Dialysis Centers | 2025 Update
Market Size and Growth
As of 2024, the U.S. dialysis services market was estimated at $27 billion, with projections to grow to approximately $43 billion by 2032. This translates to a compound annual growth rate near 6%. The growth is primarily driven by the increase of End-Stage Renal Disease (ESRD) in the U.S. Approximately 808,000 Americans are living with ESRD, of whom nearly 69% receive in-center dialysis, while others have received kidney transplants.
As of March 31, 2025, there are 7,556 dialysis centers in the U.S., treating over 500,000 patients for dialysis and roughly 300,000 transplant patients. The breakdown of treatment methods shows that about 433,400 patients are treated in-center, 78,400 at home, and a smaller number in skilled nursing environments.
The Rise of End-Stage Renal Disease
The uptick in ESRD across the country is driven by increasing rates of diabetes and hypertension, the two primary causes of kidney failure. An aging population, combined with the obesity epidemic, has further amplified risk factors. Advances in medical care allow patients with chronic kidney disease to live longer, giving the disease more time to progress to ESRD. Additionally, health disparities and limited access to preventive care in certain communities contribute to higher prevalence. Together, these factors lead to a rise in demand for dialysis services nationwide.
Geography of ESRD
ESRD prevalence in the U.S. is highest in states such as Texas, Florida, Georgia, South Carolina, and Ohio, with particularly pronounced clustering in the Southeast, southern Texas, and parts of
the Midwest. Geographic analyses reveal distinct hotspots at the county level, especially in rural and coastal areas, where limited physician density and reduced access to preventive care contribute to higher ESRD incidence. In Texas and the Southeast, socioeconomic disparities and high rates of diabetes and hypertension further drive prevalence, while Florida’s large aging population and Georgia’s and South Carolina’s rural regions show similar patterns. Ohio, though outside the Southeast, reports elevated ESRD rates tied to regional healthcare access and population health factors.
Market Share
DaVita and Fresenius remain firmly entrenched as the dominant operators in the U.S. dialysis industry. As of 2024, DaVita serves approximately 281,100 patients across 3,166 outpatient dialysis centers, with 2,657 of those located in the U.S., giving it about 37% market share domestically. Fresenius Medical Care operates between 2,600–2,800 U.S. centers and holds roughly 38% of the domestic market share, positioning it as a peer to DaVita in terms of scale. Collectively, these two companies control almost 80% of U.S. dialysis facilities. Other market leaders include U.S. Renal Care, Dialysis Clinic Inc, and Satellite Healthcare.
Shift Toward Home Dialysis
COVID-19
During the COVID-19 pandemic, the market faced significant challenges as patients with ESRD experienced disproportionately high infection and mortality rates. Around 25% of infected dialysis patients died, exceeding general population rates. This led to the first decline in the U.S. dialysis patient census due to excess deaths and treatment disruptions. Concerns about virus exposure in crowded clinics accelerated the shift toward home dialysis therapies, supported by regulatory easing and increased reimbursement incentives. While the pandemic caused significant patient losses, it also sped up the move to home therapies, improving safety and independence while changing how dialysis care is delivered.
Medicare Changes
Recent Medicare updates are creating incentives for dialysis providers to expand home therapies. Payments now cover a significant portion of home dialysis equipment, and telehealth options make caregiver training easier while reducing travel. Clinics in remote areas receive extra reimbursement, and fewer reporting requirements lower administrative burden.
These changes could shift some patients away from in-center treatment, potentially reducing traffic and revenue at physical dialysis locations. At the same time, centers that invest in home dialysis programs may offset this impact and even increase overall facility value by offering a broader range of services.
