RENAL DIALYSIS EQUIPMENT: TECHNOLOGIES AND GLOBAL MARKETS

Transcription

1 RENAL DIALYSIS EQUIPMENT: TECHNOLOGIES AND GLOBAL MARKETS HLC164A March 2014 Krishanu Bhattacharjee Project Analyst ISBN: BCC Research 49 Walnut Park, Building 2 Wellesley, MA USA (toll-free within the USA), or (+1) information@bccresearch.com

2 TABLE OF CONTENTS CHAPTER 1 INTRODUCTION 2 STUDY GOALS AND OBJECTIVES 2 REASONS FOR DOING THIS STUDY 2 INTENDED AUDIENCE 3 SCOPE OF THE REPORT 4 METHODOLOGY AND INFORMATION SOURCES 5 RELATED BCC RESEARCH STUDIES 5 ANALYST CREDENTIALS 6 BCC RESEARCH ONLINE SERVICES 6 DISCLAIMER 6 CHAPTER 2 SUMMARY 8 SUMMARY TABLE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH SUMMARY FIGURE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, CHAPTER 3 OVERVIEW 11 INTRODUCTION 11 ANATOMY OF KIDNEYS 11 BLOOD FILTRATION PROCESS 11 KEY FUNCTIONS OF KIDNEYS 12 UNDERSTANDING RENAL FAILURE 13 TYPES OF KIDNEY DISEASE 13 Acute Renal Failure 13 Chronic Renal Failure 14 Risk Factors 15 EPIDEMIOLOGY 15 TABLE 1 INCIDENCE OF ESRD BY COUNTRY, 2011 (PER MILLION POPULATION) 16 TABLE 2 PREVALENCE OF ESRD BY COUNTRY, TABLE 3 PERCENTAGE OF INCIDENT ESRD PATIENTS DUE TO DIABETES BY COUNTRY, 2011 (%) TABLE 4 KIDNEY TRANSPLANT RATES BY COUNTRY, 2011 (RATE IN PATIENTS PER MILLION) UNDERSTANDING RENAL DIALYSIS 20 OVERVIEW 20 PRINCIPLES OF DIALYSIS 20 HEMODIALYSIS 21 Overview 21 Types of Hemodialysis 22 Hemodialysis Equipment 22 Components of Hemodialysis Dialysis Equipment 23 Functioning of Hemodialysis Equipment 23 Advantages of Hemodialysis 24 Side Effects of Hemodialysis 24 PERITONEAL DIALYSIS

3 Overview 25 Types of Peritoneal Dialysis 25 Advantages of Peritoneal Dialysis 26 Side Effects of Peritoneal Dialysis 26 CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) 27 Overview 27 Types of CRRT 27 Comparison of Intermittent Hemodialysis and CRRT 27 TABLE 5 COMPARISON OF INTERMITTENT HEMODIALYSIS AND CRRT 28 Comparison: Home-based vs. In-center Dialysis 28 TABLE 6 COMPARISON: HOME-BASED VS. IN-CENTER DIALYSIS 29 TABLE 7 DISTRIBUTION OF PREVALENT DIALYSIS PATIENTS BY COUNTRY AND MODALITY, 2011 (%) 30 CHAPTER 4 GLOBAL MARKET FOR DIALYSIS EQUIPMENT AND ACCESSORIES 33 MARKET DYNAMICS 33 KEY MARKET DRIVERS 33 Integration of Dialysis Equipment to Medical Information Systems Expected to Drive New Sales Expansion of Manufacturing Facilities in Emerging Markets to Aid Global Companies Rise in Number of Dialysis Centers Across the World Aiding Revenue Growth Rising Prevalence of ESRD Patients to Aid Growth of Overall Dialysis Equipment and Services Market Laboratory Services to Aid the Overall Portfolio Utilization of Dialysis Product Manufacturers APAC Markets Present Growth Opportunities for Peritoneal Dialysis 34 Cost-Effectiveness and Better Quality of Life to Increase PD Usage Globally INDUSTRY CHALLENGES 35 Lack of Adequate Training Hampering Growth of Home Dialysis 35 Adverse Economic Conditions in Europe May Impact Short-Term Revenue Growth Lack of Adequate Number of Nephrologists Hampers Growth in Emerging Markets Market Saturation and Reimbursement Cuts to Adversely Impact Market Growth of HD Equipment REVENUE ANALYSIS OF THE GLOBAL RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET GLOBAL MARKET SUMMARY 36 TABLE 8 GLOBAL MARKET FOR RENAL DIALYSIS EQUIPMENT AND ACCESSORIES, THROUGH TABLE 9 SHARE OF THE RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT SEGMENT, 2013 AND 2018 (%) TABLE 10 SHARE OF THE TOTAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY REGION, 2013 AND 2018 (%) PATENT ANALYSIS

