Authors make urgent recommendations toward providing patients
with access to the life-changing benefits possible with home
haemodialysis
LONDON, Oct. 9, 2018 /PRNewswire/ -- NxStage
Medical, Inc. (Nasdaq: NXTM), a leading medical technology company
focused on advancing renal care, today published a report, 'Home
haemodialysis: Tackling unequal access in the UK'. The report,
developed by NxStage in collaboration with renal health
professionals, kidney patients, and patient charities including
Kidney Care UK and the National Kidney Foundation, highlights
significant disparities over patient access to the life-changing
benefits possible with home haemodialysis, and makes urgent
recommendations towards improving access across the country. It
also discusses opportunities for home haemodialysis to reduce costs
associated with dialysis treatment for the NHS.
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The National Institute for Health and Clinical Excellence (NICE)
recommends that all patients who are suitable for home
haemodialysis should be offered the choice of home therapy, but
this is far from the case.1 Just 4.4% of the 28,000
patients on dialysis in the UK are on home haemodialysis -
approximately 10% lower than NICE's recommendation.2 As
a global comparison, compared to the UK's 4.4%, New Zealand has more than 17% of its dialysis
patients dialysing at home and Australia has 9%.3
The report identifies lack of patient awareness and education of
home haemodialysis as primary reasons for low penetration of the
therapy. Independent polling of kidney haemodialysis patients found
that 27% were not educated on all types of dialysis that would be
beneficial to them, and 31% of in-centre patients cite never being
offered home haemodialysis as a treatment option.4
The report shows that, city to city, it is a postcode lottery as
to who has access to the potential benefits of home haemodialysis.
Derby has the highest uptake in the UK, with 13.2% of dialysis
patients on home haemodialysis, three times higher than the
national average. Portsmouth and
Manchester are the only other
cities hitting recommended targets, with an uptake over
10%.5 Where patients live in the UK has a significant
impact on their ability to access home haemodialysis as a therapy
option.
This lack of access to home haemodialysis denies many patients
the opportunity for improved health and a better quality of life -
the home is the most practical setting for patients to perform
haemodialysis at the frequency and duration that best suits their
clinical needs. More frequent haemodialysis has been shown to lead
to better clinical outcomes, including improved
survival6, reduced risk of cardiovascular morbidity,
7, reduced need for blood pressure
medications8, improved physical and mental quality of
life9, and more energy.10 Improved health can
also increase a patient's likelihood of receiving a kidney
transplant.11
More frequent haemodialysis can also dramatically reduce
recovery time. The average in-centre patient reports eight hours of
post-dialysis recovery time, compared to just one hour for those
dialysing more frequently at home.12 Compared to home
haemodialysis patients, in-centre haemodialysis patients lose 52
days per year to recovery time, travelling to appointments, and
waiting at the hospital.13
Increasing the uptake of home haemodialysis has potential
benefits for the NHS, especially considering the need for
haemodialysis may double across the world by 2030.14 A
large cost of in-centre haemodialysis is transport, with patients
travelling to and from the hospital for therapy. According to the
National Kidney Federation, in the 52 hospitals across England that offer dialysis, 50% of their
patient transport costs are accounted for by
dialysis.15
The report urges healthcare professionals and the government to
take action towards increasing patient access to home
haemodialysis. Recommendations include strengthened patient
education programs, dedicated staff responsible for supporting home
programmes, and better patient-to-patient interactions.
Other key data from independent polling of kidney haemodialysis
patients mentioned in the report include:
- 77% of home haemodialysis patients report an improvement in
their health since dialysing at home and 26% relied less on
medication.
- 62% of in-centre haemodialysis patients want more flexibility
on how often they dialyse, with 63% spending less time with friends
and family and 52% not being able to go on holiday.
- Since beginning home haemodialysis, 58% of patients report
being happier, 52% witness decreased anxiety levels, and 71% have
more leisure time.
- Taking into account additional costs that otherwise wouldn't be
spent, such as travel, parking, food, and childminding, the average
in-centre patient also spends £1,019 of their own money each year
on their own life-saving treatment.16
Dr. Natalie Borman, Care Group
Director for Renal and Transplantation, Wessex Kidney Centre,
Portsmouth, which has one of
the largest home haemodialysis departments in the UK, says:
"Queen Alexandra's home
haemodialysis programme was established in response to increasing
evidence that more frequent haemodialysis is associated with
improved survival, better patient outcomes and improved quality of
life. It's important for patients to have the right to choose which
treatment is best for them and their life. Of course, it is not
right for everyone, but patients should not be excluded based on
their medical conditions alone."
