Field Notes Ep. 20 | What’s Next for NxStage with Joe Turk

Hey Brad, it's good to be here. Thanks for inviting me.

It depends on whether you were in the moment or in your heart or thinking about it in your head. In the moment, we were so focused on building the business and bringing new therapies to patients at home and in the hospital that we didn't have a lot of time to think about it. When you step back, the combination of NextStage and Fresenius was logical — complementary, with NextStage strong in home hemo and critical care, and Fresenius strong in in-center and PD. The biggest surprise was the incredible alignment in mission and philosophy, despite how different the companies were in size and maturity.

First, the rapid and continued acceleration of home dialysis training. Many more people are realizing the benefit of home hemodialysis. Second, advancing tools like the TCU, staffing, connected health, and telemedicine to take home to the next level. Third, I'm really proud of how we as an organization responded to the pandemic — helping patients in ICUs across the country and patients at home.

We were always optimistic about home hemodialysis potential. Patients told us how it changes lives, and there were markets with high and low home adoption, so room to grow. When the time came, it took all hands on deck — education teams, clinical training, manufacturing, supply chain, and technical support. I'm proud of what the team accomplished. The growth surprised us all in a good way. The biggest driver was clear alignment from the start that growth was possible and a priority. The NextStage merger was a catalyst, and changes in government programs like ETC and CKCC models, plus competition, will continue to drive growth.

The NextStage system's flexibility — portable, deployable in different parts of the hospital, uses bagged fluids, and delivers a wide range of therapies — made it a great option. When the pandemic hit, we identified hot spots, got machines and supplies to hospitals, and helped create capacity by training hospitals on different ways to use the machines. We collaborated with Fresenius Kidney Care and inpatient services to get staffing to the right places, especially early in New York City. We also created the National Renal Intensive Care Reserve to rapidly move machines and supplies as hot spots shifted. I was proud of how the team identified and reacted quickly, and the feedback from physician partners and customers was tremendous.

Connected health is hugely important for home dialysis — it makes it easier for staff and patients to communicate, improves care through better fluid management and training follow-up. Most patients are already connected via Next to Me, the Hub, or Connexus for PD, and we'll keep improving functionality. Transitional care units are a game changer — half of patients start dialysis unplanned, so the TCU offers a simpler, more focused start. Over 40% of patients who go through TCUs choose a home modality, and it gives better chance of permanent access and staying out of the hospital. These are areas we'll focus on in 2021 and beyond.

Definitely. NextStage has worked with DaVita for a long time, and it's nice to see them committing to home hemodialysis and PD with our product. With both Fresenius Kidney Care and DaVita expanding home programs, that's good for patients. What makes the NextStage system unique is its size and portability — it's the only machine small enough to take on the road or even a plane. Most patients travel, and it's the only system that can do that. We've worked with the FDA for solo and nocturnal dialysis, and it's the only system that can use both on-site produced dialysate and bag dialysate when water is unavailable, which is critical for travel and emergencies. The support — clinical education, technical support, customer supply chain — also makes it competitive.

The biggest challenge in dialysis is water. Without water, you can't make dialysate. The NextStage system's ability to use bag fluid is key. In Texas, we saw how severe it was, but these things happen often — water main breaks, algae blooms. We make sure home patients have extra supplies of cartridges and bag fluid. We also helped dialysis centers without water and hospitals with our technology. Hats off to the team for making a big difference.

I truly believe we're just at the start. NextStage will continue to innovate to make dialysis simpler and more doable at home — through interface improvements, building on our technology, and connected health via the Next to Me platform. We're also investing in how we deliver dialysate to make the system even more flexible. There are opportunities to share best practices between the services side, dialysis centers, and home programs. The sky's the limit.

Hey Brad, always happy to talk about home dialysis. I'm excited about it — it's a chance to do a really fantastic thing for patients.