Blumenthal Presses FTC to Curb Concentration in Dialysis Market, Release Findings of Investigation

[WASHINGTON, D.C.] – U.S. Senator Richard Blumenthal (D-CT) is calling on the Federal Trade Commission (FTC) today to ramp up its efforts to crack down on concentration in the dialysis market. Currently, just two companies, DaVita and Fresenius, control more than three-fourths of the dialysis market, which more than a half a million Americans rely on to access lifesaving kidney dialysis.

In a letter, Blumenthal raised alarm over Americans’ complaints with DaVita and Fresenius: “Vulnerable Americans receiving care from DaVita and Fresenius report gravely worrisome problems: understaffed clinics, safety shortcuts, rushed treatment, and high rates of potentially life-threatening mistakes. When staff try to address their concerns through unionization, they are reportedly blocked by aggressive anti-union tactics. When physicians who serve as the medical director for a dialysis clinic try to move to a competitor or open their own clinic, they are reportedly blocked by onerous non-compete clauses. When nascent competitors develop new technology that promises to improve the care available to patients, they are bought up. And most disturbing, when patients have tried to raise awareness and advocate for themselves, they have reportedly been blackballed – denied medically necessary, life-sustaining treatment.”

The Senator called on the FTC to take additional steps to respond to the market concentration in the dialysis industry: “…[G]iven the ongoing harm to dialysis patients, doctors, and other employees at these companies, more must be done.”

Blumenthal concluded by requesting a briefing on the status of the Commission’s investigation of DaVita and Fresnius’ violations of antitrust laws reported in 2024, DaVita’s compliance with its final order restricting future acquisitions of dialysis clinics by the company in 2022, and any other antitrust issues the FTC may be investigating in the dialysis industry. He concluded by urging the FTC to take “…robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies.”

The full text of the Senator’s letter is available here and copied below.

Dear Chairman Ferguson,

I write with concerns regarding concentration in the dialysis market. Over half a million Americans, including over 40,000 veterans, receive kidney dialysis. For these patients, dialysis treatment is necessary and life-saving. Notwithstanding the importance of this care, most of these patients are forced to rely on just two companies, DaVita and Fresenius Medical Care (“Fresenius”), with checkered track records, as they control at least 77% of the national dialysis market.

Vulnerable Americans receiving care from DaVita and Fresenius report gravely worrisome problems: understaffed clinics, safety shortcuts, rushed treatment, and high rates of potentially life-threatening mistakes. When staff try to address their concerns through unionization, they are reportedly blocked by aggressive anti-union tactics. When physicians who serve as the medical director for a dialysis clinic try to move to a competitor or open their own clinic, they are reportedly blocked by onerous non-compete clauses. When nascent competitors develop new technology that promises to improve the care available to patients, they are bought up. And most disturbing, when patients have tried to raise awareness and advocate for themselves, they have reportedly been blackballed – denied medically necessary, life-sustaining treatment.

These kinds of complaints are hallmarks of unlawful abuse of market power. Despite the unpopularity of DaVita and Fresenius, their share of the national market has increased dramatically over the past two decades.

The Commission has begun taking some initial steps to respond to the market concentration in the dialysis industry, including the imposition of a final order restricting future acquisitions of dialysis clinics by DaVita in 2022, as well as reports that, in 2024, the Commission opened an investigation of violations of antitrust law by DaVita and Fresenius. However, given the ongoing harm to dialysis patients, doctors, and other employees at these companies, more must be done. I write to request a briefing on the status of your investigation, DaVita’s compliance with the 2022 final order restricting future acquisitions, and any other antitrust issues the FTC is currently examining in the dialysis industry. Further, upon prompt completion of the investigation, FTC must take appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies.

-30-