able to travel via an airplane, ship, or car. Talk with your care team for assistance if you are interested in planning a trip.

How do I Stay Connected with my Clinic and Care Team?

Nx2me Connected Health is an application that helps you stay connected to your clinician and care team by securely collecting and sharing health information in a timely manner. The application uses Wi-Fi, and if you don’t have access to Wi-Fi, a cell data plan is available.

How do I get Technical Support for NxStage Systems?

Patients have access to Fresenius Medical Care (FMC) Technical Support and Customer Service for peritoneal dialysis (PD) equipment questions and NxStage Technical Support and Customer Service for HHD equipment questions. See below for contact information for FMC.

How Much Space do NxStage Systems Take Up?

The NxStage dialysis systems are designed to fit easily in your home.

The NxStage VersiHD measures approximately 18 inches high by 15 inches wide by 16 inches deep and weighs less than 80 pounds.⁸ It can easily fit into most rooms without any home modifications and can also be packed into a car or checked for airplane travel (with the appropriate preliminary steps and protective case).
The PureFlow SL dialysate purification system is about the size of an end table, and the NxStage cycler sits on top of it. The PureFlow SL is not portable for travel.

In addition to the machines, you will also need storage space for the disposable supplies, such as cartridges, sacks of concentrated dialysate, and bags of premixed dialysate (for backup and travel), as well as access-related supplies and saline bags.

Does the NxStage Equipment Work with Well Water?

There are no restrictions on the use of well water for home dialysis patients using NxStage equipment. Patient source water is tested while the patient is training, and any necessary adjustments can often be made, depending on the quality of the water to ensure it meets the U.S. EPA Safe Drinking Water Act (SDWA) guidelines. There may be cases where certain source water does not meet the outlined standards and, in those cases, bagged dialysate may be used for treatments.

What are the Differences Between the NxStage Cyclers?

VersiHD is the latest version of the home hemodialysis cycler from NxStage. Designed for simplicity, the VersiHD cycler’s compact size and functionality are complemented by a touchscreen interface that allows for responsive key presses and advanced on-screen displays. While the touchscreen buttons are the same buttons patients are familiar with across all of our cycler systems, on the VersiHD touchscreen, the buttons illuminate only when they can be adjusted or pressed during operation, enhancing clarity and confidence during treatment. The VersiHD and System One S cyclers are also capable of higher dialysate flow rates compared to previous systems.

Do I Need a Large Amount of Available Storage Space for NxStage Equipment?

Some storage space is needed for treatment supplies. Many patients use a closet or under-bed area for storage, and clinic staff may be able to help access space if needed. Home patients treat in many types of settings, from large homes to small apartments, RVs, and mobile homes. If you have any concerns or questions, reach out to a NxStage Patient Consultant.

Can I Have Pets While Using NxStage Equipment?

Many patients are also pet owners. However, it is recommended to keep pets out of the dialysis treatment area.

Care Partner FAQs:

In this section, you’ll find answers to frequently asked questions about care partners, including what a care partner is and how to become one. If you don’t find the answers you’re looking for, contact one of our patient consultants at 888-200-6456 or contact our customer support team at 888-200-6456.

What is a Home Dialysis Care Partner?

Some patients may require a care partner to help them perform home dialysis. He or she doesn’t need to be a medical professional and also doesn’t have to be a live-in relative, spouse, or family member. Your care partner can be a family member, friend, neighbor, work colleague, church friend, or even a business associate.

How do I Become a Care Partner?

If you are interested in learning more about being a care partner, fill out this form or call 1-888-200-6456 to talk to an expert. You will also receive formal training if you decide to become a care partner so that you are prepared to assist your loved one with treatment.

What Support is Available for Care Partners?

While you’re caring for someone else, you also need to take care of yourself. NxStage Atlas is a health and wellness website that focuses on mind, body, and spirit and is a great resource for patients and care partners alike. You can also speak to one of our Patient Consultants for support. Our consultants are current or former NxStage patients or care partners.

Are Care Partners Required to Have a Medical Background or Medical Training?

There are no medical training requirements for care partners. Care partners can be spouses, friends, or neighbors. The only requirement is that they attend training sessions for the specific duties they decide to take on.

Home Dialysis Training FAQs:

Does my Center Need to Offer Home Dialysis to Begin Training?

Even if a center doesn’t offer home training, center staff can often connect an interested patient to a home training program in their network. It is possible for patients to move to a home training center—they are not required to stay at their center, especially if another therapy option might be a better fit for them.

Can I Still do Home Dialysis if I am Afraid of Needles?

This is a common concern, however, many people with a needle phobia have successfully trained on home dialysis, overcome their fears, and succeeded at home. Cannulation teams and experts in certain centers can also help address these concerns.

When do You Need to Decide Whether or Not you Want to try Home Dialysis?

