Expecting the Unexpected: Managing Dialysis at Home

Expecting the Unexpected: Managing Dialysis at Home


When an ice storm hit Texas, shutting down the water supply that so many dialysis patients depend on to live, many patients who perform hemodialysis at home never missed a treatment.

As a mom of three and grandmother to another trio, 58-year-old Angela Smith is always preparing for unexpected situations. And living with kidney failure makes proper preparation and having the right home hemodialysis machine absolutely critical. So, when the catastrophic ice storm hit Texas in March 2021, Angela was ready.

During an emergency room visit to treat pneumonia in 2010, Angela was unexpectedly diagnosed with kidney failure, which can often present with no symptoms. Her diagnosis meant she would either need a kidney transplant or life-sustaining dialysis treatment, which mimics the water and toxin removal function of the kidneys.

Over the years, Angela has continued to work with her care team to improve her overall health to become eligible for kidney transplantation. While working to achieve this, Angela quickly discovered that home dialysis can provide many potential benefits, including improved clinical outcomes1 and improved appetite2 with more frequent dialysis, and increased flexibility in scheduling. In partnership with her care team, Angela learned to use a NxStage home dialysis machine to complete her home hemodialysis regimen by herself.

While dialysis is most often performed in a dedicated center, data now shows that more than 12.5 percent of the 550,000 dialysis patients in the U.S. are doing their treatments at home3 and the numbers continue to accelerate. Those rising numbers are due in part to advances in technology, training, and support that is helping home patients be better prepared for any situation.

As the storm winds picked up and temperatures plummeted, Angela, like 15 million4 other Texans, lost access to clean water. Some home hemodialysis machines require a clean water supply to dialyze.  A lack of clean water could present a high-risk situation for dialysis patients like Angela. A missed treatment increases the risk of complications and hospitalization.

Because Angela dialyzes with a NxStage machine, she could use her emergency supply of bagged dialysate, or sterile pre-mixed solution. In fact, NxStage systems are the only home hemodialysis machines in the US with this capability. Angela already had five days’ worth of dialysate in her home, as recommended by NxStage, and her care team delivered additional supplies to ensure she was supported throughout the storm.

Angela’s care team remained in touch to check on her status and safety. Daily communication helped confirm that she always had the supplies and support needed to continue her dialysis at home—even without running water.

Angela was lucky and maintained power throughout the storm. Should she have lost power, she knew from her home dialysis training – and from her own domestic and international travels – that her NxStage machine was portable and could be easily relocated in her travel case if needed, or simply connected to power from an appropriate generator.

Having a machine that can accommodate unexpected situations is of utmost importance for those on home dialysis. It is also important to have flexibility that extends beyond natural disasters. This flexibility is essential to maintaining the freedom and empowerment for people with kidney failure to live their fullest possible life.

For those who may be facing kidney failure, Angela shared, “Dialysis is a change of lifestyle, but you can do it. I’ve been on dialysis for ten years now, and while it’s different, I am able to do everything I did before. I paint, dance, walk, and travel with my machine. It just takes a little planning.”

Angela is just one of many people living and still thriving with kidney failure. To continue thriving, she must have consistent, dependable treatment solutions that can help patients expect the unexpected.


Risks and Responsibilities:

Home hemodialysis with NxStage systems involves risks, and users may not experience the potential benefits of such therapy. NxStage systems require a prescription for use. If a doctor prescribes more frequent therapy, vascular access is exposed to more frequent use which may lead to access related complications, including infection of the site.


1. Daugirdas, John T.; Blake, Peter G.; and Ing, Todd S., “Handbook of Dialysis (5th ed.)” (2015).

2. Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis. 2003;42(1 suppl):30-35.

3. United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.

4. https://www.vox.com/2021/3/1/22305616/water-texas-winter-storm-outage-california-fire-climate-change-infrastructure.

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