Technology, more education can take home dialysis to the next level

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October 18, 2021

4 minutes to read

Source / Disclosures

Disclosures: Burbank is an employee of Fresenius Medical Care North America. Khawar is CEO of Diality Inc.


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Osman Khawar, MD, remembers the home dialysis machines he worked with during his nephrology training at Harbor-UCLA Medical Center.

“They were big, heavy machines,” said Khawar, now a member of Balboa Nephrology in San Diego. Nephrology News and Problems. “They were workhorses, built for reliability and power.”

Today, technology has streamlined home dialysis machines. Starting with NxStage Medical’s SystemOne, approved by the FDA in 2005 for home hemodialysis, other devices from Outset Medical – approved for home dialysis last year – and companies like Quanta Medical and DEKA Research & Development Corp./CVS, both continuing clinical trials with their machines, home dialysis has become more patient-friendly.

Osman Khawar, MD, a member of Balboa Nephrology in San Diego, Calif., And CEO of Diality Inc., said the technology must make the home dialysis experience less intrusive while providing a prescription that can be personalized for patients with the disease. from ESK.

Source: Mike Sleva

But the technology still needs to be improved, Khawar said. As CEO of Diality Inc., the nephrologist said he hopes the company will seek FDA clearance of the 510 (k) device next year for its home dialysis machine, and then begin trials with it. patients soon after.

“We see two prospects in the home dialysis market,” Khawar said. “For the patient, we see it as a consumer product. This means that it must be easy to use, offer an interface that provides fast feedback and a seamless connection, as well as safety measures to make patients feel taken care of.

“For providers, a machine should also offer the nephrologist a full range of easy-to-use prescribing options based on the needs of each patient. It also needs to have a good feedback mechanism for prospective patient data, ”Khawar said.

Jeff Burbank, director of strategy and transformation of Fresenius Medical Care North America, said home dialysis cannot take the next step in the mainstream without including technological improvements.

“We should consider Internet access to be just as important to the success of a home dialysis patient as the prescription of iron supplements or a phosphate binder,” said Burbank, former CEO of NxStage. Medical. Nephrology News and Problems. “We must not let financial barriers get in the way of connected health technologies to improve the quality of patient care. While studies have clearly shown that using connected health improves lives, limitations on access to technology, technological literacy and financial stability must be eradicated. “

The technological divide is greater for some populations in the United States, he said. “A recent study from the Pew Research Center shows that while 80% of white adults report having a broadband connection at home, that number drops to 71% for black adults and 65% for Hispanic adults,” Burbank said. “Among Americans 65 and over, only 61% own a smartphone or have high-speed Internet access. ”

Interest in home hemodialysis

Most home dialysis research and development has focused on hemodialysis devices despite the market dominance of peritoneal dialysis.

Robert lockridge

“I think most of these companies see hemodialysis as the long-term modality option for the home,” Robert Lockridge, MD, a nephrologist from Lynchburg, Virginia, said Nephrology News and Problems. “Peritoneal dialysis is a great first treatment, especially for urgent starts when patients still have residual kidney function. Hemodialysis may be the next step for patients who want to stay home.

Lockridge recently co-chaired a one-day symposium sponsored by the International Hemodialysis Society that evaluated new technology for home hemodialysis (a recording of the program is available at www.ishd.org).

One of the new home hemodialysis machines presented during the program was the S³, developed by the French company Physidia. It has been used to treat more than 1,000 patients in Europe and is designed for short daily hemodialysis, Lockridge said. The machine was approved in France in 2013 and launched in Europe in 2017.

Like Lockridge, Brent Miller, MD, professor of medicine at Indiana University Health, said the technology is what manufacturers should focus on when developing a home dialysis machine. “They have to be easy to use – that’s the key for patients,” Miller said. Nephrology News and Problems.

Brent Miller

Miller remains a leading advocate for nocturnal home hemodialysis, a therapy similar to continuous cycle peritoneal dialysis (CCPD) in terms of nighttime dialysis, but not necessary every night like CCPD.

“I think it’s a niche,” said Miller, who has managed nighttime dialysis patients for more than 20 years. Nephrology News and Problems. “But we have a whole generation of nephrologists who haven’t heard of it.

“Clearly, from a biological and physiological point of view, this is the best therapy we have; however, therapy is not scalable or practical. Better technology to handle night therapy and a comprehensive support system is lacking. If we can fix those two issues, I think nighttime dialysis takes off, ”Miller said.

A prescription for nighttime dialysis can be every other night for many patients with residual kidney function or up to 5 nights per week for those with co-morbidities, such as heart disease, Miller said.

Patient education

Education of patients who have early or intermediate stages of kidney disease should include a discussion of modalities. Corn Lisa Koester Wiedemann, CS, MSN, ANP, CNN-NP, a nurse practitioner in nephrology at the Washington University School of Medicine in St. Louis, said educators should first focus on the whole end-stage kidney disease.

Lisa Koester Wiedemann

“I have faced skeptics who think it is too early to educate patients with stage 3 CKD,” said Koester Wiedemann. Nephrology News and Problems. “But I remind them that it’s not just about educating patients on the modalities. This is to remind them to have their blood pressure checked. We ask them to watch their diabetes and what they are doing about exercise. We ask them to watch their salt intake.

“Once they resolve these issues and become comfortable with them, patients will be better informed about how to decide on kidney replacement treatment options.

“Patient education takes time. It’s not a session and you are done. But if you wait too long, it will be a knee-jerk reaction to which modality you choose. “

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