One of the holy grails of kidney medicine is portable dialysis. Peritoneal dialysis offers that option and it’s surprising to me to see that modality continues to attract fewer patients, proportionally, year on year. Haemodialysis is of course much less portable and we know the shocking figures regarding the number of people on dialysis in England who have holidays or other breaks away from home and their dialysis unit each year – less than 10%! Home haemodialysis using traditional equipment and water purification systems has lots of advantages – less dietary and fluid restriction, less drug burden, feeling better and better survival. One of the problems of home haemodialysis is however, the size of the kit and particularly the water treatment unit – depending on individuals’ housing circumstances that can be a reason not to choose this option. I am therefore pleased to see that the National Institute for Health and Clinical Excellence is scoping a health technology assessment to appraise the clinical and cost effectiveness of a tap water haemodialysis system for home haemodialysis.
The PureFlow SL (NxStage Medical Inc) is an integral portable water purification system which uses domestic tap water which is passed through a series of carbon filters to produce very pure (‘ultrapure’) water. The PureFlow SL system is used in conjunction with a portable home haemodialysis device called NxStage System One. Drainage of used dialysate occurs through an under sink connection. If a patient needs to be mobile (i.e. away from the home) the System One cycler can be removed from the top of the PureFlow SL unit and used with bagged fluids instead.
The questions for consultation are:
- Which haemodialysis systems used for home haemodialysis should be included as comparators in the appraisal?
- Are there any subgroups of patients in whom the technology is expected to be more clinically effective and cost effective or other groups that should be examined separately
- Are there any issues that require special attention in light of the duty to have due regard to the need to eliminate unlawful discrimination and promote equality?
NICE intends to appraise this technology through its Multiple Technology Appraisal (MTA) Process. We welcome comments on the appropriateness of appraising this topic through this process. (Information on the Institute’s Technology Appraisal processes is available here
This looks like progress towards the introduction of some of the new haemodialysis technology that we have read about, seen on UTube or seen in action in North America.