Three times a week, hundreds of thousands of Americans with end-stage kidney disease trudge to dialysis centers to get the treatment that keeps them alive. Costs are exorbitant and growing, and many patients aren’t even told there may be other options.
Nephrologists say the system -- dominated by two companies -- is long overdue for an overhaul, and now President Donald Trump is trying to provide one. On Wednesday, he will sign an executive order to push what administration officials called the biggest change to kidney care in decades.
The administration’s goals include getting 80% of patients who would otherwise get dialysis at thousands of clinics around the U.S. into less-costly home care, or to an organ transplant. Health officials plan to launch a public awareness campaign to identify more patients at an early stage of sickness, and to take steps to boost the number of available organs.
“For 50 years we have basically had a stagnant system of how we treat people with chronic kidney disease,” said Health and Human Services Secretary Alex Azar.
Dialysis centers are big business, dominated by two entrenched companies, DaVita Inc. and Fresenius Medical Care AG. Shares of both companies have fallen this week as news of the plan leaked out, with DaVita down 7.6% despite a gain on Wednesday morning, and Fresenius down 3.8%.
The U.S. has “too much in-center dialysis,” said Azar, who called the regimen “mentally and physically draining.” Dialysis in a clinic typically means spending hours in a chair multiple times a week, hooked up to a machine that helps clean the blood of toxins.
Medicare spent $114 billion on kidney care in 2016, about a fifth of the health-care program’s total budget. Of that, $35 billion went to patients in the late stages of kidney failure, who need dialysis, according to a government-funded data registry.
Those costs could soon explode, with the number of patients with advanced disease expected to grow from about 700,000 today to more than 1 million by 2030 thanks to obesity and aging baby boomers, according to one recent study.
“I am not a Trump supporter at all, but this is one of the few things where I completely agree with him,” said Holly Mattix, a nephrologist at Loyola University Medical Center in Chicago and president of the National Kidney Foundation, in an interview on Tuesday before she flew to to Washington for Trump’s announcement. “There are so many issues with chronic kidney disease. It is the neglected stepchild of all chronic diseases.”
Dominant Duo
DaVita operates more than 2,500 dialysis centers in the U.S. and generated $10.3 billion in sales from dialysis in 2018. Fresenius runs almost 4,000 centers around the world and reported 16.5 billion euros ($18.5 billion) in dialysis revenue in 2018. Together, the companies have more than 70% of the dialysis market in the U.S., according to Bloomberg Intelligence. Both companies also offer home dialysis services.