Portable System Offers Dialysis Patients 'Liberating' Changes

A year ago, researchers at IU and across the country began testing the NxStage System One, a portable unit that allows patients to conduct their own dialysis at home or on the road. And the preliminary results are promising, says Michael A. Kraus, M.D., the study's principal investigator and medical director of IU's Continuous Ambulatory Peritoneal Dialysis and Acute Dialysis Units.

Dr. Kraus says patients treated with the System One therapy have more stable blood pressure and all of them have reduced or completely stopped their blood-pressure medications. Anemia rates seem to have declined and patients' appetites have increased. There has been a marked improvement in quality of life for the dialysis patients on daily treatments at Indiana University Hospital, a member of Clarian Health Partners.

"We've had mothers who didn't have the energy take care of their kids, people who had resigned themselves to never work or have a career, basically a lesser quality of life. Now their situations have reversed," Dr. Kraus says. "It has given patients back control over their lives."

Currently, about 70 patients with kidney failure nationwide are treated with NxStage System One, a third of which of these treated at IU and Clarian Health.

Kidney failure, or end stage renal disease, affects some 400,000 Americans, which cause a person to experience a total and irreversible loss of kidney function, leading to the eventual need for dialysis or transplantation. It can be caused by a number of conditions such as nephritis, traumatic injury, diabetes, hypertension or genetic-related disorders.

For end-stage patients who do not have a match for kidney transplant or are not candidates for deceased donor transplantation, the only treatment is dialysis of which there are two types. Less common is peritoneal dialysis, where the patient's abdominal membrane filters out waste, a process usually performed at home.

The most common form of treatment is hemodialysis, which separates toxins and excess water artificially from the patient's blood. Hemodialysis usually takes place in clinics or hospitals, though some units have been adapted for home use. Traditionally, patients undergo four hours of "cleansing," three days a week. While effective, the process often leaves patients physically exhausted and unable to resume normal activities.

The NxStage System One delivers hemodialysis, hemofiltration, or ultrafiltration to patients with kidney failure or fluid overload. The system is compact and weighs about 70 pounds. It's portable because of its freedom from unique electrical requirements and water processing, and can be used not only in a person's home but also when traveling.

Patients at IU have performed their dialysis in their homes, campers, hotel rooms and other locations far from their homes.

With this system, patients conduct daily dialysis (up to 2 ½ hours) to accommodate their schedules.

"NxStage trial participants at IU undergo extensive training before they are allowed to take the system home with them," Dr. Kraus says. "Training time is typically one to three weeks, and patients also must have trained partners who can assist with the set up and maintenance of the device and its components."

The system has given Indianapolis resident Angela Bunch, who is receiving in-center therapy at IU Hospital, a new lease on life. "I work full time night shifts. I would leave work in the morning, come into the hospital for dialysis three times a week, go home and rest and after that I would crawl into work.

"No pep, no get up and go whatsoever," says Bunch a postal worker who has been on dialysis since 2001. "Now, I can take those stairs at work and at home. The energy level I have now is so much higher. It's all so very liberating."

That freedom is what allowed Rick Skiles to go on his first extended vacation since starting dialysis in 1997. Last Christmas, the 51-year-old Indianapolis resident was able to cruise the Caribbean with his wife and visit relatives in Virginia. At the end of each day during the trip, Skiles would set up the portable system and conduct his own dialysis.

"There's no comparison to what I was doing before," Skiles notes of his previous dialysis regimen. "This approach definitely has been life-changing for me."