Dialysis in Nursing Homes

Share this infographic on your site:


Protecting Our Seniors


Kidney failure is a growing crisis in the U.S. — especially in nursing homes


The Kidney Failure Crisis In the US

  • In 2018, 786,000 Americans were living with ESRD ( end-stage renal disease)
  • 80% of patients with ESRD are age 65+


  • The Financial Impact of Kidney Disease
  • In 2018, total Medicare spending on patients with ESRD reached $49 billion — Up 11% from 2009 (adjusted for inflation) 
    • Hemodialysis: $93,191 per patient per year
    • Peritoneal dialysis: $78,741 per patient per year
    • Transplant care: $37,304 per patient per year
  • Patients with ESRD make up 1% of Medicare beneficiaries, but account for 7% of Medicare spending
  • Yet mortality risk for kidney failure is higher in the United States than in countries that spend less on kidney care
    • 15% higher than in Europe 
    • 33% higher than in Japan


Dialysis Treatment Options

70% of patients with ESRD are undergoing dialysis — 30% have functioning kidney transplants



  • 86% – Outpatient Hemodialysis
    • Patient travels to clinic multiple times for treatment
    • Clinical staff is present during treatments
  • 12% – At Home Peritoneal Dialysis 
    • Patient receives treatment in the comfort of own home
    • Clinical staff provide training, oversight, and equipment
  • <2% – At Home Hemodialysis
    • Patient receives treatment in the comfort of own home
    • Clinical staff provide training, oversight, and equipment


Home Hemodialysis Treatment Options (Weekly treatment time)

  • Option one:
    • Conventional (3-day) Dialysis
      • 9 – 12 HOURS per week
  • Option two:
    • Daily Dialysis
      • 10 – 21 HOURS per week


For too long, the industry has focused on the needs of active, middle-aged dialysis patients and failed to address the needs of a growing nursing home population


The Nursing Home Dialysis Dilemma

  • The Limits of Outpatient Services
    • Outpatient dialysis clinics are not designed for nursing home residents
      • Outpatient treatment poses an infection risk — for dialysis patients, staff, and other residents
      • Highly acute residents struggle to find placement at outpatient clinics
      • Traveling to a dialysis clinic is disruptive, confusing, and time consuming
    • Outpatient providers have failed to address the needs of an aging population of patients with ESRD, especially nursing home residents

Nursing Homes Need 3-Day On-Site Dialysis (Not Daily)

  • Benefits for Residents with ESRD
    • Conventional dialysis is provided on-site, eliminating outpatient drawbacks
    • 98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis
      • Switching to daily dialysis requires prescription changes
      • Changes may cause confusion and disrupt continuity of care 
    • On-site, 3-day dialysis requires 17% less treatment time than daily dialysis and eliminates hours of travel time per week
      • More time for therapies and social activities
      • Decreased risk of infection and complications
    • Daily dialysis carries greater risk potentially leading to hospitalization or surgery, and greater opportunity for missed treatments
      • Greater opportunity for missed treatments
      • Higher risk of complications
        • Difficulty with the blood-access site
        • Blood clots
        • Aneurysms


  • Benefits For Nursing Home Operators
    • On-site dialysis is at the forefront of clinical innovation
      • Better collaboration of care
      • Fewer hospital readmissions
      • Stronger relationship with hospital partners
    •  Nursing homes with on-site dialysis can accept higher acuity patients
      • Eliminate transportation costs
      • Providing ambulance transportation for outpatient dialysis may cost nursing home operators up to $411 per round trip


For the same initial investment on-site, 3-day dialysis provides treatment to 3x more patients than daily dialysis


6 chairs can support

  • 3-day dialysis can support 36 patients 
  • Daily dialysis can support only 12 patients


Large dialysis providers have failed to deliver effective and flexible treatment for nursing home patients, highlighting the need for a different model


Concerto Renal Services is the Solution

Nursing homes need in-house dialysis care designed for geriatric patients


Why Choose Concerto?

  • Founded by experienced skilled nurse facility (SNF) operators who saw a need for quality on-site dialysis in nursing homes
  • Provides on-site 3-day hemodialysis in a home-like setting Embraces all patient comorbidities (vent, trach, LVAD, etc.)
  • Collaborates closely with SNF team to
    • Ensure continuity of care
    • Create customized care plans
    • Offer nursing, nutritional, and psycho-social care
      • All without the need for transportation

Capital investment spent on building a 6-chair den will support the needs of 36 patients in a Concerto 3-day dialysis model vs 12 patients total supported in a daily dialysis model


Nursing home dialysis is not an arm to our business – It IS our business