4 APPARATUS FOR EXTRACORPOREAL BLOOD TREATMENT AND METHOD FOR PREDEFINING AN INITIAL BLOOD TREATMENT MODE FOR AN EXTRACORPOREAL BLOOD TREATMENT APPARATUS DIALYSIS CONCENTRATE RECEPTACLE WITH SUPPORT ELEMENTS 40 SYSTEM AND METHOD OF MONITORING AND CONTROL OF ULTRAFILTRATION VOLUME DURING PERITONEAL DIALYSIS USING SEGMENTAL BIOIMPEDANCE HEMODIALYSIS DEVICE OPERATION METHOD AND HEMODIALYSIS DEVICE 40 DIAGNOSTIC METHOD OF DIALYSATE PREPARATION DEVICE, AND DIALYSATE PREPARATION DEVICE DIALYSIS UNIT 41 PORTABLE DIALYSIS MACHINE WITH IMPROVED RESERVOIR HEATING SYSTEM DIALYSIS SYSTEM HAVING PERISTALTIC PUMP ARRANGEMENT 41 NOISE-REDUCING DIALYSIS SYSTEMS AND METHODS OF REDUCING NOISE IN DIALYSIS SYSTEMS MULTIMODAL DIALYSIS SYSTEM 42 PERITONEAL DIALYSIS SYSTEMS, DEVICES, AND METHODS 42 HEMODIALYSIS MACHINE 43 TECHNOLOGY TRENDS 43 ARTIFICIAL KIDNEYS FOR GRADUAL REPLACEMENT OF DIALYSIS 43 PORTABLE, CARTRIDGE-BASED HEMODIALYSIS DEVICE 43 WEARABLE PERITONEAL DIALYSIS DEVICE 44 PRICING AND REIMBURSEMENT TRENDS 44 TABLE 11 REIMBURSEMENT OF DIALYSIS SERVICES PER WEEK BY SELECTED COUNTRIES, ($) THE U.S. 44 CANADA 45 JAPAN 45 GERMANY 45 FRANCE 46 ITALY 46 THE U.K. 46 BRAZIL 47 OTHER COUNTRIES - CHINA, INDIA AND SPAIN CHAPTER 5 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY COUNTRY 49 RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN THE U.S. 49 HEALTHCARE SYSTEM IN THE U.S. - OVERVIEW 49 RENAL DIALYSIS IN THE U.S. 49 MARKET OPPORTUNITIES AND RISKS IN THE U.S. 50 New Bundled Payment System to Drive PD Market Growth 50 Promotion of AV Fistula as the Preferred Vascular Access to Drive the Dialysis Accessories and Disposables Market Training and Awareness to Aid the Growth of Home Dialysis in U.S. 50 Lowered Reimbursements to Restrict the Growth of Dialysis Market 51 Recent Healthcare Insurance Reforms to Hamper HD Market 51 REVENUE FORECAST FOR THE U.S. DIALYSIS EQUIPMENT AND ACCESSORIES MARKET 50 51