Matt Walker of NxStage Medical
UK, Ltd., provider of home haemodialysis
machines says:
"Dialysis is a life-saving treatment for patients with kidney
failure and access to it should not be impacted by differences
across NHS trusts, a person's financial circumstance, or
geographical location. With the number of people needing dialysis
continuing to rise, now is the time for government and healthcare
professionals to focus on improving the uptake of home
haemodialysis. Whether dialysing in hospital or at home, all
patients should have access to the treatment that is right for
them."
Matt Herbert, current home
haemodialysis patient, says:
"Because I dialyse more frequently, my overall health has
improved. I found it to be really difficult to rely on hospital
visits, especially for my mental health. It was really tricky to
juggle all aspects of my life – my dialysis appointments, my job,
and my family. Moving to home haemodialysis has really helped me to
have the freedom to choose when and where I dialyse. I can now
travel abroad for holidays, be more focused at work, exercise, and
spend quality time with my new-born child and
family."
About NxStage Medical
NxStage Medical, Inc. (Nasdaq:
NXTM) is a leading medical technology company, headquartered in
the United States, that develops,
manufactures and markets innovative products for the treatment of
end-stage renal disease (ESRD) and acute kidney failure. For more
information on NxStage and its products and services, please visit
https://www.nxstage.co.uk/.
Despite the health benefits that home and more frequent
hemodialysis may provide to those with chronic kidney disease,
these forms of therapy are not for everyone. Home hemodialysis with
the NxStage System One requires a patient and partner who are
committed to being trained on and following the guidelines for
proper system operation.
The reported benefits of home hemodialysis may not be
experienced by all patients.
The NxStage System One is a prescription device and, like all
medical devices, involves some risks. The risks associated with
hemodialysis treatments in any environment include, but are not
limited to, high blood pressure, fluid overload, low blood
pressure, heart-related issues, and vascular access complications.
When vascular access is exposed to more frequent use, infection of
the site, and other access related complications may also be
potential risks. The medical devices used in hemodialysis therapies
may add additional risks including air entering the bloodstream,
and blood loss due to clotting or accidental disconnection of the
blood tubing set.
Certain risks are unique to the home. Treatments at home are
done without the presence of medical personnel and on-site
technical support. Patients and their partners must be trained on
what to do and how to get medical or technical help if
needed.
Certain risks associated with hemodialysis treatment are
increased when performing nocturnal therapy due to the length of
treatment time and because therapy is performed while the patient
and care partner are sleeping. These risks include, but are
not limited to, blood access disconnects and blood loss during
sleep, blood clotting due to slower blood flow or increased
treatment time or both, and delayed response to alarms when waking
from sleep.
Patients should consult their doctor to understand the risks
and responsibilities of performing these therapies using the
NxStage System.
Forward-Looking Statements
This release
contains "forward-looking statements" within the meaning of the
Private Securities Litigation Reform Act of 1995. All statements
contained in this release that are not clearly historical in nature
are forward-looking, and the words "anticipate," "believe,"
"expect," "estimate," "plan," and similar expressions are generally
intended to identify forward-looking statements. Actual results may
differ materially from those indicated by these forward-looking
statements as a result of various important factors including those
that are discussed in NxStage's filings with the U.S. Securities
and Exchange Commission, including its Quarterly Report on Form
10-Q for the quarter ended June 30,
2018. NxStage is under no obligation to (and expressly
disclaims any such obligation to) update or alter its
forward-looking statements, whether as a result of new information,
future events or otherwise.
For more information contact:
Becky Merchant / nxstage@standagency.com /
0203 6965800
1 nice.org.uk. (2002). Guidance on home compared with
hospital haemodialysis for patients with end-stage renal failure.
[online] Available at:
https://www.nice.org.uk/guidance/ta48/chapter/6-resource-impact-for-the-nhs
[Accessed 2 Feb. 2018].
