Radu Sigheti/Reuters A nurse prepares a dialysis machine.
- The Trump Administration recently announced plans to reshape how people get care for kidney disease by pushing for more people to get care at home, rather than in special centers.
- People whose kidneys don't work properly can undergo a treatment called dialysis to clean their blood. Currently, just 12% of patients get dialysis at home in the US.
- President Donald Trump issued an executive order on kidney care earlier this month. The administration aims to have 80% of patients with kidney failure either getting home-based care or receiving transplants by 2025.
- Right now, for-profit companies Fresenius Medical Care and DaVita control a large portion of the kidney-care market. They largely operate centers where people go three times a week to get dialysis.
- A slew of companies are seeking to disrupt the market by offering cheaper and more convenient care at home. They could benefit from Trump's executive order and related policies.
- CVS Health recently invested in a hemodialysis device, and Cricket Health, Outset Medical, and Somatus are trying to break into the market.
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In the US, 37 million people have chronic kidney disease, and it's the ninth leading cause of death.
Because such a significant part of the population is affected, and because treatment can be so expensive, the government covers the medical expenses of people with end-stage kidney disease through the Medicare program. In 2016, Medicare spent about $114 billion caring for people with chronic and end-stage kidney disease.
Earlier this month, Trump released an executive order to transform kidney care in the US, reducing costs and improving outcomes for patients by encouraging more home-based kidney care. The order also outlined the need to provide better access to kidney transplants and to prevent kidney disease from progressing.
To address the high cost of kidney care, the goal is to target dialysis, a procedure that filters the blood for people whose kidneys are failing. Currently, 88% of patients receive their dialysis in centers. They must go three times a week for hours at a time. By 2025, The Trump administration wants 80% of patients who are newly diagnosed with kidney failure to be able to get care at home or get a kidney transplant.
Home-based dialysis treatment can be better for patients, as patients can perform their own dialysis more frequently, leading to improved health and potentially lower costs.
"Home dialysis has a lot of advantages in terms of quality of life, convenience, and control of one's schedule," said Dr. Leslie Wong, the vice chairman of the Department of Nephrology and Hypertension at Cleveland Clinic. "I've been in the field for 15 years and physicians have been supportive of home dialysis since I began practicing."
For-profit companies DaVita, Fresenius, US Renal Care, and American Renal Associates operate centers where people can get dialysis. Currently, Fresenius and DaVita control about 75% of the market, according to an analysis from S&P Global. US Renal Care has about 5% and and American Renal Associates has 3%, S&P said.
Startups like Somatus, Outset Medical, and Cricket Health, which offer different types of kidney care, including home-based dialysis, are trying to break in. CVS Health, which operates in-store clinics and owns the health insurer Aetna, is now investing in home-dialysis technology, too.
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There are two types of dialysis: hemodialysis and peritoneal. Hemodialysis pumps blood out of the body to an artificial kidney machine and returns the clean blood to the body via tubes connected to the patient. That's the type of dialysis you'd usually get at a center. Peritoneal dialysis fills the abdomen with fluid and uses the membranes in the body as a filter. Most home dialysis is peritoneal, which is easier to do.
Medicare spent $28 billion on hemodialysis and about $2 billion on peritoneal dialysis in 2016, according to the US Renal Data System. Peritoneal dialysis is cheaper on a per-person basis. It cost about $76,000 for each recipient, while hemodialysis cost about $91,000.
Business Insider talked to top executives at CVS Health, Cricket Health, Outset Medical, and Somatus, which are all seeking to reshape kidney care. We also checked in with DaVita and Fresenius. Here's what they told us about how the Trump's administration's moves could affect the market and their companies.