5 TABLE 12 U.S. DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH 2018 ($ MILLIONS) TABLE 13 SHARE OF THE U.S. DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN CANADA 53 HEALTHCARE SYSTEM IN CANADA - OVERVIEW 53 RENAL DIALYSIS IN CANADA - OVERVIEW 53 MARKET OPPORTUNITIES AND RISKS IN CANADA 54 Centralization and Integration of Various Dialysis Facilities to Aid Ease of Penetration Lack of Hemodialysis Facilities in Canada Presents an Opportunity in Long-term Future Community Settings Offer Growth Opportunities for Dialysis Equipment Peritoneal Dialysis to Drive Growth in Canada 55 Negative Attitude of Hospitals towards Dialysis Expansion Presents a Significant Industry Challenge REVENUE FORECAST FOR CANADIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET TABLE 14 CANADIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH TABLE 15 SHARE OF THE CANADIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORIES, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN JAPAN 57 HEALTHCARE SYSTEM IN JAPAN - OVERVIEW 57 RENAL DIALYSIS IN JAPAN 57 MARKET OPPORTUNITIES AND RISKS IN JAPAN 58 Education and Awareness in PD to Aid New Market Creation 58 Need for cost-effective PD solutions to drive long-term market growth 58 Increase in Automated Peritoneal Dialysis (APD) to aid market penetration of PD PD-HD Combination Modality to Offer Greater Business Opportunities for PD Suppliers Market Saturation in HD Segment to Impede Growth 59 MARKET IN JAPAN TABLE 16 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN JAPAN, THROUGH TABLE 17 SHARE OF THE JAPANESE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN FRANCE 60 HEALTHCARE SYSTEM IN FRANCE - OVERVIEW 60 RENAL DIALYSIS IN FRANCE - OVERVIEW 61 MARKET OPPORTUNITIES AND RISKS IN FRANCE 61 Hemodialysis to Continue Driving the French Dialysis Market 61 Negative Attitudes and Limited Number of Healthcare Staff Impeding Growth of Autonomous Dialysis Market Penetration of Peritoneal Dialysis to be Slow Owing to the Lack of Incentives for Caregivers Dialysis Machines Market Likely to Be Hit by Federal Cost-Containment Measures

6 MARKET IN FRANCE TABLE 18 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN FRANCE, THROUGH TABLE 19 SHARE OF THE FRENCH DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN GERMANY 64 HEALTHCARE SYSTEM IN GERMANY - OVERVIEW 64 RENAL DIALYSIS IN GERMANY 65 MARKET OPPORTUNITIES AND RISKS IN GERMANY 65 Advances in Telemedicine-linked PD to Aid Adoption Rates 65 Patient Education and Training to Aid PD Penetration in Germany 65 Potential Treatment Options for Acute Renal Failure in Multiple Myeloma Patients to Aid Market Growth for High-Cut Off Dialyzers HD Market to Remain Stagnant Owing to Cost-Cutting Measures 66 MARKET IN GERMANY TABLE 20 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN GERMANY, THROUGH TABLE 21 SHARE OF THE GERMAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN ITALY 68 HEALTHCARE SYSTEM IN ITALY - OVERVIEW 68 RENAL DIALYSIS IN ITALY 68 MARKET OPPORTUNITIES AND RISKS IN ITALY 69 Heavy Reliance on Imports and Need for Replacement to Drive the Renal Dialysis Equipment Market Lack of Awareness of CKD Expected to Slow Volume Sales 69 Long Payment Delays in Public Hospitals Likely to Reduce Market Attractiveness of Italy MARKET IN ITALY TABLE 22 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN ITALY, THROUGH TABLE 23 SHARE OF THE ITALIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN SPAIN 71 HEALTHCARE SYSTEM IN SPAIN - OVERVIEW 71 RENAL DIALYSIS IN SPAIN 72 MARKET OPPORTUNITIES AND RISKS IN SPAIN 72 Increasing Costs of Dialysis Likely to Favor the Growth of PD 72 Lack of Financial Incentives to Nephrologists to Hamper Quality of Dialysis High Transplant Rate in Spain to Impede the Growth of Dialysis Market MARKET IN SPAIN TABLE 24 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN SPAIN, THROUGH TABLE 25 SHARE OF THE SPANISH DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, BY PRODUCT CATEGORY, 2013 AND 2018 (%)

7 RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN THE U.K. 74 HEALTHCARE SYSTEM IN THE U.K. - OVERVIEW 74 England 75 Wales 75 Scotland 75 Ireland 75 RENAL DIALYSIS IN THE U.K. 75 MARKET OPPORTUNITIES AND RISKS IN THE U.K. 76 Increased Hospitalization Costs on Aging Population Hampering the Cost Advantage Offered by PD Indicative National Tariffs to Incentivize Use of PD 76 Increased Competition in the PD Market Lowering Market Prices 76 MARKET IN THE U.K. TABLE 26 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN THE U.K., THROUGH TABLE 27 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY IN THE U.K., 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN CHINA 78 HEALTHCARE SYSTEM IN CHINA - OVERVIEW 78 RENAL DIALYSIS IN CHINA 79 MARKET OPPORTUNITIES AND RISKS IN CHINA 79 Establishment of New Dialysis Centers to Drive Long-Term Market Growth Need for New Hemodialysis Equipment and Disposables to Promote Market Growth Increased Government Support for Home Dialysis to Aid PD Market Growth Stringent Regulatory Policies to Hamper Market Penetration 80 MARKET IN CHINA TABLE 28 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN CHINA, THROUGH TABLE 29 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN BRAZIL 82 HEALTHCARE SYSTEM IN BRAZIL - OVERVIEW 82 RENAL DIALYSIS IN BRAZIL 82 MARKET OPPORTUNITIES AND RISKS IN BRAZIL 83 Clinical Benefits of PD in Acute Kidney Injury to Aid Market Penetration in Critical Care Units in Long Term Promotion of Early CKD Diagnosis to Aid Dialysis Market 83 Unfavorable Healthcare Policies to Slow Down PD Adoption Rates in Short Term MARKET IN BRAZIL TABLE 30 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN BRAZIL, THROUGH TABLE 31 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY IN BRAZIL, 2013 AND 2018 (%)