2 MacNeill, S., Ford, D., Evans, K. and Medcalf, J.
(2018). K Renal Registry 20th Annual Report: Chapter 2 UK Renal
Replacement Therapy Adult Prevalence in 2016: National and
Centre-specific Analyses. [online]
Renalreg.org. Available at:
https://www.renalreg.org/wp-content/uploads/2018/06/02-Chap02.pdf
[Accessed 4 Jul. 2018].
3 Anzdata.org.au. (2017). ANZDATA Australia and New
Zealand Dialysis and Transplant Registry. [online] Available at:
http://www.anzdata.org.au/v1/report_2017.html [Accessed
2 Feb. 2018].
4 Commissioned by NxStage, hosted by Censuswide. (102
participants who are/have been treated for kidney failure and have
been treated with either Centre Haemodialysis, Home Haemodialysis
or Peritoneal dialysis, November
23rd, 2017)
5 MacNeill, S., Ford, D., Evans, K. and Medcalf, J.
(2018). K Renal Registry 20th Annual Report: Chapter 2 UK Renal
Replacement Therapy Adult Prevalence in 2016: National and
Centre-specific Analyses. [online]
Renalreg.org. Available at:
https://www.renalreg.org/wp-content/uploads/2018/06/02-Chap02.pdf
[Accessed 4 Jul. 2018].
6 Weinhandl ED, Lie J, Gilbertson DT, Arneson TJ,
Collins AJ. Survival in daily home hemodialysis and matched
thrice-weekly in-center hemodialysis patients. J Am Soc
Nephrol. 2012;23(5):895-904.
7 McCullough PA, Chan
CT, Weinhandl ED, Burkart JM, Bakris GL. Intensive
Hemodialysis, Left Ventricular Hypertrophy, and Cardiovascular
Disease. Am J Kidney Dis. 201 Nov;68(5S1):S5-S14. doi:
10.1053/j.ajkd.2016.05.025.
8 Bakris GL, Burkart JM, Weinhandl ED, McCullough PA, Kraus MA. Intensive
Hemodialysis, Blood Pressure, and Antihypertensive Medication Use,
Am J Kidney Dis. 2016 Nov;68(5S1): S15-S23.
9 Finkelstein FO, Schiller B, Daoui R, Gehr TW, Kraus
MA, Lea J, Lee Y, Miller BW, Sinsakul M, Jaber BL. At-home short
daily hemodialysis improves the long-term health-related quality of
life. Kidney Int. 2012 Sep;82(5):561-9.
10 Finkelstein F, Gehr T, Kraus M, et al. Daily
hemodialysis (DHD) improves quality of life (QofL): interim results
from the FREEDOM study. Abstract presented as poster at Annual
Dialysis Conference, 2011.
11 Weinhandl E, Liu J, Gilbertson D, Arneson T,
Collins A. Transplant incidence in frequent hemodialysis and
matched thrice-weekly hemodialysis patients. Poster presented at
National Kidney Foundation Spring Clinical Meeting, 2012.
12Jaber BL, Lee Y, Collins AJ, et al. Effect of daily
hemodialysis on depressive symptoms and postdialysis recovery time:
interim report from the FREEDOM (Following Rehabilitation,
Economics and Everyday-Dialysis Outcome Measurements) Study. Am
J Kidney Dis. 2010;56(3):531-539
13 Commissioned by NxStage, hosted by Censuswide. (102
participants who are/have been treated for kidney failure and have
been treated with either Centre Haemodialysis, Home Haemodialysis
or Peritoneal dialysis, November
23rd, 2017)
14 Liyanage, T., Ninomiya, T. and Jha, V. (2015).
Worldwide Access to Treatment for End-Stage Kidney Disease: A
Systematic Review. Journal of Vascular Surgery, 62(4).
15 kidney.org.uk. (2017). Home Haemodialysis the
advantages for suitable patients. [online] Available at:
https://www.kidney.org.uk/help-and-info/medical-information-from-the-nkf-/medical-info-haemodialysis-why-home-dialysis/
[Accessed 2 Feb. 2018].
16 Commissioned by NxStage, hosted by Censuswide. (102
participants who are/have been treated for kidney failure and have
been treated with either Centre Haemodialysis, Home Haemodialysis
or Peritoneal dialysis, November
23rd, 2017)
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