The new retrospective study published in the NEJM should be beneficial to NxStage if the results hold up. The study found that the day after the 2-day weekend for thrice weekly treatment had more cardiac events and more deaths. With the NxStage frequent treatment modality, there's no 2-day weekend. Patients don't suffer the extreme swings in fluid or toxins.
As a patient I've felt much better with NxStage than I did on conventional dialysis. The frequency of treatment is the key benefit. Of course, the flexibility to manage my own dialysis schedule and the ability to travel with the system are strong positives, too.
Time/duration of treatment more important then frequency for metabolic clearance. More frequent treatments are better to control BP/fluid gain and prevent intradialytic hypotension or myocardial stunning.(you feel better because of less osmotic dysequilibrium) And yes a low K bath is horrible for dialysis patients. The rapidity of lowering can provoke cardiac arrythmias. However, longer term next-stage is just as bad as conventional thrice weekly dialysis. FYI. IT is the same more or less, but convenient. Clinical outcomes are unchanged sadly.
You sound like a clinician with little regard for the patient's quality of life. Your off-hand comment disregards the benefits to the patient to be able to schedule one's own treatment, to travel freely, and to have a somewhat normal life. The fact that I can consume relatively normal amounts of fluid and that I never have to suffer through a weekend with two days between treatments are all more than enough for me to continue with NxStage.
I will agree that once I can start doing daily slow/nocturnal treatments that I should have better labs and a better long-term outcome. For the home-hemo systems that I know about, though, the additional flexibility and ease-of-use makes NxStage well worth it.