Since the hand started writing on the wall that Hemo is looming in my future, now is the time to start investigating it. Thus far I have ascertained that Fresenius, my company support provider, has two models that it uses, the NxStage Versi HD and the NX System One. Regardless of which one is provided, patients can essentially opt for either daytime or nighttime usage. Therefore, our decision tree involves selecting a model and then selecting a use.
To aid and abet in our decision process, I turned to Perplexity with the following Prompt and results. Note that I was informed by Fresenius that they assign Nxs based on their inventory at the time the request is submitted, making choice problematic. Spoiler – at this point, it looks like VersiHD and night is best for me.
Prompt: I am a 3-year peritoneal dialysis patient. informed by my dialysis team that soon I may have to switch to home hemo. Fresensis, my dialysis company, provides either NxStage Versi HD or System One, depending on what they have. Which is better for me, and should I go for night or day?
If you are transitioning from peritoneal dialysis (PD) to home hemodialysis (HHD) with Fresenius, your main options will be the NxStage VersiHD or System One. Both are designed for home use, but there are important differences and considerations for choosing between them, as well as deciding between daytime and nocturnal (overnight) dialysis.
NxStage VersiHD vs. System One
| Feature | NxStage VersiHD | NxStage System One |
|---|---|---|
| Portability | Designed for easier learning, skill retention, and less risk of contamination | Compact, portable |
| Dialysate options | Pre-mixed bags, PureFlow SL | Pre-mixed bags, PureFlow SL |
| Ease of use | Enhanced touchscreen, GuideMe software | Simple interface, “Guide Me” steps |
| Data management | Nx2me app, automatic data transfer | Nx2me app, automatic data transfer |
| Training | Faster, more intuitive with GuideMe | Straightforward, but less advanced |
| FDA clearance | Approved for nocturnal and solo use | Approved for nocturnal and solo use |
| Maintenance | Disposable cartridge, minimal cleaning | Disposable cartridge, minimal cleaning |
| User experience | Designed for easier learning, skill retention, less risk of contamination | Well-established, widely used |
- VersiHD is the newer generation, featuring a more intuitive touchscreen interface, advanced GuideMe software for step-by-step instructions, and streamlined training. It’s designed to be easier for new users and care partners to learn and retain skills, with features that reduce the risk of contamination and simplify setup and cleaning123.
- System One is the original NxStage portable HHD machine, also user-friendly and portable, but with a less advanced interface. It remains reliable and effective, especially for patients already familiar with NxStage systems456.
Both systems are FDA-cleared for day or night use, with similar clinical outcomes and safety profiles46. VersiHD’s newer software and interface may make it preferable if you are new to home hemo or want the easiest possible transition.
Daytime vs. Nocturnal (Night) Home Hemodialysis
Daytime HHD
- Typically involves shorter (3–4 hour) sessions, 4–6 times per week.
- Leaves nights free, but requires time during the day.
- May be more familiar if you’re used to daytime PD exchanges.
- Can be more flexible for people with variable sleep schedules or those who prefer to monitor their treatment closely78.
Nocturnal HHD
- Performed overnight, usually 6–8 hours while you sleep, 4–6 nights per week.
- Frees up your daytime for work, family, or activities.
- Longer, slower treatments are gentler on your body, more closely mimic natural kidney function, and are associated with:
- Requires a stable sleep schedule and, in most cases, a care partner at night. Some people take time to adjust to sleeping with the machine, but alarms and safety features are built in1012.
Patient Experience
Many patients report feeling healthier and more energetic on nocturnal HHD, with the added benefit of having their days free for other activities. The gentler, longer treatments reduce the “washed out” feeling common after conventional dialysis and may allow for a more liberal diet11128.
Which Is Better for You?
- VersiHD is likely the better choice if you want the latest technology, easier training, and enhanced support features. Its design is especially helpful for new home hemo patients and those who value simplicity and clear instructions123.
