home dialysis Daily home dialysis with Nxstage System One: analysis of results in an Italian single-casuistic series

Daily home dialysis with Nxstage System One: analysis of results in an Italian single-casuistic series

  



Chiara Brunati

Chiara Brunati

Chiara Brunati1, Franca Cassaro1, Laura Cretti1, Michela Izzo1, Marisa Pegoraro1, Daniela Negri1, Francesca Gervasi1, Giacomo Colussi1

1 S.C. Nephrology, Dialysis and Renal Transplant, ASST, Great Metropolitan Hospital Niguarda, Milan

Correspondence to:
Dr. Chiara Brunati
S.C. Nephrology, Dialysis and Renal Transplantation
ASST, Great Metropolitan Hospital Niguarda, Milan
Piazza Ospedale Maggiore, 3 - 20133 Milan
Tel 02.64442521, Fax 02.64442909
e-mail: chiara.brunati@ospedaleniguarda.it

Abstract

The NxStage One System is an extremely simplified system proposed for home hemodialysis that involves the use, through a small size equipment, of low volumes of dialysate, usually 15-30 liters depending on the patient's anthropometric parameters, administered with values of dialysate flow of about 1/3 with respect to those of the blood flow, in order to ensure saturations of the dialysate for very high diffusible solutes (for about 85-90% urea). Under these conditions the values ​​of urea clearance obtained with each session are approximately equal to those of the dialysate flow. The purifying target set for the achievement of weekly Standard Kt / V (StdKt / V) values ​​≥ 2.1 is obtained with an increase in the frequency of the sessions, usually six a week, which guarantees a better volume control of the patients. The following is an account of our experience in treating this system with 12 patients from May 2011 to December 2016.

Keywords: NxStage system One, Home Hemodialysis, Daily Dialysis

visual abstract
Introduction

In 2004, the scientific publication with which Clark presented to the nephrology community a new technology for the home dialysis treatment (1): a machine that is not cumbersome (31 kg of weight with a volume of 38x38x45cm3), easy both in maintenance (filter and lines mounted in a "drop in" cartridge), which in the management (few parameters to be entered for the setting and system with alarm codes) and without the need for adjustments to the hydraulic and electrical network at home. The approach of the system is very peculiar as it provides, as a fundamental cornerstone of the dialysis prescription, the maintenance, during the session, of a very low ratio (on average 30-40%) between dialysate flow and blood flow, the so-called "Flow Fraction ", with the aim of ensuring saturations of the dialysate, at the output of the filter, close to 100% (2). In these conditions the values ​​of the dialysate flow, on average 100-200 ml / min, are practically superimposable to the values ​​of the obtained urea clearance.

The total amount of dialysate used (usually between 15-30 liters provided with bags similar to those used in peritoneal dialysis) is calculated on the basis of the weekly urea clearance to be achieved and depends, as well as on the patient's anthropometric parameters, on the number of weekly sessions. The NxStage One system is born as a multifrequent dialytic system with a consequent better control of the patient's volemias.