SHORT-TERM CLINICAL OUTCOMES OF A NEW HOME HEMODIALYSIS PROGRAM USING NXSTAGE SYSTEM ONE IN A SINGLE CENTER

Home hemodialysis (HD), especially short frequent HD, has proven clinical benefits to end-stage renal failure patients. The introduction of NxStage System One cycler offered an alternative option for home HD, by the Frequent short-duration Low Dialysate Volume Approach (FLDVA). The NxStage platform offers the advantage of easier and simpler set-up, occupies less space and requires less home modification. This helps to increase the uptake of home HD, especially where people live in crowded cities like Hong Kong. Whether NxStage could provide similar clinical benefits as conventional home HD is still uncertain, but this therapy may still offer better clinical outcomes compared to in-center HD. We compared the short-term outcomes of patients started on NxStage home HD in our center and those who were otherwise eligible for NxStage home HD but chose to receive in-center HD.

Our hospital established the NxStage home HD program in April 2023. Patients already receiving in-center HD/impending to start HD were screened for suitability for NxStage home HD by their medical and social information. Suitable patients were invited for further assessment and counselling. Patients were allowed to choose to switch to/start NxStage home HD or remain on/start in-center HD by their own free selection.  Patient demographics, laboratory and clinical outcomes data were collected prospectively. 

Eighteen patients were screened suitable for NxStage home HD and were invited for participation. 7 patients received training and started NxStage home HD. 11 patients refused due to home constraints (36.4%) and psychological stress (63.8%). Patients on NxStage had a mean age of 50.6±16.9, and 42.9 % were male. The major cause of renal failure was glomerulonephropathy. Charlson Comorbidity Index was 4.0±2.2 and their dialysis vintage was 45.7 (IQR 22.6, 163.5) months. Baseline demographics of the two groups were mostly similar except there were less male patients in the NxStage group (42.9% vs. 90.9%; p=0.026) and had a lower body mass index (19.9±2.4 vs. 26.1±5.2 kg/m2, p=0.011) (Table 1).

The median duration of patients on NxStage therapy was 8.5 (IQR 6.0, 15.9) months. NxStage patients receive a median of 3.5 (IQR 3, 4) treatments per week with a dialysate volume of 38.6±9.0L per treatment. The mean stdKt/V was 2.92±0.46. Patients on NxStage had a higher albumin level (43.6±2.1 vs. 39.3±3.3 g/L, p=0.004) compared to patients receiving in-center HD. 71.4 % of patients were able to reduce anti-hypertensive medications. They had a lower number of anti-hypertensive agent requirement but the difference the difference between the two groups did not reach statistical significance (1 (IQR 0,1) vs. 2 (IQR 2, 3), p=0.057). There were no other differences in clinical and laboratory parameters between the two groups. There were no differences in the use of phosphate binders, and the change in phosphate binders and erythropoietin stimulating agents (Table 2).

There was one patient mortality in the in-center HD group due to non-dialysis related sepsis. There were no differences in the rate of acute hospitalizations, cardiovascular events, infection episodes, access-related infection, and other access complications in the short-term (Table 3).

Patients on NxStage had a better albumin level and showed a trend towards a lower antihypertensive agent requirement in the short-term in this local cohort. Further possible translation of these favourable parameters into other clinical outcomes would require longer term data.