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Approximately 30 million adults suffer from chronic kidney disease in the United States—or one in seven people. According to the National Kidney Foundation about one-third of the total population is at risk for developing the condition, which can lead to total kidney failure, atrial fibrillation, and heart disease if untreated. More than 60 percent of diagnoses are related to diabetes and high blood pressure, but ethnicity and genetic risk factors may also increase a patient’s risk of diagnosis. As the number of people affected by kidney disease rises, so does the demand for renal dialysis.
In extreme cases of chronic kidney failure, when a patient has lost between 85 and 90 percent of all kidney function, dialysis becomes vital for maintaining normal bodily function. Renal dialysis cleanses patients’ blood, removing waste, salt, and excess water in order to prevent buildup. Dialysis also ensures a safe balance of essential elements in patients’ blood, including potassium and sodium while controlling blood pressure.
There are two varieties of dialysis, both performed in a hospital setting: hemodialysis and peritoneal dialysis. Hemodialysis utilizes an external artificial kidney to regulate waste removal and chemical imbalance. Peritoneal dialysis cleanses blood inside the body, using a catheter to draw waste products into the abdomen and out of the body.
Top 10 Renal Dialysis Networks by Net Patient Revenue
|Network Name||Net Patient Revenue (M)|
|Fresenius Kidney Care||$8,999|
|US Renal Care||$1,038|
|American Renal Associates||$646|
|Dialysis Clinic Inc||$630|
|Renal Ventures Management||$117|
|Northwest Kidney Centers||$103|
|Atlantic Dialysis Management Services||$94|
Fig 1 Data from Definitive Healthcare
A study from Market Research Engine estimates that the global renal dialysis equipment market will grow by more than $22.8 billion from 2017 through 2022. In 2016, the global renal dialysis market was valued at more than $62 billion. With industry growth comes the opportunity for innovation in treatment methods.
Cosmos Magazine reported this month that stem cell trials have been successful in growing miniature kidneys. Though the study focused on polycystic kidney disease, come of the results could increase how doctors understand chronic kidney disease and the effects of various treatments. The growth of small kidneys may also allow for experimental treatment testing on human tissue.
In 2015, CNN reported on an experimental device that could alter how patients undergo renal dialysis treatments. The device, called the Wearable Artificial Kidney (WAK), would continually filter the patient’s blood, eliminating the need for hospital and clinic visits multiple times per week. A wearable device would also allow greater flexibility for patients in terms of diet and daily activity. With a device that continually filters blood, patients would not have to avoid foods with large amounts of phosphorous and potassium—like bananas, potatoes, and oranges—between treatments for fear of toxic buildup.
Top 10 Health Systems by Total Renal Dialysis Charges
|Health System Name||Renal Dialysis Total Charges (M)|
|Providence St. Joseph Health||$318|
|Catholic Health Initiatives||$307|
|Community Health Systems||$241|
|UVA Health System||$219|
|Mayo Clinic Health System||$211|
|CHI Franciscan Health||$159|
Fig 2 Data from Definitive Healthcare
For patients with concurring health problems, treatments can be dangerous when combined with loss of kidney function. A study published by the Journal of the American Society of Nephrology found that hemodialysis patients were prescribed opioids at high rates—more than 60 percent of patients filled at least one opioid prescription every year. Additionally, about 20 percent of hemodialysis patients received a 90-day supply of prescription opioids each year. More than a quarter of patients received an opioid prescription during the study’s duration from 2006 to 2010.
All opioid drugs are associated with increased mortality rates, and are particularly damaging to patients with decreased kidney function. The study also found that opioid prescription was associated with increased risk of renal dialysis discontinuation and hospitalization. The most common opioids prescribed were hydrocodone, oxycodone, and tramadol.
In better news, patients with both chronic kidney disease and hepatitis C have a safe option for treatment. A study by the Clinical Journal of the American Society of Nephrology found that direct-acting antiviral therapy is safe and effective, and may actually aid in improving kidney function. Conducted at Massachusetts General Hospital, the study involved 98 patients receiving a sofosbuvir-based antiviral treatment.
Renal dialysis continues to be the primary source of chronic kidney disease treatment and has been used for nearly 60 years. Though it was traditionally only available within hospitals, it has since become more widely available at freestanding clinics, making it more convenient for patients to get the treatment they need. Perhaps soon there will be mobile—and potentially wearable—treatment options.
Fig 3 Data from Definitive Healthcare and the National Kidney Foundation
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