Davita — Business Overview

What does DaVita do?

DaVita is primarily a kidney dialysis company, treating patients whose kidneys have stopped working well enough to sustain life. When kidneys fail — a condition called end-stage kidney disease (ESKD) — patients must either receive a transplant or undergo dialysis (a machine-based process that filters toxins and fluid from the blood) for the rest of their lives. DaVita operates dialysis centers across the United States and internationally, serving roughly 200,500 U.S. patients and 94,500 international patients as of the end of 2025.

DaVita operates across three main business areas:

The company also has smaller units covering clinical research, transplant software, and a venture investment group, all of which are relatively minor contributors today.

How does DaVita make money?

The core revenue engine is billing payors — mostly government programs — for each dialysis treatment performed. Medicare and Medicare Advantage plans account for 57% of U.S. dialysis patient service revenue, Medicaid another 7%, and other government programs 3%, making total government sources 68% of the mix. Commercial insurers cover the remaining 32%. Critically, even though only about 11% of U.S. dialysis patients are on commercial plans, those patients generate approximately 26% of U.S. dialysis service revenue because commercial rates are significantly higher than Medicare rates. The filing states explicitly that "all of our non-hospital dialysis profits come from commercial payors."

DaVita also earns revenue through integrated care contracts that pay the company to manage patient health outcomes rather than just bill per treatment. Its IKC business participates in arrangements where DaVita takes on some financial risk — earning more if it keeps costs down and patient health improves. These include Medicare Advantage special needs plans, shared savings contracts, and the federal government's Comprehensive Kidney Care Contracting (CKCC) program. As of year-end 2025, IKC served 66,000 patients in risk-based arrangements and another 9,400 in other integrated care deals.

What market does DaVita operate in?

DaVita operates in the U.S. ESKD dialysis market, which is large, steady, and driven by chronic disease prevalence. According to the most recent federal data (from the U.S. Renal Data System), there were over 557,000 ESKD dialysis patients in the U.S. in 2023. The patient population grew at roughly 1.8% annually from 2013 to 2023, though that rate slowed to about 0.2% annually from 2018 to 2023. Growth is supported by aging demographics, rising rates of diabetes and hypertension (the leading causes of kidney failure), and the growth of minority populations with higher ESKD incidence rates.

Several trends could affect future patient volumes — both positively and negatively. The aging U.S. population and continued prevalence of diabetes should support demand. However, newer drug classes — particularly GLP-1 receptor agonists (medications like Ozempic/Wegovy) and SGLT2 inhibitors — have shown promise in slowing kidney disease progression, which could reduce the future flow of patients reaching ESKD. Transplant availability and mortality rates also influence the size of the dialysis patient pool at any given time.

Who are DaVita's main competitors?

The U.S. dialysis market is a duopoly at the top, with DaVita and Fresenius Medical Care collectively dominating. The filing identifies Fresenius Medical Care as DaVita's largest competitor, noting that Fresenius has a potential cost advantage because it also manufactures its own dialysis supplies and equipment. Beyond Fresenius, DaVita competes with mid-sized dialysis chains, private equity-backed kidney care providers, and individual nephrologists who open their own dialysis units.

DaVita's claimed competitive advantages center on clinical quality and physician relationships. The company highlights 11 consecutive years of industry leadership in the CMS Quality Incentive Program and 10 consecutive years as a leader in CMS's Five-Star Quality Rating System for dialysis centers. It also maintains relationships with roughly 5,200 referring nephrologists, has over 900 medical director contracts, and operates a national laboratory specialized in ESKD testing. In the integrated care space, DaVita faces newer competition from non-traditional entrants and well-capitalized technology or healthcare companies expanding along the kidney care continuum.

Where does DaVita operate?

DaVita's business is heavily concentrated in the United States, which generates roughly 86% of consolidated revenues. Its 2,657 U.S. outpatient dialysis centers span 46 states and the District of Columbia. The company also holds contracts to provide hospital inpatient dialysis services at approximately 740 U.S. hospitals.

Internationally, DaVita operates 585 dialysis centers across 14 countries, serving about 94,500 patients. Its largest international presences are in Brazil (127 centers), Colombia (74), Malaysia (71), Poland (64), and Chile (63). Other markets include Germany, the United Kingdom, Ecuador, Saudi Arabia, Panama, Portugal, China, Japan, and Singapore. The filing notes DaVita is subject to the Foreign Corrupt Practices Act and international data privacy laws including GDPR (Europe) and Brazil's LGPD, reflecting the compliance complexity of operating across this many jurisdictions. No single international country appears to dominate, though Latin America collectively represents the largest non-U.S. cluster.