Abstract: SA-PO838

Application of Extended Home Hemodialysis with the NxStage System One

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Leypoldt, J. Ken, None, San Clemente, California, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Extended hemodialysis, which is characterized by session duration beyond the usual interval of 3 to 5 hours, facilitates the removal of large fluid volumes at slow rates, likely resulting in fewer intradialytic hypotensive episodes and lower interdialytic blood pressure. There are few data about applications of extended hemodialysis with a low volume of dialysate per session. We used a telehealth platform to collect data about home hemodialysis (HHD) patients using the NxStage System One for extended hemodialysis.

Methods

We collected treatment factors and intermediate outcomes in HHD patients using the NxStage System One in tandem with the Nx2me Connected Health platform. We analyzed digital flowsheets collected from US patients between Nx2me product launch and March 31, 2016, and retained those patient-weeks with prescription of at least 3 sessions and receipt of at least 3 flowsheets with session duration ≥6 hours. We used descriptive analysis to summarize collected data.

Results

We identified 1932 patient-weeks of extended hemodialysis among 56 patients. Percentages of patient-weeks with 3.5, 4, and 5 prescribed sessions per week were 5%, 30%, and 65%, respectively. The mean number of delivered sessions per week was 4.22 (adherence, 90%). Mean session duration was 421 minutes, with 5th and 95th percentiles of 353 and 481 minutes, respectively; the mean number of cumulative treatment hours per week was 29.3. Sixty liters of dialysate were prescribed for 67% of sessions and the median blood flow rate was 300 mL/minute. Mean ultrafiltration volume was 2.1 L, with 5th and 95th percentiles of 0.6 and 3.9 L.

In patient-weeks of extended hemodialysis, we identified 7429 digital flowsheets with complete data. Mean (standard deviation [SD]) ultrafiltration rate (UFR) was 2.97 (1.37) mL/hour/kg; 99.9% of sessions had UFR < 10 mL/hour/kg. Before treatment, mean (SD) systolic blood pressure (SBP) was 127 (24) mmHg and mean (SD) diastolic blood pressure (DBP) was 72 (12) mmHg. After treatment, mean (SD) SBP was 122 (23) mmHg and mean (SD) DBP was 72 (12) mmHg. The percentages of sessions with predialysis and postdialysis blood pressure in KDOQI target ranges were 67% and 56%, respectively.

Conclusion

Extended HHD on the NxStage System One delivered almost 30 hours of treatment each week, partially due to excellent adherence. UFR was very low and BP control was generally very good.