In 2012, about 370,000 ESRD patients in the Medicare program received dialysis treatment in 5,800 facilities, according to a March report to Congress by the Medicare Payment Advisory Commission. Medicare spent a total of $10.7 billion for dialysis in 2012, a 6% increase from 2011. That spending covered the dialysis procedures, medications and ESRD-related lab tests.
The majority of centers are freestanding clinics, which make up 92% of all dialysis facilities in the U.S. and accounted for 93% of Medicare dialysis spending in 2012. While the number of hospital-based and not-for-profit facilities has decreased in recent years, the share of for-profit centers has increased, from 82% in 2008 to 86% by 2013, according to MedPAC.
The growth in dialysis facilities, which has increased by 6% annually over the past five years, has been accompanied by an increase in the population of Americans diagnosed with ESRD. That total rose from 411,000 in 2001 to more than 615,000 by 2011 as more Americans developed chronic conditions such as diabetes and hypertension. While the share of Americans receiving dialysis dropped by 2 percentage points during that period, the overall number of patients receiving dialysis increased from 296,000 in 2001 to more the 430,000 by 2011, according to government figures. The incidence rate for ESRD in the U.S. was 425 per million people in 2010, second only to Mexico.
About 63% of ESRD patients are under age 65, according to MedPAC. Hispanics and Asian Americans were the fastest-growing ethnic groups newly diagnosed with ESRD from 2006 to 2011.
Currently, more than 20 million Americans have some level of chronic kidney disease. That's related to an increase in diabetes, the most common cause of renal failure. Experts predict that as the prevalence of diabetes increases, so will the demand for dialysis.
The U.S. had the second-highest rate of dialysis utilization among advanced countries after Japan, according to a 2011 report by the Organization for Economic Cooperation and Development. The U.S. rate of 125.7 per 100,000 population trails Japan, which had a rate of 186. The next closest country, Germany, had a rate of 80.7per 100,000 population, with France at 52, Canada at 66, Italy at 76, and the U.K. at 41.
But the U.S. has the highest mortality rate for ESRD patients among the advanced countries, according to the 2011 OECD report.
About 20% of American ESRD patients die annually, a rate more than twice that of Japan. One of the reasons for the disparity could be that dialysis patients in other countries tend to suffer from less comorbidities, said Dr. Leslie Spry, a spokesman for the National Kidney Foundation and medical director of the Nebraska-based, Dialysis Center of Lincoln.
In the U.S., average life expectancy for people on dialysis is about eight years for patients between the ages of 40 to 44 and four-and-a-half years for patients between 60 and 64. A comparison of two-year survival rates of patients on dialysis published in the Journal of the American Society of Nephrology found that the U.S. had a rate of 64%, significantly lower than the U.K., France, Canada, Spain and Japan, which had the highest rate at 83%.
According to a 2013 report by the U.S. Renal Data System, 52% of hemodialysis patients and 61% of patients receiving peritoneal dialysis who began treatment in 2006 were still alive three years later.
Both modalities are covered by Medicare, with hemodialysis used by more than 90% of the more than 400,000 dialysis patients. Hemodialysis uses a machine to filter wastes and remove extra fluid directly from the blood. Peritoneal dialysis uses the lining of the abdominal cavity and a solution to remove wastes and extra fluid from the body.
Follow Steven Ross Johnson on Twitter: @MHSjohnson