2 Decades in Dialysis: Improving Outcomes, Saving Lives

Picture of Kent Thiry
Kent Thiry

Kent J Thiry is an Entrepreneur, Philanthropist, and Civic Leader.

I served as CEO of DaVita Inc. from 1999 to 2019, and also served as chairman or co-chairman of the board in that time. In 2019, I was appointed Executive Chairman of the board of directors.  We ultimately had approximately 65,000 teammates across 12 countries, almost all of whom were good and hard-working people that did great things for patients and society.

During those two decades, DaVita was at the forefront of improving clinical outcomes and extending the lives of dialysis patients while providing greater access to high-quality care — regardless of income — for all patients.

The approach our team took has been studied, cited and celebrated in numerous case studies, and has provided life-saving treatment for millions of Americans.

On the whole, the industry in the U.S. in that time prevented hundreds of thousands of deaths, greatly expanded the no. of clinics to improve patient access, increased one-year survival rates and reduced hospitalizations for many patients. DaVita and our competitor Fresenius were the primary driving forces behind this expansive progress – and our quality metrics consistently outperformed most non-profit clinics.

But for right now let’s look at the entire kidney care community, because the community overall achieved dramatic improvements during those 20 years.

  • Between 2000 and 2019, mortality rates for patients with end stage renal disease dropped a full 32%, with the biggest gains seen for the elderly and patients with diabetes. Improvements were fairly consistent across gender and ethnicity. This was achieved despite increases in average age and the number of comorbidities (like diabetes or high blood pressure or heart disease).  That means while patients were getting older and sicker because of other things going on in their bodies or in society, our outcomes were steadily getting better. This drop meant that thousands of dialysis patients were alive at the end of each year who would have been dead only 5 years earlier.  In my view, this is one of the great “untold” stories in American healthcare.
  • In that same period hospitalization rates for dialysis patients dropped nearly 9% for all patients – led by a nearly 10% drop for Black patients, a 14% drop for Hispanic patients, and a 19% drop for Native American patients. These dramatic decreases, despite having older and sicker patients, demonstrate our commitment to expanding the scope and effectiveness of our care – moving from “just” providing dialysis to providing more and more services – and in most of those cases, with no increase in reimbursement. We did it because we cared. And it worked.
  • The privatization of dialysis services has increased the accessibility to renal replacement therapy around the globe, preventing some 1.5 million deaths.[1] In 2010, an estimated 2.3 million to 7.1 million people with end-stage kidney disease died from a lack of access to chronic dialysis.[2] That number dropped to 1.2 million by 2019.[3]
  • In the United States, the number of dialysis clinics has nearly doubled over the last two decades, growing from 4,013 certified facilities in 2000 to 5,799 in 2010 and 7,966 in 2019 thanks in large part to expansions of two major players, DaVita and Fresenius. This exemplifies how access to care became more convenient over time.
  • That growth, in turn, fueled a steady increase in one-year survival rates for patients on dialysis, from approximately 73% to over 80% in recent years, according to data from the United States Renal Data System, an arm of the National Institutes of Health. At DaVita we were particularly proud to be the initiator of a community-wide effort to significantly increase one-year survival rates, meaning the percentage of patients who move beyond what is often a very difficult first year of treatment.  We shared our new and innovative protocols to dramatically increase pre-kidney failure care so patients would be better prepared for their new life, as well as more comprehensive and holistic attention in those first few months. We were thrilled when most of the community got involved, using the community association “kidney care partners” as the organizing vehicle and first year mortality dropped from 27% to less than 20%. Once again, we did this with no extra reimbursement, and shared all the data and results with CMS, the department that oversees Medicare.

[1] U.S. dialysis centers market size, Share & Growth Report 2030. U.S. Dialysis Centers Market Size, Share & Growth Report 2030. (n.d.). https://www.grandviewresearch.com/industry-analysis/us-dialysis-centers-market-report 

[2] Worldwide Access to Treatment for End-Stage Kidney Disease … – the Lancet, www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61601-9/fulltext. Accessed 17 July 2023. 

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427524/