- System One remains a solid option, especially if VersiHD is not available; both provide similar clinical outcomes46.
- Nocturnal HHD is generally preferred for those who want the best health outcomes, more flexibility, and a lifestyle closer to normal kidney function—if you can accommodate overnight treatments and have a care partner9101112813.
- Daytime HHD may be better if your sleep is disrupted, you don’t have a care partner at night, or you simply prefer to keep nights free for rest78.
Recommendations
- Discuss your body weight, home environment, and lifestyle needs with your care team. For patients over 60 kg, achieving dialysis adequacy on NxStage may require longer or more frequent sessions, which is easier to accomplish with nocturnal treatments6.
- If you value the most intuitive, modern system and easier training, ask for the VersiHD if available.
- If you want to maximize your energy, minimize dietary restrictions, and have your days free, nocturnal HHD is likely the best fit—provided you can sleep with the machine and have a care partner9101112813.
- If you have concerns about sleeping with the machine or lack a care partner, daytime HHD is still a strong option78.
In summary: Both NxStage VersiHD and System One are excellent, portable systems for home hemodialysis, with VersiHD offering a more user-friendly, modern experience. Nocturnal HHD provides the most health and lifestyle benefits for many patients, but your choice should ultimately reflect your personal needs, home situation, and preferences. Your care team can help guide you through training and setup for either option14923128.
- https://freseniusmedicalcare.com/en-us/products/treating-with-home-hemodialysis/home-hemodialysis-products/versihd/
- https://hometherapies.freseniusmedicalcare.com/home-dialysis-systems/versihd/
- https://freseniusmedicalcare.com/en/media/newsroom/fresenius-medical-care-grows-number-of-u-s–patients-using-company-s-home-hemodialysis-machines–launches-nxstage–versi-hd-with-guideme-software/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11020435/
- https://freseniusmedicalcare.com/en-us/products/treating-with-home-hemodialysis/home-hemodialysis-products/nxstage-system-one/
- https://www.scirp.org/journal/paperinformation?paperid=101285
- https://aakp.org/short-daily-home-hemodialysis/
- https://www.kidney.org/kidney-topics/home-hemodialysis
- https://hometherapies.freseniusmedicalcare.com/home-hemodialysis/nocturnal-hhd/
- https://homedialysis.org/news-and-research/blog/513-the-benefits-of-dialyzing-while-you-sleep
- https://www.kidneyresearchuk.org/case-studies/nocturnal-dialysis-a-patients-experience/
- https://homedialysis.org/home-dialysis-basics/nocturnal-home-hemodialysis
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3569086/
- https://forums.homedialysis.org/t/nxstage-vs-fresenius/745
- https://www.youtube.com/watch?v=fYTlaB1JiB0
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9937637/
- https://www.reddit.com/r/dialysis/comments/11dd5bx/experience_with_nxstage_versihd_or_system_one/
- https://forums.homedialysis.org/t/concerns-with-the-nxstage-system-one/2924
- https://pubmed.ncbi.nlm.nih.gov/22613922/
- https://www.kidney.org/kidney-topics/nocturnal-hemodialysis
- https://aakp.org/dialysis-while-you-sleep-an-alternative-therapy/
- https://homedialysis.org/home-dialysis-basics/machines-and-supplies/hemodialysis-machines
- https://www.medicalexpo.com/prod/nxstage-medical/product-81164-1078249.html
- https://finance.yahoo.com/news/fresenius-medical-care-stock-rises-164700077.html
- https://www.massdevice.com/fresenius-launches-new-home-hemodialysis-system/
- https://en.wikipedia.org/wiki/Home_hemodialysis
- https://www.nice.org.uk/guidance/mib12/resources/the-nxstage-system-one-nx10001-home-haemodialysis-device-for-renal-replacement-therapy-in-chronic-kidney-disease-pdf-63498981303493
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6452820/
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