Busy lives demand at-home dialysis

Being confined to a dialysis clinic three times a week for up to four hours each session didn't make sense to 29-year-old kidney patient Ryan Stanger.

The full-time Tufts University School of Dental Medicine student and father of two young children couldn't fit 12 hours in a dialysis clinic into his schedule -- at least not without making major career or family sacrifices.

So after his kidneys failed, Stanger this year became one of a tiny fraction of dialysis patients who treat themselves at home.

Among the advantages: Instead of long sessions three times a week, he undergoes shorter dialysis treatments daily, which have been shown to be better for patient health. His portable machine doesn't take up much space in the office of his Watertown home, and it only weighs about 70 pounds so he can lug it along on trips.

Best of all, instead of sitting with 20 other kidney patients in a medical facility full of bright lights and machinery, he gets to read bedtime stories to his children while his leased dialysis unit, manufactured by NxStage Medical Inc., of Lawrence, purges toxins from his blood.

''I can be with my family rather than go to a dialysis clinic every other night," he said. ''I can do it whenever I want."

More than 300,000 Americans undergo hemodialysis treatments to compensate for their loss of kidney function, with the majority covered by the government's Medicare program.

Home dialysis has been available for years, but its use has yet to become widespread. Most of the machines available until recently have been similar to in-clinic equipment, which requires electrical wiring and plumbing modifications to supply purified water.

As a result, about 99 percent of patients travel to specialized dialysis clinics three times a week. They sit in big vinyl recliners and doze, read, or watch television while their blood is cycled through thin plastic tubes.

That may not be the best form of care for many kidney patients. About one-third of them are under 50, and many attempt to lead active lifestyles. Increasingly, patients are demanding more flexible care, fueling a nascent market in smaller, more convenient dialysis machines like the NxStage unit in Stanger's home, which uses preshipped bags of purified water.

NxStage believes there are at least 45,000 US kidney patients who could benefit from the flexibility of home dialysis and who also have the skills required to operate the equipment. The company won Food and Drug Administration approval for its system in June and launched an initial stock offering Oct. 27 at $10 a share. NxStage stock closed Friday at $12.10 on the Nasdaq exchange, down 3.89 percent. It reached its highest point in November at $14.80.

Economics and ingrained physician attitudes have prevented faster adoption of in-home dialysis, said Dori Schatell, executive director of the Medical Education Institute Inc., a Madison, Wis., nonprofit foundation that receives funding from companies in the dialysis industry, including NxStage, a competitor called Aksys Ltd., and DaVita at Home, a division of the large DaVita Inc., the country's largest for-profit chain of dialysis clinics.

Having patients centrally located in a clinic is more convenient for doctors, so they have little incentive to encourage home treatment, said Schatell. ''The doctors make the rounds in the dialysis clinic and they can see 20 patients at a time, and they can bill for all of them," she said.

Physicians also underestimate the ability of patients to handle the technical aspects of dialysis on their own, said Schatell. As a result, she said, surveys have shown that few kidney patients are aware that home dialysis is available.

''If 75 percent have never heard of these treatments, they are not asking their doctors for them," she said. ''But any of that in-home technology will deliver a good treatment and give patients a better life."

Dr. Lynda Szczech, chairwoman of the dialysis advisory group of the American Society of Nephrology and a professor at the Duke University School of Medicine, said Schatell's criticisms were ''not entirely off-base." She agreed that many physicians worry that their patients cannot handle home dialysis.

''You wouldn't want to risk the patient's safety for a clinical improvement that they may not be able to achieve," Szczech said. Because of the logistics, training, and complex billing procedures required, traditional dialysis clinics are in the best position to support patients who want to do dialysis at home, Szczech said, but they have been slow to support in-home dialysis.

''Is it because the center doesn't have the resources for it? Or because the center has looked at it and decided that the amount of people who would be eligible for this kind of home-program doesn't justify the investment? It could be both," she said.

NxStage says it has developed an economic model that will work. The company charges $1,500 a month for the rental of equipment and supplies, which NxStage chief executive Jeffrey H. Burbank said is enough to provide a dialysis clinic supervising an in-home program the same profit that a clinic-based patient would generate.

The company also is lobbying Medicare to boost reimbursements specifically for in-home dialysis. Currently, Medicare does not have a separate reimbursement system for in-home dialysis. ''Improved reimbursement would drive adoption as well," Burbank said.

Christopher Rowland can be reached at crowland@globe.com.