8 RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN INDIA 85 HEALTHCARE SYSTEM IN INDIA - OVERVIEW 85 RENAL DIALYSIS IN INDIA 85 MARKET OPPORTUNITIES AND RISKS IN INDIA 86 Cost-Effective and Portable Solutions to Aid Market Expansion 86 Increasing Awareness of CKD and Its Dialysis Guidelines to Promote Market Growth Health Insurance Reforms to Aid Penetration of PD in Long Term 86 Public-Private Partnerships (PPPs) to Complement the Growth of Dialysis Market Need for Economies of Scale to Offer Opportunities for Dialysis Centers Accessibility, Affordability and Awareness Issues to Impede Market Growth MARKET IN INDIA TABLE 32 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN INDIA, THROUGH TABLE 33 SHARE OF THE INDIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) MARKET IN THE REST OF THE WORLD TABLE 34 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET FOR THE REST OF THE WORLD, THROUGH CHAPTER 6 HEMODIALYSIS EQUIPMENT MARKET 92 MARKET LANDSCAPE FOR HEMODIALYSIS EQUIPMENT 92 OVERVIEW 92 MARKET DRIVERS 92 High Frequency Hemodialysis Aiding Market Penetration 92 Gradual Demand for Home HD to Drive the Hemodialysis Market 93 Portable HD Machines to Drive Volume Sales in Emerging Markets 93 KEY INDUSTRY CHALLENGES 93 Market Maturity in the Western Economies Leading to Stagnant Sales Curve Increasing Number of Kidney Transplants in Certain Countries to Impede Growth for HD REVENUE FORECAST FOR HD EQUIPMENT MARKET 94 TABLE 35 GLOBAL HD EQUIPMENT MARKET BY SUBSEGMENTS, THROUGH 2018 ($ MILLIONS) TABLE 36 PERCENTAGE SPLIT FOR THE GLOBAL HD EQUIPMENT MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) CHAPTER 7 PERITONEAL DIALYSIS MARKET 97 MARKET LANDSCAPE FOR PERITONEAL DIALYSIS 97 OVERVIEW 97 KEY MARKET DRIVERS 97 Active Fluid Management to Aid Market Penetration of Peritoneal Dialysis Improvements in Biocompatible PD Solutions to Aid Adoption Rates 97 97

