1. Home haemodialysis with NxStage and its impact on environment A fresh approach to improving the impact of haemodialysis on the environment

2. Key features of the NxStage home system • Dramatically reduced water consumption • Lower electricity/power consumption • Reduced patient travel for hospital visits • Reduced clinical waste disposal • Reduced prescription medication required

3. How do all these features help to reduce the environmental impact of haemodialysis Well let us take a look in more detail at the features we at Kimal believe can go some way to making this happen

4. Water consumption • In a traditional home haemo machine: • A clean/disinfect cycle is required which uses water and power • During the dialysis treatment typically 800 ml/min goes down the drain (192 litres for a 4 hour treatment) • This does not include what the RO unit supplies to the machine and rejects down the drain which can be typically 50% e.g. a further 800 ml/min in total (192 litres per 4 hour treatment)

5. Water consumption • In the NxStage home haem machine this can be reduced as follows: • The NxStage Pureflow unit produces a 60 litre batch of dialysate which is enough for 2-3 dialysis treatments • As the NxStage has no internal dialysate pathway cleaning/disinfecting is not required • No additional water to the above 60 ltrs is consumed

6. Water consumption • Water is taken direct from the house mains supply and fed to the Pureflow via a very high efficiency filter unit • A standard home dialysis RO system is not required along with its associated softener unit • Apart from bleach solution to clean the Pureflow drain line, no other harsh chemicals are required for routine cleaning tasks

8. Power consumption • In broad terms the functions/equipment requiring power during a standard dialysis treatment on a traditional home haemo machine and the same treatment on a NxStage home haemo machine are about the same • All the same pumps, heaters and control systems have to be used on both systems

9. Power consumption • The NxStage machine scores well in the ‘green stakes’ when considering the following: • The machine is only using around 20 litre of fluid per dialysis treatment • So all the delivery pumps/heater etc are pumping/heating a much smaller volume of water during each dialysis treatment in comparison with a conventional haemo machine

10. Power consumption • Recent monitoring by a UK NxStage patient revealed: • Total energy consumption costs for his NxStage Pureflow and control units over a one year period would be around the £250.00 figure

11. Power consumption • This can be compared with the following figures for running a 100 watt light bulb for 24 hrs a day for one year • This would use around 876 units of electricity • Which at say 15p per unit would work out at £131.40 a year

12. Water / energy consumption • In summary the NxStage home machine can be seen to be making very positive savings in both water and energy consumption in patients homes • This has to be seen as a good thing in reducing our global carbon footprint within the home haemodialysis world