U.S. Dialysis Centers Market (By Modality: In-center, In-home, SNF-based; By Dialysis Type: Hemodialysis, Peritoneal Dialysis; By Facility Type) - Industry Analysis, Size, Share, Growth, Trends, Revenue, Regional Outlook and Forecast 2022-2030

The U.S. dialysis centers market was surpassed at USD 26.94 billion in 2021 and is expected to hit around USD 40.6 billion by 2030, growing at a CAGR of 4.66% from 2022 to 2030.

The high prevalence of End-Stage Renal Disease (ESRD) and favorable reimbursement are some of the key factors expected to boost growth. The expenditure on treatment is gradually rising due to the increasing prevalence of ESRD.

The availability of Medicare reimbursement for kidney disorder treatment is increasing the accessibility to the treatment. The Center for Medicare & Medicaid Services announced a new end-stage renal diseases treatment choice model for the maintenance & improvement in the reimbursement for chronic kidney disorder patients. The new model is encouraging the use of home-based treatment. In August 2022, the CMS expanded the eligibility for reimbursement for kidney disorder treatment. The expansion includes certain capital assets, mainly equipment used at home for treatment. This is increasing the accessibility to the services.

The patients need to travel to and fro the center for around 3 days per week, the proximity from the patient's residence is generally an important criterion for the center of choice. Hence the launch of new facilities is a key strategic initiative undertaken by major players to increase their market share. For instance, in May 2021, U.S. Renal Care, Inc. inaugurated three new facilities, one in-center facility and two focusing on home therapies. This expanded the company’s presence in the Southwest Florida region.

The COVID-19 pandemic resulted in patients facing difficulty in having an access to treatment for end-stage renal disorder, requiring multiple sessions within a month. According to the national kidney foundation, 15.8% of the patients undergoing treatment for end-stage renal disease had COVID-19 infection. The federal government & service providers promoted home treatment. In June 2021, a new campaign innovative kidney care was launched by nine leading healthcare organizations for patient options for receiving home treatment.

Scope of The Report

Modality Insights

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.

Dialysis Type Insights

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.

Facility Type Insights

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.

Regional Insights

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.

Key Players

• 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
• Dialysis Care Center
• USCF Health
• Rhode Island Hospital
• University of Iowa Hospital & Clinics
• Saint Anthony Hospital
• Rush Unit Children’s Hospital

Market Segmentation

• By Modality Outlook

• In-center
• In-home
• SNF-based
• By Dialysis Type Outlook
• Hemodialysis
• Peritoneal Dialysis
• By Facility Type Outlook
• Dialysis Chains
• Independent Facilities
• Hospital Based
• By Region Outlook
• Northeast
• Southeast
• Southwest
• Midwest
• West