Use of NxStage VersiHD for Frequent Home Hemodialysis in a Hospital Setting: A New Opportunity for Complex Patients.

Background. The spread of home hemodialysis is increasing in Italy and across Europe, as noted in the document ("La diffusione dell'emodialisi domiciliare sta aumentando in Italia ed in Europa"). Its main feature enabling hospital use is its portability and independence from centralized water treatment systems, thanks to the use of sterile pre-mixed dialysate bags. This allows treatments to be delivered in environments not traditionally equipped for dialysis, such as isolation rooms on inpatient wards, emergency departments, or temporary units prior to definitive intrahospital transfer. Materials and Methods. Dialysis therapy used: The NxStage VersiHD system was employed to perform hemodialysis in three clinical scenarios: 1. Non-transportable patient with anasarca and acute kidney injury. The patient, hospitalized in the pulmonology ward and receiving oxygen therapy via tracheostomy, developed acute kidney injury with anuria requiring renal replacement therapy. The NxStage VersiHD device, already available in the dialysis unit, was transported to the patient's room. Two treatments were performed using 25 L of dialysate: the first lasting 3 hours and the second 4 hours. The system was used emergently for ultrafiltration and solute clearance until spontaneous diuresis resumed, despite a logistically challenging setting. 2. Chronic hemodialysis patient presenting to the emergency department with severe dyspnea due to fluid overload and SARS-CoV-2 infection. Because timely isolation in the dialysis unit was not feasible, urgent hemodialysis was performed using the NxStage VersiHD in a day-hospital room of our department, achieving reduction of pulmonary edema. 3. A 61-year-old woman with cirrhosis presented with splenic hemorrhage and acute renal failure. Admitted to intensive care, she underwent CVVHDF for 72 hours. She was transferred to the nephrology ward, which was not transportable due to the risk of hemorrhage. The NxStage VersiHD and the necessary equipment for dialysis scheduled for the following day were transported to the ward. Conclusions. The report aims to highlight the feasibility of using a home-designed dialysis technology safely within specific intrahospital contexts, offering an alternative strategy for dialysis support when infrastructural limitations or patient immobility prevent standard approaches. Staff training on NxStage operation, emergency procedures, and complication management is essential to minimize human error. The main challenges in training hospital nursing teams for occasional NxStage use include limited operational familiarity, management of device-specific complications, and integration of safety protocols. Operational unfamiliarity arises because, although NxStage is designed to simplify setup through preassembled cartridges and sterile dialysate bags, it differs technically from conventional dialysis systems. Lack of routine use is the primary reason for failure of NxStage implementation projects in hospital settings. To address this issue, our center adopted continuous use of NxStage in the dialysis unit for selected patients, ensuring regular machine operation. To avoid inadequate clearance with a thrice weekly schedule, 4 hour sessions were performed in patients with a distribution volume compatible with achieving a weekly Kt/V of 2.2, in accordance with international guidelines.