The U.S. dialysis centers market size was valued at USD 26.9 billion in 2022 and is expected to expand at a compound annual growth rate (CAGR) of 5.29% from 2023 to 2030. Major factors driving the growth of the market in the country are the high prevalence of renal diseases, technological advancements, favorable reimbursement, and the lack of kidney donors.
According to the national kidney foundation, 78,600 Americans have end-stage renal disease, wherein 71% of them are on dialysis while 29% had kidney transplants. As per the united health foundation, West Virginia had the highest prevalence of kidney disorders in the U S. 4.6% of the population in the state has been diagnosed with a kidney disorder, while 2.9% population in the U.S. have been diagnosed with the same, indicating the extremely high prevalence in the state.
According to the CDC, the prevalence of Chronic Kidney Disease (CKD) in the U.S. is higher in individuals aged above 65 years or older (38%) as compared to those in the age group of 45-64 years (12%) and 18-44 years (6%). As the U.S. has a significantly high geriatric population, due to increased life expectancy, the demand for the services is high in the country.
Post COVID Outlook
The COVID-19 pandemic resulted in restrictions on the operations of outpatient clinics resulting in the loss of revenue for the clinics. The risk of infection at the centers resulted in a decline in the number of patients visiting the center. For instance, during 2020 DaVita Inc. recorded a 1.3% decrease in patients as compared to 2019. As the patients cannot discontinue the treatment, there was a strain on the service providers to manage effective accessibility to the services.
The outpatient centers collaborated to offer in-center isolation for COVID-19 patients on dialysis. The COVID-19 infection resulted in patients with other comorbidities requiring treatment due to kidney malfunction. This is expected to increase the market demand. The high prevalence of kidney disorders in the U.S. currently indicates that more people would require the service in the future, resulting the high market demand in the future.
The demand for home services increased during the pandemic owing to the benefit of home comfort & reduced exposure to virus infection. This resulted in the adoption of telehealth services by outpatient centers. The federal government has also taken initiatives to ensure better access to dialysis treatment for ESRD patients. The government aims to have 80% of the new kidney patients undergoing treatment at home.
The COVID-19 pandemic changed the view toward peritoneal dialysis. Peritoneal dialysis can be facilitated at home without assistance, by just coordinating with the 24/7 online help from the center. The ease & improved safety in peritoneal dialysis is expected to increase the market demand post-COVID-19.
End-Stage Renal Disease (ESRD) or kidney failure is the last stage of chronic kidney disease where kidney functioning drops to a level where dialysis or kidney transplant becomes necessary for survival. The requirement for dialysis or transplantation for ESRD in the U.S. is among the highest globally. Although there is a huge demand for dialysis care among ESRD patients, a significant proportion of them remains inaccessible to pre-ESRD nephrology care that includes services such as early detection of progressive renal disease and interventions to reduce its progression.
In addition, Medicare covers up to 80% of the service cost, resulting in access to better quality services. However, despite the coverage end-stage kidney disease treatment is expensive for the uninsured population. The cost of one dialysis treatment session in the U.S. is USD 110 with medicare, and the patients require multiple sessions frequently making it expensive.
The cost of treatment without medicare goes up to more than USD 500 per session. Annually, the patients have to spend USD 72,000 on the treatment, making it beyond reach for low-income families without medicare. The market in the U.S. is heavily dependent on public & private insurance coverage.
The kidney donor shortage in the U.S. is a major challenge faced by ESRD patients requiring a transplant. The rejection of a high number of donors’ kidneys every year due to anomalies observed in procurement biopsies. A kidney transplant requires a lot of time and requires a detailed examination of the transplanted kidney to prevent post-transplant problems. This is resulting in the rejection of a large proportion of kidneys donated, eventually leading to a shortage.
Many states have long waiting times for kidney transplants due to the shortage of kidneys. According to a study for health testing centers, Alabama has the highest waiting time for a kidney transplant in the U.S. in 2018, 30% of the people waiting for a transplant had completed 5 years of waiting and 5, 800 such Americans died before the transplant. These patients are heavily reliant on dialysis services in such regions.
The modality segment is categorized into in-center, in-home, and SNF-based. In 2022, the in-center segment had the highest revenue share owing to the high adoption of the service. The in-center services are required for ESRD patients in need of hospitalization for other reasons, suffering from acute kidney failure mainly arising from trauma, and early-stage ESRD patients.
The treatment in such cases is performed in a dedicated treatment room in a hospital or at the patient’s bedside at the center. Certain service providers such as DaVita, Inc. contract with a group or individual nephrologists to provide care at their facilities. However, the accessibility to centers varies state-wise. Missouri, South Dakota, Alabama, and Kentucky are among the states having high no of outpatient facilities accounting for 13.07 to 17.05 facilities per 1000 patients as per the CDC. This is resulting in higher growth opportunities for the segment in these states.
