Kidney Dialysis Centres Market

Global Industry Analysis (2018 – 2021) – Growth Trends and Market Forecast (2022 – 2026)

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Low Accessibility, and Longest Waiting Time for Kidney Replacement Therapy Uphold Demand for Efficient Kidney Dialysis Centres

The primary function of the kidney is to get rid of body waste and excess fluid, and kidney failure happens when kidney function falls below 15% of normal. As per the Department of Health and Human Services, there are more than 85 million suffering from kidney ailment{s) in the world; 94,000 people in the US are waiting for new kidneys, by far the longest waiting list for an organ transplant. The median wait time is nearly four years, according to the US Renal Data System. Some 14,000 people - about 15% of the list - have been waiting for a new kidney for 5+ years. The Global Kidney Health Atlas by International Society of Nephrology (ISN) highlights the huge gap in kidney diseases care, and prevention in both developed, and developing countries, with many not prioritising kidney health.

Approximately 0.1% of the world’s population has end-stage kidney disease (ESKD), and estimates suggest a higher prevalence in upper-middle (0.1%), and high-income countries (0.2%), compared to low- (0.05%), or lower-middle (0.07%) income countries. However, the proportion of people with ESKD not receiving treatment in the form of dialysis, or transplantation is much higher in low- (96%), and lower-middle, (90%) income countries than that in upper-middle (70%), and high (40%) income countries. This limited access to kidney replacement therapy (KRT) in low-, and lower-middle income countries warrants attention, as associated ESKD morbidity, and mortality rates are high in these nations. Over 2 million people die each year due to limited access to KRT.

Availability of Dialysis and Transplantation Therapy Varies by Almost 1000–Fold Worldwide

The average prevalence of chronic dialysis globally is 343 pmp, largely ranging from 0.5 pmp in Tanzania to 3251 pmp in Taiwan. In high-income countries, the prevalence of chronic dialysis is 620 pmp compared to 339 pmp in upper-middle, 94.5 pmp in lower-middle, and 3.4 pmp in low-income countries. Globally, the average number of people who have undergone kidney transplantation surgery is 255 pmp, ranging from 3.1 pmp in the Bahamas to 693 pmp in Portugal. On average, high income countries have a much higher prevalence of kidney transplantation (363 pmp) than upper-middle (80 pmp) or lower-middle (27 pmp) income countries.

This is where dialysis centres play a significant role.

Haemodialysis (HD), although the most common method, often puts patients at a high risk for infection as the process of haemodialysis requires frequent use of catheters, or insertion of needles to access the bloodstream. These patients thus tend to have a weakened immune system that demands frequent hospitalisation, and surgeries, which again raise the risk of hospital-acquired infections. Peritoneal dialysis (PD) is another type of dialysis. If home dialysis becomes commonplace, dialysis centre chains would stay in the market by providing equipment, supplies, and training on both types of dialysis for patients and their caregivers, monitoring patients, and providing on-call support.

CKD - A Worldwide Public Health Issue, Social Calamity, and Economic Catastrophe

Acute kidney injury (AKI), and chronic kidney disease (CKD) are linked to high health care costs, poor quality of life, and serious adverse health outcomes. If CKD is not detected early enough, the patient may progress to kidney failure - end-stage renal disease (ESRD) - which requires renal replacement therapy (dialysis, or transplantation) that is highly expensive, and weighs heavily on the healthcare budget. CKD treatment costs in the US were US$84 Bn, ESKD US$36 Bn according to The United States Centers for Disease Control and Prevention (CDC). The high price point associated with HD remains the key barrier for rapid market penetration in many countries. According to recent estimates, the cost of HD for one patient is approximately US$ 100,000 per year. PD is a relatively less costly alternative as also comprehensive conservative care may be a more suitable option in resource-limited settings. Selecting the best viable route of care is thus imperative from a financial, clinical, and patient-centred perspective.

Long-term Outlook of Kidney Dialysis Centres Looks Promising

It is projected that by 2030, nearly 14.5 million people will have ESKD, and need treatment, yet only 5.4 million will actually receive it due to economic, social, and political factors. Government spending for chronic, and end-stage kidney disease, also known as kidney failure, reached $121 billion in 2019, which is roughly a quarter of all Medicare payments for health services, according to the most recent data published by the US Renal Data System (USRDS), the registry for information on end-stage kidney disease, funded by the National Institutes of Health. About 498,000 people are on dialysis in the US alone, and there are more than 7,500 dialysis centers in the country. People with kidney failure typically visit a dialysis centre three days a week or more, at the cost of roughly US$239 per treatment to the government. These centers make up a multibillion-dollar, mostly for-profit industry.

There are many factors influencing the outlook for dialysis clinics. The consistent growth in the prevalence of CKD, and ESRD has created an opportunity for large operators to expand their footprint, and many of the leading kidney disease indicators such as diabetes, point to a continuing trend. The profitability of individual companies is linked to efficient operations, and successful marketing. Large companies have economies of scale in administrative costs, which has driven consolidation in the industry. Whereas, small operators can compete successfully if they have centers at desirable locations, or established business relations with doctors who refer patients. Costs would likely be facility expense, medical equipment such as dialysis stations and water filtration systems, other fixed assets, expenses associated with hiring the workforce necessary to staff the clinic, as well as the costs associated with obtaining the necessary licenses, and accreditations to legally operate the clinic.

Role Health Information Systems and Regulatory Entities

Adequate efforts to prevent ESKD through appropriate detection strategies are needed to reduce the burden the disease. On September 21, 2020, the Redsense Alarm, a medical device that uses proprietary, optical fibre technology to monitor the access sites for blood leakage during haemodialysis and trigger an alarm when blood is detected, was introduced in the market. Health information systems are essential for collecting information to guide surveillance programs and further support decision making with respect to policies, and resource allocation. The US has cms.gov (federal government website managed, and paid by the US Centers for Medicare & Medicaid Services), and ESRD Network Organisations. Despite their importance, renal registries are lacking, particularly in lower income countries. The American Society of Nephrology (ASN), the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), and the International Society of Nephrology (ISN) are the key authoritative bodies for education, training, advocacy, publications, and grants.

Key Players in Kidney Dialysis Centres Market

DaVita, and Fresenius constitute the two companies that significantly control the bulk of the US dialysis centres market. US Renal Care, American Renal Associates, Dialysis Clinic Inc., Satellite Healthcare, Atlantic Dialysis Management, Northwest Kidney Centres, Rogosin Institute, and Centres for Dialysis Care represent some of the prominent US-based kidney dialysis centres.

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