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Aksys Ltd. Message Board

  • sneff14 sneff14 Apr 2, 2002 8:41 PM Flag

    Baxter: the writing is on the wall.

    This is a good thread to regarding Baxter renal business.

    Sure looks like Mr. Harry Jansen Kraemer, Jr. has a clear and visible threat to Baxter's core businees in his own backyard. How would you react if you were their CEO. Must be a good topic at their board meeting.

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    • Excellent points...PD and Hemodialysis should be complementary, but too many people aren't fully informed of the availability and viability of PD.

      As an ESRD patient that has transitioned from PD to HEMO, I wish an AKSYS like solution were available to me today. The "clinic-dialysis-at-home" currently available is not as attractive to me. So in the short term I'm in the clinic 3 times a week. In the long run, I'm a transplant candidate. If my transplant fails, then I hope to have something like AKSYS available to maintain my life and lifestyle.

    • I know this. That is the reason I want to know why a physician would prescribe pd/capd rather than home hemo. Why be surgically altered to accomodate peritoneal dialysis first? can the same site be used for hemo?

      Why? HD and PD are equal the first two yrs of a patients dialysis Life. ie Fenton-Canada study, Mendalson. The leading cause of morbidity and mortality rates in hemodialyis patients 3 x a week is cardiovascular disease ( starts out as LVH) PD reduces the strain that Hemodialysis has on a patient which reduces LVH, preservation of the residual renal function, and PD offers the best chance for transplantation sucess. Pd and HD should be used in conjunction with one another, not competing with one another. The paradigm according to many Nephrologist should be, PD, if failed go to Home Hemo, when this is too much then in center hemodialysis.

      Additionally, what causes hemodialysis failure is access failures. when surgically putting in an access they usually wait two weeks to a month to use the access. Why not put a Pd catheter in, and a hemo access, allow the hemo access to mature and when the patient is ready for Hemo, their access will have less complications and the patients long term survivabilty will increase. That is a few reasons why PD and HD should work together

    • me too!

    • I know this. That is the reason I want to know why a physician would prescribe pd/capd rather than home hemo. Why be surgically altered to accomodate peritoneal dialysis first? can the same site be used for hemo?

    • Peritoneal Dialysis. Although peritoneal dialysis accounted for 11% (or 27,000) of the dialysis patient population in 1999 according to HCFA, approximately 22% (or 6,000) of the patients in the United States switched to outpatient in-center hemodialysis. The Company believes that most of these patients switched from peritoneal dialysis to outpatient hemodialysis because of the following limitations presented by CAPD, the most common form of peritoneal dialysis: (i) due to the limited efficiency of using the peritoneal membrane as a filter for toxin removal, patients must have a relatively low body weight or have some residual kidney function to achieve adequate levels of dialysis (once residual kidney function is lost, which is eventually the case in most patients, CAPD is no longer a viable treatment for a majority of the population); (ii) CAPD demands considerable responsibility and time to perform the required four exchanges of solution each day, which often causes patient "burnout" and non- compliance with the prescribed regimen; (iii) peritoneal dialysis demands that patients follow strict aseptic techniques when changing dialysate bags because the failure to do so often leads to peritonitis, an infection of the peritoneum; and (iv) the supplies used in peritoneal dialysis require considerable storage space given the quantity of dialysate (up to 30 large boxes per month) used in this treatment.

    • Would really like your input:

      Don't capd/pd patients have to have some residual kidney function?

      Do all, or the majority of pd/capd patients ultimately require hemodialysis?

      If a physician would presently qualify a patient as a candidate for pd/capd, knowing the patient will ultimately require hemodialysis, would he still prescribe pd/capd first? why?

      I do look forward to a future where dialysis centers buy/lease home hemo machines and manage home programs.
      I expect in-center use to a lesser extent the machine (for other than patient training); would defeat the cost efficiencies attributable to home hemo (travel, professional assistance).

      agree with you in re: Baxter's hemo sales, products and weaknesses. has long been the case. they must protect their capd/pd market share and grow hemo...grow hemo...grow hemo

    • I would agree that the paradigm will be shifting toward shorter and frequent 5 x a week dialysis. I look for the market to start doing in center programs before doing a complete shift to in home. Reason, too many to list with regards to safety concerns. As we speak, CAPD or PD is about 9% of the MKT place, home hemo is less then 2% so that leaves 89% to in center dialysis. You may see the shift to maybe 10% home hemo, but your still going to see many people chose PD for the various reasons. In center will still carry the majority of the MKT share, because the majority of those patients are 60 yrs of age an older. As we see younger and younger patients ending up with ESRD, you will see home hemo and PD taking a larger share of the MKT place. JMHO

    • wouldn't you agree approval of a patient-friendly home-hemo machine designed for more frequent and shorter (healthier) periods of dialysis, is reason for considerable growth in what we now refer to as a "niche" market?
      Just a matter of reimbursement changes and production, neither of which worries me.
      This is the future prescription.

    • I apologize about the confusion. I merely skimmed your last post note realizing that you where referencing another article from Pacific Equities/ They can short themselves to death. This is clearly a long play and to go short, doesn't seem to be prudent. Do you think AKSY will do a co-marketing compaign, Buy-out or go at it alone? IF they go at it alone, it will cost them at least 25 -50 million if not more. In order to raise capital they will have to use their shelf offerings

    • Of course I know CAPD is a niche market! and I know if a patient can do CAPD, they can do home hemo...which cannot be said for every dialysis patient.
      I dont believe you have read any post I have written saying "any dialysis machine can be used for home dialysis"...except in context with the rag piece written by Pacific Equities/ tried to convince readers a home hemo machine was already out there.
      I specifically pointed out aksys was the first approved machine specifically designed for home hemo; others are "modified".
      Other than that, we agree on all fronts, though my timeframe for reimbursement approval and time to market is shorter than yours.
      Best to you.

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