Australia and New Zealand evaluate NxStage

By Bill Peckham

Australia and New Zealand have an initiative called the Australia and New Zealand Horizon Scanning Network that is tasked with to providing advance notice of significant new and emerging technologies. They have a paper posted, a "Prioritising Summary", from last November looking at the NxStage. NxStage System One home dialysis for patients waiting for kidney transplantation (pdf link) concludes that it is a technology to watch:

The NxStage System One provides greater versatility for patients requiring dialysis and may be especially useful in rural and remote populations. Based on the high need and potential great gains from the successful introduction of such a device into the Australian market and that there is a large ongoing trial it is recommended this the NxStage System One be monitored.

There wasn't any communication with NxStage that was made to inform the report; it's not clear that reports from the Scanning Network ever amount to anything. What caught my eye was the title phrasing, for patients waiting for kidney transplantation. Are all people on dialysis in Aus/NZ considered to be waiting for kidney transplant? When the report went through the Aus/NZ incidence numbers they didn't parse out those on dialysis not waiting for a transplant vs. those waiting. It's an unusual way to put it.

The report does contain an error in magnitude:

A large trial of 5,000 RRT patients is underway with the NxStage System One (6 dialysis periods per week) being compared to conventional centre based haemodialysis (3 dialysis periods per week). The trial will run over three years (Jaber et al 2008).

This is the FREEDOM study which will include up to 500 participants at 70 clinical sites. Back to the issue of populating studies - it'll be hard enough to randomize 500 people. 5,000 is not going to happen.

I know many people in Australia would like to have a transportable machine, I don't think this report will make it any more likely to happen. It's a generalist committee writing about a very specific segment of medicine; it's hard for me to see how they can make a useful contribution.

Comments

[Zach]

"What caught my eye was the title phrasing, for patients waiting for kidney transplantation."

It might be the usual medical propaganda that is: "if you're on hemodialysis you must be waiting for a transplant."

Or perhaps only those waiting for a transplant will be allowed to use NxStage.

[Bill Peckham]

The more I've thought about it ... I think the title reflect the way medical generalists might think of CKD5 - everyone is waiting for a transplant. In the report they never identify people by their transplant choice. One other tip that they were talking from outside the field was their contention that the reason home dialysis is relatively popular in Oz is the rural nature of much of the country.

That was specifically refuted by Agar in an attempted podcast that I botched for technical reasons. Most people using home hemodialysis in Australia live close to a unit. Again from the outside looking in that makes sense but if you are familiar with the data it just not true.

I would say the reason that Australia and NZ have high rates of home dialysis use is that there isn't a charade of modality neutrality. They say to people who need dialysis that they will do best if they dialyze themselves at home, ideally for longer and more frequently they the dialysis they would otherwise receive incenter.

[Peter Tonkin]

I dialyse at home five times a week for up to eight hours and still work full time, ride motor bikes, play tennis and pretty much do everything that i used to do except TRAVEL. i would love to have a NXStage so as that I could complete my quewst to traverse all of Austrlia's great 4WD tracks such as The Simpson Desert, Canning Stock Route and Cape York again. I have been doing this for four years and do not necessarily want a transplant as it comes with it's own side effects which would interfere with my love of the water and outdoors. i also live within 5 minutes of a unit but avoid it as much as possible and in the four years i have been home dialysing have never been admitted to hospital.

Cheers

Happy Home Patient