ASN Kidney Week 2025 Through a Home Dialysis Lens

If you missed ASN in San Diego this year, or had other sessions and exhibitors to visit and couldn’t focus your attention on home therapies, this blog’s for you. First, two quick caveats: First, the MEI team was not at all systematic about visiting booths or attending sessions—both had to fit in to otherwise very busy days filled with meetings. So, we absolutely missed some things. We did not get photos of the Outset Tablo or the Diality Moda-flx this year, for example.

If you saw an amazing thing that I didn’t, please feel free to add it in the comments section! Also, no company I am covering paid to be mentioned or had a chance to review what I wrote. Now, off to the future.

SIX Home HD Machines We Did See (One Does PD, Too!)

We saw a plethora (I haven’t gotten to use that word since college Latin class!) of new and in-the-pipeline-but-close options that were the most exciting things we saw in the exhibit hall this year. They included—in the order we happened to see them:

• NxStage, of course, whose new Versi®HD with GuideMe software now leads users step-by-step through set-up, treatment, and end-of-treatment. Apparently, it can walk and dance, too. (Seeing is believing).

• The Quanta Dialysis System just received FDA 501 clearance last week, so congratulations. The 71-lb. bag-free system can do intermittent HD, three ICU options (SLED, CVVHD, and SCUF), and high-flow (500mL/min) home HD using a built-in RO system or a portable RO cart for dialysate. More than 90% of the patients who took part in the trials for FDA approval opted to continue using the system at the end of 8 weeks.

• Canadian i-Dialco’s Dimi does PD, HD, HDF, and UF-only treatments. The bag-only machine does not require plumbing, is built into a travel case (both together weigh 99 lbs.) and lifts up at the touch of a button. A sturdy stand can hold 40 liters of bags. The Dimi has FDA 510K clearance as of 8/28/2020 for hospital and clinical settings.

• The Nextkidney short (2-hour) daily HD Neokidney™ machine uses a sorbent cartridge to make dialysate, weighs just 10kg (about 22 pounds), collapses into a suitcase for travel and uses blood flow rates of 150-300 ml/min and dialysate flows of 300 ml/min. Developed with patient input from the Dutch Kidney Foundation, the Neokidney won the Innovative Device of the Year Award from the Spanish Patient Association, Alcer, which I presented to Dutch Kidney Foundation Managing Director, Tom Oostrom. The Neokidney is not yet FDA-approved.

• In development right in my own backyard (in Maryland), the exorenal XKIDNEY is a small, lightweight HD (23kg) machine that will sit on top of a newly designed RO filter. With innovation driven by biomedical engineer and CEO, Dr. Jake Lee, and partners that include Johns Hopkins University, the University of Toronto, the Launchport in Baltimore, and Boryung, we look forward to watching its progress. The XKIDNEY is not yet FDA-approved.

New, First-in-Class Antihypertensive: Tryvio™ (aprocitentan) by Idorsia, Ltd.

We haven’t seen a new class of blood pressure meds since a renin inhibitor was approved in 2007—18 years ago. Once-a-day Tryvio is FDA-approved to treat resistant hypertension by keeping the hormone endothelin from acting to constrict blood vessels.

Monitor Key Labs Instantly

Wouldn’t it be handy to get timely creatinine, hematocrit, and eGFR levels in 30 seconds from just one drop of blood? Nova Biomedical thinks that their FDA-approved StatSensor device could be used to prevent contrast dye or chemotherapy injury by assessing kidney status prior to an intervention or treatment. CKD screenings could provide immediate, no-wait results, too. A new StatSensor Xpress is awaiting approval.

Kidney Forward CEO and Founder Andrew Luu has been through the process of getting a transplant, and believes there is room to improve the patient experience through support, education, and navigation.

Home Dialysis Sessions

As I mentioned, we were busy! But MEI Program Director and PD/home HD training nurse Jenn Ravert, RN and I were able to attend talks by a few of my very favorite patient-centered nephrologists. I didn’t bother to write down the talk titles—because I would go to hear them on any topic. These included:

• Dr. Jenny Flythe, whose evidence-based analysis of the impact of high ultrafiltration rates on patient mortality informed our free UFR calculator (MEI offers wipeable vinyl Who is at Risk for Organ Stunning? stickers for HD machines with QR codes pointing to the calculator here.) I was glad to hear her emphasize longer HD treatment times and still using cool dialysate. Things I learned in her UF talk on Saturday morning included:

• Loop diuretic doses might need to be as high as 320 mg/day.

• Timing of antihypertensive medications need to be optimized vs. treatment time (some do not dialyze off and make it harder to pull fluid).

• Focusing on dialysate and dietary sodium—not fluid—is likely to reduce stunning.

• Dr. Joann Bargman, global PD expert, has a pragmatic, take-no-prisoners approach that guides countless other practitioners (and if they are not listening to her, they should be!). Things I learned from her case-based talk:

• There was no evidence of outcomes differences in patients made to stop PD prior to cardiac surgery and those who continued doing PD. “We don’t tell surgeons what kind of valves to use in the heart, why do you tell us which form of dialysis to use?”

• A “Do Not Forget PD” list can be a useful tool to recover patients who do have to temporarily stop PD due to a leak or other surgery.

• Post-op PD leaks carry a minimal risk of infection, as fluid is going outward, not inward.

• Umbilical hernias have the highest risk of incarceration of a PD catheter, which patients need to be warned about. Only anuric patients or those with strangulated bowels need to stop PD during a repair.

• 8mL/hour of GFR is equivalent to a Kt/V of 1.6.

• Dr. Chris McIntyre is an out-of-the-box thinker who not only gets out of silos, he blows them up. Some of the (in my opinion) most innovative and impactful patient care dialysis research in the field on the topic of multi-organ stunning has come from him and his team, and he always has great slides. I learned:

• Okay, I knew all of those things, but couldn’t resist the slide…

• Excessive ultrafiltration drives ischemia in ALL of the organs, and since all organs are interconnected, all are affected in various ways that impact health, quality of life, and survival.

• Cumulative injury to the heart, brain, endothelium, gut, and kidneys happens FAST—within 6 months of starting standard in-center HD.

• Hemolab is a 3-station HD unit that offers an intensive, multifactorial approach to optimizing HD treatment through personalized medicine. Using this approach, recovery time dropped from 15 hours to 2.

Whew! While this was a bit longer than our usual posts, I hope you found it informative.