9 Distinct Clinical Advantages for Pediatric and Elderly Population to Drive Growth of PD MAJOR INDUSTRY CHALLENGES 98 Training and Awareness Issues to Continue Hampering the Growth of PD Limitations of PD in Long-term Care to Affect Market Growth 99 REVENUE FORECAST FOR PD SOLUTIONS MARKET 99 TABLE 37 GLOBAL PD SOLUTIONS MARKET, THROUGH 99 TABLE 38 PERCENTAGE SPLIT FOR THE PD SOLUTIONS MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) CHAPTER 8 CONTINUOUS RENAL REPLACEMENT THERAPY MARKET 103 MARKET LANDSCAPE FOR CRRT MACHINES 103 OVERVIEW 103 MARKET DRIVERS 103 Increasing Awareness of the Benefits of CRRT Aiding Market Growth in ICUs Increased Incidence of Acute Kidney Injury to Boost CRRT Sales 103 MAJOR INDUSTRY CHALLENGES 104 Need for a Multidisciplinary Team Hinders the Growth of CRRT 104 High Cost and Lack of Proper Identification of CRRT Patients Impacting Market Growth REVENUE FORECAST FOR CRRT MARKET 104 TABLE 39 GLOBAL CRRT MARKET, THROUGH 104 TABLE 40 SHARE FOR THE GLOBAL CRRT MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) CHAPTER 9 ACCESSORIES FOR DIALYSIS EQUIPMENT 107 MARKET LANDSCAPE FOR DIALYSIS ACCESSORIES 107 OVERVIEW OF DIALYSIS ACCESSORIES 107 MARKET DRIVERS FOR DIALYSIS ACCESSORIES 107 Single-Use Dialyzers to Drive the Global Markets for Dialysis Accessories Creation of New Dialysis Centers in Emerging Market to Promote Volume Sales MAJOR INDUSTRY CHALLENGES 108 Reduced Use of Dialyzer Reprocessing to Impact High-Flux Dialyzer Sales High Cut-off Dialyzers Likely to Gain Acceptance across Many Clinical Indications Low-cost Dialyzers to Negatively Impact the Average Selling Prices 109 REVENUE FORECAST FOR DIALYSIS ACCESSORIES MARKET 109 TABLE 41 GLOBAL DIALYSIS ACCESSORIES MARKET BY SUBSEGMENTS, THROUGH TABLE 42 PERCENTAGE SPLIT OF THE GLOBAL DIALYSIS ACCESSORIES MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) CHAPTER 10 COMPETITIVE LANDSCAPE 112 MARKET SHARE ANALYSIS 112

10 TABLE 43 MARKET SHARE OF KEY COMPANIES IN THE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, 2013 (%) MERGERS, ACQUISITIONS AND KEY STRATEGIC INITIATIVES 113 BAXTER INTERNATIONAL INC. ACQUIRED GAMBRO AB 113 DAVITA INC. ACQUIRED CALIFORNIA-BASED HEALTHCARE PARTNERS INC. 113 FRESENIUS MEDICAL CARE AG & CO. KGAA PURCHASED LIBERTY DIALYSIS HOLDINGS INC. FRESENIUS MEDICAL CARE AG & CO. KGAA ACQUIRED SHEIL MEDICAL LABORATORY INC. BAXTER INTERNATIONAL INC. AND AWAK TECHNOLOGIES PARTNER IN PD BUSINESS U.S. RENAL CARE ACQUIRED AMBULATORY SERVICES OF AMERICA 114 AWAK TECHNOLOGIES PTE. LTD. AND DEBIOTECH SA PARTNERSHIP AGREEMENT NXSTAGE MEDICAL INC. AND ROCKWELL MEDICAL INC. ENTERED INTO A SUPPLY AGREEMENT WITH DAVITA INC. B. BRAUN AND DAVITA INC. SIGNED SUPPLY AGREEMENT 115 COMPANY AND PRODUCT PROFILE 115 ALLMED MEDICAL GMBH 115 ASAHI KASEI CORP. 115 Overview 115 Healthcare Business Segments 116 Dialysis Segment 116 Product Profile 116 Recent Activity 116 AWAK TECHNOLOGIES, INC. 117 Overview 117 Recent Activities 117 B. BRAUN MELSUNGEN AG 117 Overview 117 Business Segments 118 Product Profile 118 Recent Activities 118 BAXTER INTERNATIONAL INC. 119 Overview 119 Business Segments 119 Renal Care Segment 119 Product Profile 119 Recent Activities 120 BELLCO SOCIETA UNIPERSONALE A. R. L. 120 Overview 120 Product Profile 121 Recent Activities 121 DAVITA 121 Overview 122 Business Segments 122 Recent Activities 123 FRESENIUS SE & CO. KGAA 123 Overview

11 Dialysis Segment 123 Product Profile 124 Recent Activities 124 GAMBRO AB (NOW A PART OF BAXTER INTERNATIONAL INC.) 124 Overview 124 Business Segments 125 Product Profile: 125 Recent Activities 126 LANDWIND INTERNATIONAL MEDICAL SCIENCE PTE. LTD. 126 Overview 127 Product Profile 127 MEDIVATORS INC. 127 Overview 127 Business Segment 127 Renal Systems Group 128 NIKKISO CO., LTD. 128 Overview 128 Medical Division 128 Product Profile 128 Recent Activities 129 NIPRO CORP. 129 Overview 129 Business Segments 129 Product Profile 129 Recent Activities 130 NXSTAGE MEDICAL INC. 130 Overview 130 Business Segment 130 Product Profile 131 Recent Activities 131 ROCKWELL MEDICAL U.S. INC. 131 Overview 131 Dialysis Business Segment 131 Recent Activities 132 TORAY INDUSTRIES INC. 132 Overview 132 Business Segment 133 Product Profile 133 Recent Activities 133 ZHENGZHOU NIGALE ELECTRONIC TECHNOLOGY 133

