JMIR Publications

ABSTRACT

Background:

Chronic kidney disease (CKD) affects approximately 674 million individuals globally and represents a growing contributor to morbidity, mortality, and healthcare expenditure. Progression to end-stage kidney disease (ESKD) requires kidney replacement therapy through dialysis or kidney transplantation. Approximately 4.5 million patients currently receive maintenance dialysis worldwide, although access remains highly unequal across regions. More than 80% of individuals receiving kidney replacement therapy reside in high-income countries, while substantial treatment gaps persist across low- and middle-income regions. The global dialysis market continues to expand due to increasing CKD prevalence, aging populations, rising diabetes incidence, and improvements in healthcare access.

Objective:

This narrative review examines the global dialysis industry from clinical, epidemiological, economic, technological, and policy perspectives. The study evaluates disease burden, dialysis modalities, patient demographics, industry structure, workforce challenges, technological innovations, reimbursement models, and regulatory developments shaping dialysis care worldwide.

Methods:

A structured review of published literature, government reports, clinical guidelines, industry publications, and healthcare databases was conducted. Sources included the World Health Organization (WHO), International Society of Nephrology (ISN), Kidney Disease: Improving Global Outcomes (KDIGO), United States Renal Data System (USRDS), European Renal Association (ERA), National Kidney Foundation (NKF), Fresenius Medical Care, and TrendX Insights. Publications released between 2020 and 2026 were prioritized to evaluate recent developments in dialysis delivery, policy frameworks, patient outcomes, and market performance.

Results:

Global dialysis demand continues to increase due to population aging, rising diabetes prevalence, hypertension, obesity, and improved survival among CKD patients. Approximately 4.5 million individuals currently undergo dialysis treatment worldwide, while many additional patients remain untreated because of affordability and infrastructure limitations. Hemodialysis accounts for nearly 90% of global dialysis treatments, while home-based therapies such as peritoneal dialysis and home hemodialysis continue to expand gradually. Clinical outcomes remain challenging, with five-year survival rates for dialysis patients remaining below 50% in many populations. Technological innovation is accelerating across portable dialysis systems, wearable artificial kidney technologies, digital monitoring platforms, telehealth integration, and home dialysis solutions. The global dialysis market was valued at approximately USD 109 billion in 2026 and is projected to reach nearly USD 170 billion by 2034. Market concentration remains high, with Fresenius Medical Care, DaVita, Baxter International, and other major providers maintaining significant market shares. Government reimbursement programs, value-based care initiatives, and home dialysis incentives are increasingly influencing treatment delivery models.

Conclusions:

The global dialysis industry is undergoing significant transformation driven by increasing disease burden, technological innovation, and healthcare policy reforms. While market growth remains strong, challenges related to affordability, workforce shortages, infrastructure limitations, and treatment accessibility continue to affect patient outcomes. Future industry development is expected to focus on home-based therapies, digital health integration, portable dialysis technologies, and value-based reimbursement models. Strengthening healthcare infrastructure, promoting equitable access, and expanding kidney disease prevention programs will be essential to address the growing global demand for dialysis services. Clinical Trial: Not applicable. This study is a narrative review and did not involve a clinical trial.