Testing the Tablo
The mission of Home Dialyzors United is to inform, inspire and advocate for an extraordinary quality of life for the home dialysis community, and we have interpreted that to include supporting innovation in renal replacement therapy (RRT); home hemodialysis (HD) or peritoneal dialysis (PD). We believe that all dialyzors should be able to choose an RRT that provides them with an optimal treatment.
To this end, HDU stays on the cutting-edge of the many new RRT options, such as the Tablo, recently approved for marketing in acute and chronic settings, and now pending home approval. Other home HD machines under development are the Quanta, Physidia, Diality, and the CVS remake of the Baxter Vivia.
HDU recently partnered with Outset Medical as they developed the Tablo for market, and I had an opportunity to participate in a usability study last summer. I spent 2 days at the corporate headquarters in San Jose, CA, learning about the machine, treatment, and maintenance. It was an eye-opening experience, and I was impressed at how Outset has listened to patient and clinician feedback. Just because the Tablo has reached market does not mean their work is done. In fact, it is just the opposite!
The machine, while not portable, is very compact, and once treatment is concluded, folds up into a sleek cabinet. The Tablo needs access to water and a drain, similar to NxStage, and both use a single-use cartridge that snaps easily into place. But, that is where the similarities end. A touchscreen program walks you through each step of the treatment on the Tablo, from set-up to clean up. No more “cheat sheets;” just step-by-step directions to follow at your own pace.
Tablo is also good news for those who prefer a bicarb dialysate. Only 1 jug of bicarb and 1 jug of acid are required per treatment, and they are easily connected to the dialyzer. Prime takes 8 minutes from start to finish, significantly reducing set-up time.
The original study that took place in CA was limited to the user interface of the machine, with no opportunity to do a treatment. However, thanks to Outset and the University of Virginia Dialysis program in Staunton VA, I recently had an opportunity to do a full treatment on the Tablo.
This was the first time I had been back in a dialysis clinic in more than 6 years, and I truly appreciate how understanding the nurses were. As home dialyzors, we get used to doing things our way, forgetting some of the in-center protocols in place for hygiene, safety, and sanitation, like changing gloves (I never even use them at home), etc… They very gently reminded me, at every turn, when I needed to change gloves, sanitize, and use aseptic technique. In turn, the nurses were somewhat surprised at how independent I was as a home dialyzor. They were very respectful of that, and I appreciated the hands-off approach.
I was told to arrive at 11:30 for a 12:00 chair time. The Outset representative was there to walk me through the treatment, beginning to end, set-up to breakdown. He was extremely knowledgeable, and he stayed with me for the duration of the treatment. We started set-up at 11:30, performed the prime, and I was on treatment by noon. I must say that I did not miss the NxStage “snap and tap.”
I have always done very well on the lactate dialysate used by the majority of NxStage dialyzors, and the few times I did an incenter or hospital treatment with a bicarb solution, my blood pressure would spike into the danger zone. I explained this to the nurse and the Outset representative, and pointed out that I tend to have very low potassium. All of this was taken into consideration when they programmed my treatment. Unfortunately, unlike NxStage, there was little “wiggle room” for the patient to adjust all the treatment parameters (time, UF goal, temperature, and flow rates are adjustable), and I have discussed this with Outset at length. Home dialyzors do not have the luxury of a chairside nurse to adjust the treatment parameters as necessary, and during my treatment the clinicians saw just how necessary this would be, if I were treating at home alone.
So, I had a slight lightheadedness for the first 30 minutes or so, which coincided with an increase in blood pressure (170/100), which I would attribute to my body adjusting to the bicarb dialysate. The difference with the Tablo, unlike other times on in-center dialyzers, was that after the initial 30 minutes or so, my blood pressure dropped back into a normal range, and the lightheadedness disappeared. The remainder of the treatment was uneventful.
The treatment was very gentle. I maintained my usual 300 blood flow rates. The machine calculates the UFR, and I also discussed with the Outset representative how this could be a problem for many home dialyzors. In fact, I was able to show them. The machine calculated a 0.6 UFR, based on trying to do remove 2 K of fluid in 3 hours. On NxStage, I have never been able to use a UFR higher than 0.5. It didn’t take long into the treatment for the tell-tale signs of cramping to show up! The UFR was lowered, and all was well. I was not able to remove the full 2 K, but then I can’t do that at home on NxStage either.
I was very interested in comparing the Tablo ultrafiltration (UF) performance to the NxStage UF, since I have been concerned that perhaps the NxStage was not pulling enough fluid, despite the fact that no matter how low the UFR, I could never manage to remove more than 1 K. Ironically, my treatment on Tablo merely confirmed that fact. I removed 1.4 K on the Tablo, and showed only .8 on the scales, BUT if you add the .6 L of water I sipped, then it was an exact match. So, I am now confident that I am not capable of removing more than 1 K per treatment—if that.
I completed my treatment at exactly 3:10, a little over 3 hours, with very few alarms. Another interesting fact: alarms are universal! While this dialysis machine is as straightforward as one can possibly get, it still had occasional alarms, although they resolved quickly. Rinse back and Post-treatment cleanup were a breeze. Snap out the cartridge, and the machine prompts you to enter cleaning mode. I was done by 3:30, and out the door.
I drove the 2.5 hours back home and went straight to my usual Tuesday night trivia with no residual feeling of weakness or tiredness. However, one thing stood out, post treatment, which I cannot say for sure was treatment related, but has never happened before. I SLEPT! I got home, and that night—and the next night—I slept a deep sleep for at least 8 hours, each night. I have not done that in years. If sleep is, indeed, a side effect of the Tablo treatment, I am sold.