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Technology improves home dialysis machines
Even with robust training programs and willing partners, performing dialysis at home can be intimidating for patients with ESKD.
“Starting dialysis therapy has obstacles that we will always struggle to overcome: the symptoms of uremia that compelled the decision, the loss of control in one’s life, a stable vascular access, anxiety and possible economic hardship,” Brent Miller, MD, who manages more than 100 home patients at Indiana University Health, said. “The difficulty and complexity of using a dialysis machine — at its core a blood pump, tubing, filter and fluid — should not be added to that list.”
One of the tasks of advancing technology and improving patient outcomes should be a dialysis machine’s ability to help assess on-the-spot patient complications during treatment.
“In terms of improving clinical care, I think one of the places the field has to go is correlating technical information with patient-level data,” Luis Alvarez, MD, PhD, chief of the division of nephrology at Palo Alto Medical Foundation and medical director for Satellite WellBound of Fremont, California, told Nephrology News & Issues. Previously, Alvarez was the chief medical officer for Outset Medical and still advises the company on technology. Outset recently completed patient trials for use of the Tablo hemodialysis machine in the home setting.
“We don’t have in any current database a repository of patient symptoms or complaints (during treatment), coupled with a solution,” Alvarez said. “When we trigger atrial fibrillation, we need to understand the circumstances. Data is critical to the story. If a patient has symptoms, like a headache, cramps [or] high blood pressure, during the treatment, what is happening with the instrumentation at the time?
“Tracking the symptoms during the treatment and using that patient-level information to correlate with technical information, like sodium levels or varying degrees of body temperature, for example, will help clinicians make a connection and develop a treatment plan,” Alvarez said.
Advancement in machine technology
Dialysis machine manufacturers see an opportunity to connect symptoms and treatment algorithms as they focus on the AAKH goal of placing 50% of new dialysis patients on home dialysis by 2025. With government-supported programs like KidneyX manufacturers see redesigning dialysis machines and connective health as a way to make treatments easier for patients and to provide useful data to clinicians.
“We fully support the government’s goal,” Laura Angelini, head of the global Renal Care business at Baxter, said. “ ... It’s important to acknowledge the policy will require innovation and collective support from the renal care community to drive the change patients need. It will take a combined effort to reach patients at earlier stages of the disease, to think differently about our care models and to adopt innovation that fills the gaps in care and improves outcomes.”
Baxter launched its Amia cycler for peritoneal dialysis in 2015 and coupled it with its telehealth product Sharesource to help patients with their treatment and provide clinicians with pertinent data. The company said Sharesource has helped manage more than 11 million PD treatments in more than 44 countries, including Colombia, where a recent study associates the platform with a 39% reduction in hospitalizations for home patients.
At-home dialysate
Fresenius Medical Care, which merged with NxStage Medical in 2019, is also working on new PD technology. Joe Turk, president of Home and Critical Care Therapies at Fresenius Medical Care North America, said research is directed at a smaller, simpler, connected PD cycler as well as eliminating the need for premixed bags of PD dialysate.
NxStage has simplified the dialysate process with its SystemOne portable home hemodialysis machine, which debuted for home use in 2005. The company’s PureFlow SL application allows patients to create dialysate using a combination of purified tap water and concentrated dialysate, while its Nx2me Connected Health shows treatment data to patients and on iPad screens and makes it easy to collect and share treatment information with clinicians.
With Outset Medical awaiting FDA review of its Tablo trial results, CVS Health launched a trial for its Hemacare home hemodialysis machine last fall, and U.K.-based Quanta Dialysis Technologies said it wants to enter U.S. trials with SC+, its portable, cartridge-based hemodialysis system.
“We think [AAKH] is going to deliver better value for everybody,” Quanta CEO John Milad, told Nephrology News & Issues.
The company raised $48 million in July 2019 to help with the commercial launch of SC+, which received a CE mark in the European Union in 2015. – by Mark E. Neumann