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Large providers continue strong growth in home dialysis
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The 10 largest outpatient dialysis providers in the United States added more than 14,000 new patients to their census during the past year, according to the latest Nephrology News & Issues annual survey.
Nephrology News & Issues emails a survey each year to the 10 largest outpatient dialysis providers in the United States, determined by research and available data. Survey forms are sent to the selected providers, and data is gathered on the number of patients treated as of May of each year. Providers are asked to subdivide their patient count into those who are treated in-center and at home, based on modality — PD and home hemodialysis — as well as provide a count of dialysis clinics in operation. The ranking is based on patient count.
The number of new patients this year follows a continuing downward trend in yearly growth since 2016 to 2017, when the count for new patients topped 20,000 during those 12 months.
What makes this year’s growth number significant (see Table 1), however, is where many of these new 14,000 patients are being dialyzed – at home.
As of May 2019, when dialysis providers reported their patient census on the Nephrology News & Issues survey (American Renal Associates was an exception, with numbers reported as of March 2019), 35% of new patients this year were on home dialysis, either PD or home hemodialysis (HHD). That 35% share of growth is 15 percentage points higher than survey results from 2017 to 2018, and almost triple the 12.5% share of home patient growth from 2016 to 2017.
Thus, the number of home patients as a percentage of all new patients starting dialysis this year is the highest over the last 3 years. For the first time in more than 5 years, the annual year-to-year growth in HHD patients neared 1,000 patients, and new PD patients increased to more than 4,000 new patients, also the highest year-to-year growth during that time period (see Table 2).
PD remains the modality of choice for patients who dialyze at home, with 3,923 new patients choosing PD over the past year vs. 999 patients choosing HHD.
Increased use of home dialysis
That continuation in home dialysis growth fits in well with plans announced by the Trump administration last month to incentivize dialysis providers to direct more patients to home dialysis. The goal of CMS is to have, by 2025, 80% of patients diagnosed with ESKD to be either treated at home with PD or HHD or have a kidney transplant.
In-center dialysis remains the mainstay of dialysis providers, representing 65% of the growth in new patients this year based on the Nephrology News & Issues survey. Most of the growth, as in previous years, comes from the two largest dialysis organizations, Fresenius Kidney Care and DaVita Kidney Care. The two providers together added 11,827 of the 14,076 new patients. While DaVita dropped 100 patients from HHD therapy, it added 2,000 new patients on PD. Fresenius added 993 patients on HHD and 1,640 patients on PD.
With this year’s acquisition of HHD machine manufacturer NxStage Medical, Fresenius may be seeing even greater increases in both home therapies. The $2 billion deal also included technology for a new PD machine.
Providers add new clinics
Providers in the survey added 319 new dialysis clinics during the past year, more than double the 142 clinics added from 2017 to 2018, despite a smaller year-to-year growth in new patients. Fresenius Kidney Care and DaVita Kidney Care acquired or built 292 clinics alone.
Other mid-sized dialysis providers showed increases in patient counts this past year. Fourth-ranked American Renal Associates continued its string of adding more than 1,000 patients each year since 2014, adding 1,242 patients and 15 dialysis clinics during 2018 to 2019. U.S. Renal Care maintained its ranking as the third largest dialysis provider in the country, adding 510 patients. Rogosin Institute added 206 patients to its census this year after recent acquisitions, moving itself up to #9 in the ranking.
In dialysis care overseas, Fresenius continues to have the strongest presence, owning 1,412 clinics in 50 countries. That represents close to 100 new clinics acquired or built during the last 12 months. The company treats 130,941 patients overseas, having added 6,027 new patients with a growth of 4.8% from 2018 to 2019. DaVita’s international treatment centers added 1,100 new patients with a growth of 4.4%.
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- Mark E. Neumann is the Editor-in-Chief of Nephrology News & Issues.