Advice

Summary

Summary

The NxStage System One is a haemodialysis system for renal replacement therapy to be used at home or while travelling. The system can run from standard home electricity and water supplies, and is smaller than standard home haemodialysis systems.

Effectiveness

  • The available evidence comes from 7 published studies (reported in 9 publications) involving a total of 12,604 people.

  • Four small feasibility studies (n=4, 5, 25 and 78) confirmed at least equivalent safety and efficacy between standard in‑centre and daily home haemodialysis with the NxStage System One.

  • Two multicentre cohort studies (n=291 and 11,228) showed an improvement in health‑related quality of life and modest improvements in survival compared with standard in‑centre haemodialysis 3 times per week.

  • A large single‑centre retrospective cohort study (n=973) showed similar patient survival and better technique survival (the time between starting 1 type of RRT and switching to another) for daily home haemodialysis with the NxStage System One compared with peritoneal dialysis.

  • No studies were identified where the NxStage System One was compared with home haemodialysis using conventional equipment.

Adverse events and safety

  • A small single‑centre case series study (n=3) reported dialyser‑induced thrombocytopenia in 3 young people using the gamma sterilized PUREMA dialyser, which is part of the standard NxStage circuit. The adverse reaction was resolved in all 3 people when the dialyser and circuit were changed.

  • A feasibility study (n=25) reported the following adverse events in adults using the NxStage System One: blood under‑heating, muscle cramping, hypotension, headache, dizziness and fatigue. The incidence of adverse events was higher when the system was used in‑centre than when used in the home.

Cost and resource use

  • Limited cost information is available for the NxStage System One.

  • The Manufacturer, NxStage Medical, is unable to provide information on the purchase cost of the NxStage System One. Instead, it presents the cost on a price‑per‑treatment basis that takes a number of variables into account. The manufacturer claims that the average price per treatment across all programmes is approximately 60% of the NHS tariff price for home haemodialysis.

Technical factors

  • The NxStage System One is a transportable haemodialysis machine intended for use in the home. The NX1000‑1 is currently the only model of this system available in the UK.

  • The device functions with a standard mains electrical and water supply, without the need for conversion of domestic power or water supplies.

  • A clean and safe area is required in the home to accommodate a 2‑week supply of dialysis consumables.