However, the in-home segment is estimated to register the fastest growth over the forecast period due to government initiatives to promote the treatment. Along with enabling obtaining treatment in the comfort of their home, an increase in home treatment will also reduce the current high expenditure of Medicare for in-center treatment. Home treatment is typically preferred by patients, who are independent and healthier, in their residences using the equipment specifically designed for home therapy.
Home therapy is resulting in continued treatment, improving recovery time & survival longevity. The improved patient outcome has resulted in the service providers investing in developing platforms to promote home-based treatment. As per the data reported in Kidney week 2021 by the American Society of Nephrology, the adoption of home therapy rose from 11.6% in 2016-14.5% in 2021 in the U.S. For End-Stage renal disease patients, the adoption of home-based treatment increased from 14.0% in 2016 to 20.0% in 2021 accounting for 5.2% growth.
SNF-based modality is expected to have lucrative growth during the forecast period. The majority of the elder patients in the U.S. with comorbidities live in skilled nursing facilities as they require continuous care & assistance. According to NxStage, 65,000 Americans in the SNFs across the U.S. require dialysis. The growing geriatric population in the U.S. & Americans requiring skilled nursing services are increasing the opportunities for such services.
The SNFs are collaborating with dialysis clinics to facilitate quality services. For Instance, in August 2022, Infinite Care collaborated with Dialyze direct for facilitating dialysis service at the SNF. The collaboration will enable the company to provide dialysis services in more than 170 facilities in the U.S.
Based on dialysis type, the market is categorized into hemodialysis and peritoneal dialysis. In 2022, hemodialysis dominated the market. This can be attributed to the high efficacy of hemodialysis. As per the University of California, 90% of end-stage renal disorder patients in the U.S. are undergoing hemodialysis.
Hemodialysis requires medical staff to completely assist the patient, however, peritoneal dialysis requires patient training & dedication as it can be done independently. Hence, patients requiring complete assistance prefer hemodialysis only. The accessibility to quality services at outpatient hemodialysis centers is also increasing the demand for hemodialysis.
Home hemodialysis has resulted in improved kidney function & life expectancy for patients as per a recent study by the national kidney foundation. The recovery time has also reduced due to more frequent treatment at home. The benefits of home hemodialysis are increasing the demand for hemodialysis. In addition, the initiatives by SNFs to facilitate services benefited the segment as the patients in SNFs had to opt for hemodialysis in most of the cases due to the patient being too sick to take peritoneal dialysis by themselves.
Peritoneal dialysis is expected to have lucrative growth post-COVID-19. Peritoneal dialysis is highly convenient. Peritoneal dialysis provides a better lifestyle & flexibility to the patients. Citizens living far from outpatient centers or requiring traveling for work can continue treatment along with their activities as peritoneal dialysis can be done independently.
The accumulation of sodium, fluid & potassium is less due to continued treatment resulting in less restriction on diet compared to hemodialysis. These advantages are resulting in growth opportunities for the segment. Peritoneal dialysis accounts for the majority of home-based treatment in the U.S. As the data at kidney week 2021 by the American Department of Nephrology., peritoneal dialysis accounted for 90% of home treatments.
Based on facility type, the market is categorized into dialysis chains, independent facilities, and hospital-based facilities. In 2022, the dialysis chains dominated the industry owing to their presence across all states in the U.S. & better quality of the services offered by the chains at a national level. DaVita, one of the largest dialysis chains in the U.S. is managing 2,800 outpatient facilities in the U.S. and facilitating inpatient treatment at 900 hospitals across the nation.
Independent facilities account for non-profit & for-profit facilities operating separately. In 2020, there were 830 independently owned clinics. Better patient outcomes at such facilities are boosting the opportunities for independent centers. According to the report by the Duke school of business, the majority of the independent facilities were acquired by chains post and the patients were more likely to be hospitalized in a month.
Hospital-based facilities are witnessing high competition from private chains resulting in the dwindling of hospital-based facilities. Fewer hospitals in the U.S. are managing their own nephrology unit. The private firms in the U.S. are facilitating services at a lower cost and have less operating cost due to lower wages resulting in hospitals rather not providing the service. The majority of diagnostic chains have collaborated with hospitals to manage their nephrology units.