For some people, the decision to go home is made with their doctor prior to needing dialysis, while others make the decision later in their dialysis journey. There is no defined progression or pathway for treatment plans. Talk to your care team if you are interested in learning more about home dialysis.

How are Patients Trained for Home Therapy, and is it Difficult?

Patients are trained by their dialysis center. The pace of training will be adjusted to each individual learner, but typically takes about 4 weeks for home hemodialysis (HHD) and 2 weeks for peritoneal dialysis. During training you will learn about the various products, how to handle emergencies, disease education, and more. Please note that you will not go home until both you and your care team are confident you can perform your treatment safely.

How Long Does Training Last?

Training times vary and depend on patient experience. In a study of HHD patients, half of the patients were trained on the NxStage system itself in 10 days or less. This is a testament to NxStage systems being designed for simplicity and ease of use by patients at home. There are other components to learning about home dialysis that can increase training time to 2-4 weeks. Healthcare training teams will always ensure that patients are comfortable and can safely perform all aspects of their treatments before going home.⁹

What Resources are Available Once I Begin to Dialyze at Home?

Your center, care team, technical support, and customer service are all available resources that you can access while dialyzing at home.

If you are experiencing a medical emergency during a treatment, you should contact 911. For equipment concerns, or issues, you can contact Technical Support 24/7, 365 days a year. Customer service is available Monday to Friday during normal business hours to answer questions regarding deliveries, inventory, or travel.

References:

Daugirdas, John T.; Blake, Peter G.; and Ing, Todd S., “Handbook of Dialysis (5th ed.)” (2015).
Jaber, B.L., Schiller, B., Burkart, J.M. et al, Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;(6):1049–1056.
Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and post-dialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531-539
Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis. 2003;42(1 suppl):30-35.
Choi SJ, Obi Y, Ko GJ, et al. Comparing Patient Survival of Home Hemodialysis and Peritoneal Dialysis Patients. Am J Nephrol. 2020;51(3):192-200. doi:10.1159/000504691.
Rydell, H., Ivarsson, K., Almquist, M., Clyne, N., & Segelmark, M. (2019). Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry. BMC Nephrology, 20(1), 1–8.
Mehrotra R, Chiu YW, Kalantar-Zadeh K, Bargman J, Vonesh E. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med. 2011;171(2):110-118.
NxStage data on file, July 2021.
Cherukuri, S., Bajo, M., Colussi, G., Corciulo, R., Fessi, H., Ficheux, M., Slon, M., Weinhandl, E., & Borman, N. (2018). Home hemodialysis treatment and outcomes: Retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort 11 Medical and Health Sciences 1103 Clinical Sciences. BMC Nephrology, 19(1), 1–10. https://doi.org/10.1186/s12882-018-1059-2

Risks and Responsibilities

Patients should review the following information carefully and discuss it with their doctors to decide whether home hemodialysis with NxStage systems is right for them.

Users should weigh the risks and benefits of performing home hemodialysis with NxStage systems.

Medical staff will not be present to respond to health emergencies that might happen during home treatments, including, among other things, dizziness, nausea, low blood pressure, and fluid or blood leaks.
Users may not experience the reported benefits of home, more frequent, or nocturnal hemodialysis with the NxStage systems.
The NxStage systems require a prescription for use.

Users will be responsible for all aspects of their hemodialysis treatment from start to finish.

Medical staff will not be present to perform home treatments. Users will be responsible for, among other things, equipment setup, needle insertions, responding to and resolving system alarms, system tear-down after treatment, monitoring blood pressure, ensuring proper aseptic technique is followed, and following all the training material and instructions that nurses provide.

Users will need additional resources to perform home hemodialysis.

Users will need a trained care partner to be present during your treatment at home (unless their doctor prescribes “solo/independent” home hemodialysis, described below).
Users must have a clean and safe environment for their home treatments.
Users will need space in their home for boxes of supplies necessary to perform home hemodialysis with NxStage systems.

Certain forms of home hemodialysis have additional risks.

If a doctor prescribes home hemodialysis more than 3 times a week, vascular access is exposed to more frequent use which may lead to access related complications, including infection of the site. Doctors should evaluate the medical necessity of more frequent treatments and discuss the risks and benefits of more frequent therapy with users.
If a doctor prescribes “solo/independent” home hemodialysis without a care partner during waking hours, risks of significant injury or death increase because no one is present to help users respond to health emergencies. If users experience needles coming out, blood loss, or very low blood pressure during solo/independent home hemodialysis, they may lose consciousness or become physically unable to correct the health emergency. Users will need additional ancillary devices and training to perform solo/independent home hemodialysis.
If a doctor prescribes “nocturnal” home hemodialysis at night while the user and a care partner are sleeping, risks increase due to the length of treatment time and because therapy is performed while the user and a care partner are sleeping. These risks include, among other things, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep. A doctor may need to adjust users’ medications for nocturnal home hemodialysis, including, among other things, iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.