Nephrology News & Issues

Fluid shortage impacting growth in the PD patient population

Fluid shortage impacting growth in the PD patient population By Mark E. Neumann

Mr. Neumann has been the editor for Nephrology News & Issues since 1989.

In August of last year, Baxter Healthcare Corporation told the U.S. renal community that it could not meet the demands for its Dianeal PD4 glucose solutions for use during peritoneal dialysis. "Several factors, including limited manufacturing capacity along with increased overall demand for sterile solutions and changing PD prescribing patterns, have resulted in the current supply constraints," Baxter told NN&I at the time. The company said it would institute a process to temporarily limit the number of new peritoneal dialysis patient referrals across its base of customers.

Baxter had already begun talking three months earlier about the impeding shortage to some of the home programs it serviced. By speeding up construction of a new supply plant line for the solution, brokering an agreement with Fresenius Medical Care to help bolster its supply, and importing some fluid from an Ireland plant, Baxter helped to ease the shortage.

But the fluid shortage clearly had some impact on new starts on PD during 2014-2015, according to an annual survey among the largest dialysis providers in the U.S. Conducted by Nephrology News & Issues each July, the survey collects data on growth among all modalities (conventional, in-center hemodialysis, peritoneal dialysis, and home hemodialysis), as well as for nocturnal in-center hemodialysis programs.

From 2011-2014, the number of new patients starting on PD showed steady growth each year. From 2014 through 2015, however, at the height of the PD fluid shortage, the number of new starts dropped significantly ––by over 3,000 patients (see Table 1).

Table 1. Changes in new starts on PD and HHD among the 10 largest providers in the U.S., 2011-2015

Year New Starts for PD New Starts for HHD Total
2011-2012 3,183 1,166 4,349
2012-2013 3,619 696 4,315
2013-2014 4,357 315 4,672
2014-2015 1,393 460 1,853

NN&I surveys completed by dialysis providers represent patient counts from May to May of each year.

PD= peritoneal dialysis

HHD= home hemodialysis

While the NN&I survey doesn’t capture data among all providers, the 10 largest companies provided care for 415,794 dialysis patients as of May 2015.


U.S. Renal Data System data shows that growth in the overall ESRD patient population has slowed in recent years, so there is a smaller pool of new patients starting on dialysis each year. Growth in the number of new patients collectively among the ten largest providers has been steady at around 5-6% each year, according to the NN&I surveys, but some of that growth can be attributed to acquiring other dialysis companies.

Likewise, starting patients on a home modality can be challenging. But the drop in PD patient growth this past year, after several years of increases, will stall efforts to send more patients home.


- Largest dialysis providers in the United States, 2019-2015,,

Accessed August 10, 2015

This article was posted on August 11th, 2015