ESRD (end-stage renal disease) is permanent kidney failure — stage 5 of chronic kidney disease — treated with dialysis or a transplant. CMS lists 7,557 Medicare-certified dialysis facilities, about 90% of them chain-owned.
What end-stage renal disease is
End-stage renal disease is the point at which the kidneys can no longer filter waste and excess fluid from the blood well enough to sustain life. It is the final stage of chronic kidney disease, a gradual loss of kidney function most often driven by diabetes and high blood pressure. Once a person reaches this stage, they need dialysis or a kidney transplant to live.
Because ESRD requires ongoing, costly treatment, US policy treats it specially: it is one of the few conditions that qualifies a person for Medicare regardless of age. That is why CMS tracks dialysis facilities so closely and why nearly all of them are Medicare-certified.
The stages of chronic kidney disease
ESRD is the last of five CKD stages, measured by estimated glomerular filtration rate (eGFR), in mL/min/1.73m²:
This is general reference information, not medical advice. Staging and treatment are decisions for a patient and their physician.
What dialysis is
Blood is pumped through an external filter and returned to the body, usually at a dialysis center several times a week. Most US dialysis is hemodialysis delivered in facilities.
The lining of the abdomen filters the blood internally, often at home and overnight. It offers more independence but is not right for every patient.
US dialysis facilities and chain ownership
The US dialysis market is among the most concentrated in healthcare. Of the 7,557 Medicare-certified facilities in the CMS file, 6,815 — about 90% — report chain ownership, with two large operators accounting for much of the total. CMS publishes a five-star quality rating and chain affiliation per facility; Fonteum surfaces both with the CMS source and snapshot date, in the aggregate, without labeling any single facility.
US dialysis facilities by the numbers
Find a dialysis facility
Browse every Medicare-certified dialysis facility by state with its CMS five-star quality rating and chain-ownership status — each field traced to its CMS source and snapshot date.
Dialysis compare →Frequently asked questions
- What is ESRD?
- ESRD stands for end-stage renal disease — permanent kidney failure, the final stage (stage 5) of chronic kidney disease. At this stage the kidneys can no longer filter waste well enough to sustain life on their own, so the person needs dialysis or a kidney transplant to survive.
- What are the stages of ESRD?
- ESRD is itself the last stage of chronic kidney disease (CKD). CKD is staged 1 through 5 by estimated glomerular filtration rate (eGFR): stage 1 is near-normal function, stages 2–4 are progressive decline, and stage 5 — an eGFR below 15 — is kidney failure, the stage clinicians call end-stage renal disease.
- What is dialysis?
- Dialysis is a treatment that does the kidneys' filtering work when they fail. Hemodialysis pumps blood through an external filter, usually at a dialysis center several times a week; peritoneal dialysis uses the lining of the abdomen to filter blood and is often done at home. Both remove waste and excess fluid.
- Does Medicare cover dialysis?
- Yes. ESRD is one of the few conditions that qualifies a person for Medicare at any age. Medicare covers dialysis and many related services for people with end-stage renal disease, which is why nearly all US dialysis facilities are Medicare-certified and appear in the CMS Care Compare dialysis file.
- How many dialysis facilities are there in the US?
- The CMS Care Compare dialysis file lists 7,557 Medicare-certified dialysis facilities across 56 states and territories. Of those, 7,072 carry a CMS five-star quality rating; the rest lack enough data to be rated. Fonteum surfaces the rating per facility with its CMS source and snapshot date.
- Are most dialysis centers chain-owned?
- Yes. In the current CMS file, 6,815 of 7,557 dialysis facilities — about 90% — report chain ownership, one of the most concentrated facility markets in US healthcare. Chain affiliation is a field Fonteum surfaces per facility, stamped with its CMS source and snapshot date.
- How can I check a dialysis facility's record?
- Fonteum's dialysis compare pages list loaded Medicare-certified facilities by state with available CMS five-star quality ratings and chain-ownership status. Supported fields display the available CMS source and snapshot date. You can also screen a facility's NPI against the OIG exclusion list.
Related
- Dialysis facility quality & chain data — per-facility CMS five-star ratings and chain-ownership status by state.
- ESRD glossary entry — the short definition and where the term fits in the federal data graph.
- Skilled nursing facilities explained — another Medicare-certified facility type with CMS quality data.
- Compare loaded CMS Care Compare facilities — nursing homes, home health, hospice, dialysis, and more in one place.
- Look up a facility by NPI — search any provider or organization and check its federal records.