12 LIST OF TABLES TABLE HEADING SUMMARY TABLE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH TABLE 1 INCIDENCE OF ESRD BY COUNTRY, 2011 (PER MILLION POPULATION) 16 TABLE 2 PREVALENCE OF ESRD BY COUNTRY, TABLE 3 PERCENTAGE OF INCIDENT ESRD PATIENTS DUE TO DIABETES BY COUNTRY, 2011 (%) TABLE 4 KIDNEY TRANSPLANT RATES BY COUNTRY, 2011 (RATE IN PATIENTS PER MILLION) TABLE 5 COMPARISON OF INTERMITTENT HEMODIALYSIS AND CRRT 28 TABLE 6 COMPARISON: HOME-BASED VS. IN-CENTER DIALYSIS 29 TABLE 7 DISTRIBUTION OF PREVALENT DIALYSIS PATIENTS BY COUNTRY AND MODALITY, 2011 (%) TABLE 8 GLOBAL MARKET FOR RENAL DIALYSIS EQUIPMENT AND ACCESSORIES, THROUGH TABLE 9 SHARE OF THE RENAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT SEGMENT, 2013 AND 2018 (%) TABLE 10 SHARE OF THE TOTAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY REGION, 2013 AND 2018 (%) TABLE 11 REIMBURSEMENT OF DIALYSIS SERVICES PER WEEK BY SELECTED COUNTRIES, ($) TABLE 12 U.S. DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH 2018 ($ MILLIONS) TABLE 13 SHARE OF THE U.S. DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, 2013 AND 2018 (%) TABLE 14 CANADIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, THROUGH TABLE 15 SHARE OF THE CANADIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORIES, 2013 AND 2018 (%) TABLE 16 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN JAPAN, THROUGH TABLE 17 SHARE OF THE JAPANESE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 18 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN FRANCE, THROUGH TABLE 19 SHARE OF THE FRENCH DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 20 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN GERMANY, THROUGH TABLE 21 SHARE OF THE GERMAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 22 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN ITALY, THROUGH TABLE 23 SHARE OF THE ITALIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 24 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN SPAIN, THROUGH TABLE 25 SHARE OF THE SPANISH DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 26 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN THE U.K., THROUGH

13 TABLE HEADING TABLE 27 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY IN THE U.K., 2013 AND 2018 (%) TABLE 28 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN CHINA, THROUGH TABLE 29 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 30 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN BRAZIL, THROUGH TABLE 31 SHARE OF THE DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY IN BRAZIL, 2013 AND 2018 (%) TABLE 32 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET IN INDIA, THROUGH TABLE 33 SHARE OF THE INDIAN DIALYSIS EQUIPMENT AND ACCESSORIES MARKET BY PRODUCT CATEGORY, 2013 AND 2018 (%) TABLE 34 DIALYSIS EQUIPMENT AND ACCESSORIES MARKET FOR THE REST OF THE WORLD, THROUGH TABLE 35 GLOBAL HD EQUIPMENT MARKET BY SUBSEGMENTS, THROUGH 2018 ($ MILLIONS) TABLE 36 PERCENTAGE SPLIT FOR THE GLOBAL HD EQUIPMENT MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) TABLE 37 GLOBAL PD SOLUTIONS MARKET, THROUGH 99 TABLE 38 PERCENTAGE SPLIT FOR THE PD SOLUTIONS MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) TABLE 39 GLOBAL CRRT MARKET, THROUGH 104 TABLE 40 SHARE FOR THE GLOBAL CRRT MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) TABLE 41 GLOBAL DIALYSIS ACCESSORIES MARKET BY SUBSEGMENTS, THROUGH TABLE 42 PERCENTAGE SPLIT OF THE GLOBAL DIALYSIS ACCESSORIES MARKET BY GEOGRAPHIC REGION, 2013 AND 2018 (%) TABLE 43 MARKET SHARE OF KEY COMPANIES IN THE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET, 2013 (%)

14 LIST OF FIGURES FIGURE TITLE SUMMARY FIGURE GLOBAL DIALYSIS EQUIPMENT AND ACCESSORIES MARKET,