The Southeast region held a significant market share in 2022 owing to the high availability of facilities in the region. As per the center for disease control & prevention (CDC), Alabama & Georgia have the highest concentration of service providers per patient, ranging from 13.07-17.50 facilities per 1000 ESRD patients. The overall prevalence of the end-stage renal disease is higher in the region. As per the CDC, Alabama has a prevalence of 4% for ESRD compared to the overall prevalence of 2.9% in the U.S., which is among the highest reported in the nation.
The Northeast region is expected to witness lucrative growth during the forecast period. This can be attributed due to the rise in public healthcare funding in the region & high availability of dialysis centers in the region.
According to the Centers for Disease Control & Prevention, the majority of the states in the West region have lower than 8.65 facilities per 1000 patients, with California having the lowest no of facilities per patient accounting for 6.56 facilities per 1000 patients. The regulation on a state level in the west region are stringent in many states & the latest changes in the regulations are heavier. For Instance, in October 2021, the California state government proposed heavier regulations for the service providers.
The new regulations proposed a mandatory requirement for physicians, assistant physicians, or nursing professionals to be 24/7 on-site. The individual providing dialysis care must have 6 months of experience. The service providers will have to provide infection-related data to the California state department of public health and a list of owners of the clinics to the patients. These regulations are expected to restrict the entry of new players into the market.
The market is consolidated and is undergoing a trend shift from in-center to home-based services. To align their capabilities with the trend shift, the service providers are increasing investment in home services and retraining their medical staff to fulfill the demand. For instance, Fresenius Medical Care AG launched Patient hub, a digital platform in 2021 for training patients in peritoneal dialysis, enabling them to do peritoneal dialysis independently at home. Some prominent players in the U.S. dialysis centers market include:
Fresenius Medical Care AG & Co. KGaA
U.S. Renal Care, Inc.
American Renal Associates
Dialysis Clinic, Inc.
Northwest Kidney Centers
Centers for Dialysis Care
Dialysis Care Center
Rhode Island Hospital
University of Iowa Hospital & Clinics
Saint Anthony Hospital
Rush Unit Children’s Hospital
Market size value in 2022
USD 26.9 billion
Revenue forecast in 2030
USD 40.4 billion
CAGR of 5.29% from 2023 to 2030
Base year for estimation
2017 - 2021
2023 - 2030
Revenue in USD Billion and CAGR from 2023 to 2030
Revenue forecast, company ranking, competitive landscape, growth factors, and trends
Modality, dialysis type, facility type, region
Key companies profiled
Fresenius Medical Care AG & Co. KGaA; U.S. Renal Care, Inc.; DaVita Inc.; American Renal Associates; Dialysis Clinic, Inc.; Satellite Healthcare; Northwest Kidney Centers; Centers for Dialysis Care; Rogosin Institute; and Dialysis Care Center, USCF Health, Rhode Island Hospital, University of Iowa Hospital & Clinics; Saint Anthony Hospital, Rush Unit Children’s Hospital
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This report forecasts revenue growth at the country level and provides an analysis of the latest industry trends in each of the sub-segments from 2017 to 2030. For this study, Grand View Research has segmented the U.S. dialysis centers market report based on modality, dialysis type, facility type, and region:
Modality Outlook (Revenue, USD Billion, 2017 - 2030)
Dialysis Type Outlook (Revenue, USD Billion, 2017 - 2030)
Facility Type Outlook (Revenue, USD Billion, 2017 - 2030)
Region Outlook (Revenue, USD Billion, 2017 - 2030)
b. The in-center segment dominated the U.S. dialysis centers market with a share of around 76% in 2022. This is attributable to high adoption of the service. The in-center services are required for ESRD patients in need of hospitalization for other reasons, suffering from acute kidney failure mainly arising from trauma, and early-stage ESRD patients.
b. Some of the key players operating in the U.S. dialysis centers market include Fresenius Medical Care AG & Co. KGaA; U.S. Renal Care, Inc.; DaVita Inc.; American Renal Associates; Dialysis Clinic, Inc.; Satellite Healthcare; Northwest Kidney Centers; Centers for Dialysis Care; Rogosin Institute; and Dialysis Care Center, USCF Health, Rhode Island Hospital , University of Iowa Hospital & Clinics; Saint Anthony Hospital, Rush Unit Children’s Hospital
b. The key factors driving the U.S. dialysis centers market growth include high prevalence of End-Stage Renal Disease (ESRD), favorable reimbursement, and long waiting period for transplant.
b. The U.S. dialysis centers market was estimated at USD 26.9 billion in 2022 and is expected to decline to around USD 28.2 billion in 2023.
b. The U.S. dialysis centers market is expected to grow at a compound annual growth rate of 5.29% from 2023 to 2030 and is expected to reach USD 40.4 billion by 2030.
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