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The High Cost of Kidney Failure

This article was originally published in Start Up

Executive Summary

Dialysis prolongs the lives of patients with end-stage renal disease, but outcomes are still poor, with a 17% mortality rate in the US. Nephrologists and technology developers want to improve outcomes, but the economics of dialysis have stymied innovation. Medicare tightly controls pricing, and developers are hard-pressed to find therapies that increase clinical benefits but not cost. Recently, two major clinical trials in dialysis hint that the benefits of dialysis, as it's currently performed, are approaching their limits. Start-ups now have the ammunition with which to approach a technologically stagnant market. Small companies, however, face daunting competition: three giant players dominate the market, two of which own 40% of the service centers that provide dialysis therapies.

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Renal Devices: New Blood Revitalizes Dialysis Industry

CMS pays 33% of its budget for patients with end stage kidney disease, a group that, in terms of patient numbers, accounts for less than 1% of the Medicare population. For all this money spent, mortality rates remain high--the one year mortality rate for patients on hemodialysis stands at 24%, a survival rate that's worse than that of metastatic cancer. In an industry traditionally resistant to change, however, changes are coming, brought about by reimbursement changes and a delivery model that can't scale-up to meet a growing population, making room for new start-ups in the space.

Renal Devices: New Blood Revitalizes Dialysis Industry

CMS pays 33% of its budget for patients with end stage kidney disease, a group that, in terms of patient numbers, accounts for less than 1% of the Medicare population. For all this money spent, mortality rates remain high--the one year mortality rate for patients on hemodialysis stands at 24%, a survival rate that's worse than that of metastatic cancer. In an industry traditionally resistant to change, however, changes are coming, brought about by reimbursement changes and a delivery model that can't scale-up to meet a growing population, making room for new start-ups in the space.

NxStage: Bringing Dialysis Home

After years of steady growth, the dialysis market is predicted to increase dramatically, and this growth will severely strain the current system of dialysis clinics where most of these procedures are performed. Home hemodialysis could help relieve this bottleneck but has not been a viable alternative to date because of the lack of effective device innovation. NxStage Medical has developed a system that makes home hemodialysis a therapeutic option, which could dramatically improve both the health and lifestyle of patients, along with the economic future of the dialysis market.

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