Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Home Hemodialysis: Available Platforms and Personalizing Therapy in the Contemporary Era

Video Transcription

Video Summary

Dr. Rivara reviews current U.S. home hemodialysis (HHD) platforms and how to tailor prescriptions. Four equipment options are discussed: conventional in-center machines adapted for home (rare; require separate water treatment, plumbing/electrical modifications, and lack automated disinfection), the widely used NxStage System One/Versi (low dialysate volume, cartridge-based, uses either batch dialysate via PureFlow or sterile bags), and newer FDA-approved home systems Tableau (2020; integrated water treatment, on-demand dialysate up to 300 mL/min, strong patient-facing interface) and Quanta (home approval ~2024; on-demand dialysate up to 500 mL/min; trial showed adequate standard Kt/V and acceptable safety, with most trainees feeling competent by week five).<br /><br />For Tableau, Rivara frames two prescribing styles: “in-center HD at home” (longer, less frequent) versus short-daily (≥4x/week, ≤3.5 hours), noting larger patients may struggle to meet clearance targets with Qd capped at 300 mL/min; evidence suggests Qd 300 vs 600 reduces urea clearance only modestly.<br /><br />NxStage prescribing differs: clinicians prescribe frequency, blood flow, dialysate composition, “flow fraction” (effluent/blood flow) to target dialysate saturation, and dialysate volume (not time). Lower flow fraction increases saturation but lengthens treatments; typical frequency is 4–6x/week. He emphasizes water-quality monitoring, flexibility to match life participation, travel considerations (NxStage is most portable), and briefly advocates for nocturnal HHD with safety measures like moisture sensors.

Asset Subtitle

Matthew Rivara

Meta Tag

Module DIAL

Speaker Matthew Rivara

Keywords

home hemodialysis (HHD) platforms

NxStage System One/Versi

Tableau home hemodialysis system

Quanta home hemodialysis system

dialysate flow rate (Qd) and clearance targets

NxStage flow fraction and dialysate volume prescribing

nocturnal home hemodialysis safety and portability