If integrated care has a chance of being successful in the End-Stage Renal Disease Program, more than 30,000 patients should be a good sampling.

After two rounds of tweaking the rules, the Comprehensive ESRD Care Demonstration has attracted seven dialysis providers and 32,287 patients. Fresenius Medical Care North America and DaVita Kidney Care, ranked #1 and #2 in our 2017 provider survey, respectively, account for 27,000 of those patients. Only U.S. Renal Care, American Renal Associates, and Satellite Healthcare, all providers in the annual survey, are not participating in the five-year demonstration.

Editor’s note: We have updated our provider ranking for 2017 based on new information from Fresenius Medical Care North America. The charts presented here in this section are current.

Patient growth

FMCNA added 8,880 patients over the past year and retained first place with 192,964 patients. Together with DaVita Kidney Care, the two companies cared for 383,464 dialysis patients in the U.S. (as of May 2017). Fresenius told NN&I a big jump in their patient census since January came from a “several fold” increase in patients accepted for treatment with acute kidney injury.

The US Renal Data System reports that there were 477,476 patients on dialysis in the U.S. as of Dec. 31, 2014, the latest figures available.

Fresenius continues to have the strongest presence of dialysis clinics overseas, although DaVita showed continued growth this past year (see Figure 4). The Denver, Colo.–based provider recently acquired Polish dialysis provider Centrum Dializa II. DaVita operates dialysis centers in 12 countries.

Mid-sized dialysis providers still showing strength

Even with a growth spurt from Fresenius and DaVita, mid-sized dialysis providers also showed increases in patient counts this past year. American Renal Associates has continued its string of 1,000+ patient growth each year since 2014. The company went public in September 2015.

U.S. Renal Care, after a monster acquisition of DSI Renal Care in 2015 that helped the company grow by close to 50%, added 1,128 patients this year and 95 new dialysis centers.

Overall the 10 largest dialysis providers in the U.S. accounted for 453,043 patients, a growth of 20,238 patients over 2016. By comparison, that is the largest rate of growth in the last three years among the 10 largest providers: these dialysis companies added 17,013 patients from 2015-2016 and 19,773 patients from 2014-2015.

 

Growth in home hemodialysis slows

In 2015, a shortage of dialysate for peritoneal dialysis patients led to a significant drop in the number of new patients on the therapy. There was an uptick in the number of PD patients in 2016 (see Figures 2), That continued growth was seen this year as well, with almost 2,000 patients added between 2016-17.

10 largest dialysis providers in 2017Growth in the number of home hemodialysis patients slowed significantly this year after steady increases of 300-500 patients per year since 2013. This year, growth was limited among the top 10 providers to less than 100 patients.

Overall, the 50,718 patients on home therapies in 2017 represents 11.3% of patients treated by the 10 largest providers. That has changed little over the last four years, as providers continue to place the majority of new patients into outpatient centers. While the 2017 level is the highest since 2013, the percentage of home dialysis patients to overall patient populations has changed less than 1% since that time.