Most Americans never think about dialysis until they, or someone they love, needs it. But for the estimated 815,000 patients living with kidney failure in America today, dialysis is a non-negotiable treatment that keeps them alive. That reality makes the structure of America's dialysis industry troubling.
In most sectors of the economy, consumers can walk away from a company they don't like. They can shop around for a better price, service, or experience. Kidney patients don't have that luxury. When someone requires dialysis to survive, she enters a system where choice is often limited, competition is weak, and one company wields extraordinary influence.
DaVita has become one of the most powerful healthcare corporations in America. Since the company’s founding 34 years ago, years of consolidation, expansion, and acquisitions have enabled the company to control a substantial share of the dialysis market. MMCG Invest’s recent analysis estimates DaVita's current American market share at roughly 37.8% of total industry revenue. Through approximately 2,657 outpatient clinics, coupled with contracts with 740 hospitals for inpatient services, DaVita operates as one of the two members of America’s dialysis duopoly. As such, in many communities nationwide, patients have few practical alternatives. In some areas, there may be no meaningful alternative at all. That level of market power should concern anyone who believes healthcare exists to serve patients first.
Dialysis is not a discretionary service. Patients cannot delay treatment or wait for a better deal. Missing treatments can have devastating health consequences. And the kidney transplant wait list is notoriously long. Dialysis or transplant are literally patients’ only two options.
When a company provides a service that people cannot live without, the normal checks and balances of the marketplace begin to crack. In the case of DaVita, the result is a business model that places significant pricing power in the hands of a for-profit corporation.
Defenders of the current system often point out that DaVita provides an important service, and they are right. Dialysis clinics save lives every day. The physicians, nurses, and technicians who care for kidney patients perform essential work and deserve proper recognition. Acknowledging the importance of dialysis care, however, does not mean that we must ignore the incentives surrounding it.
At its core, DaVita is accountable to shareholders. Like any publicly traded company, it is expected to generate profits and increase returns. In 2025, the company’s revenue was $13.64 billion. That obligation creates an uncomfortable question: what happens when the financial interests of a dialysis giant collide with the interests of patients and taxpayers? Unfortunately, the incentives aren’t always aligned.
A healthcare system focused primarily on patient outcomes would invest aggressively in preventing kidney disease before it reaches the point of kidney failure. It would prioritize early screening, diabetes management, hypertension treatment, nutrition support, and access to primary care. Success would mean fewer people requiring dialysis in the first place. The uncomfortable reality here is that success for a for-profit dialysis company is more people needing dialysis.
This is not a criticism of the clinicians delivering care; it is a criticism of a system built to reward enormous profits from chronic illness while investing comparatively less attention in preventing that illness from occurring. The financial rewards in today's system often flow after patients become critically ill and dependent on long-term treatment.
Americans should be especially concerned when market concentration and healthcare intersect. Competition matters because it creates accountability. It encourages innovation. It gives consumers choices. When competition disappears, patients lose leverage and corporations gain it. At the end of the day, no company should have unchecked influence over a life-sustaining medical service.
Lawmakers and regulators should take a closer look at the dialysis industry and ask hard questions about competition, consolidation, and patient choice. They should examine whether current policies encourage prevention or simply reward treatment after patients become sick. They should also ensure that healthcare markets remain accountable to the public rather than dominated by a small number of corporate actors.
Kidney failure is already one of the most physically, emotionally, and financially challenging conditions a family or an individual can face. Patients should not have to concurrently navigate a system where corporate power is concentrated in the hands of a company whose primary responsibility is delivering profits for their shareholders.
When a corporation becomes powerful enough to shape an entire segment of medicine, it is reasonable to ask whether the system is still serving the public interest. In the case of the dialysis industry, that question is long overdue.
Christopher Sheeron is founder and president of Action for Health, a national nonprofit organization working to ensure fair outcomes for critical healthcare issues.
