Table of Contents
An estimated 788 million adults were living with chronic kidney disease in 2023. But the world's dialysis infrastructure is distributed unevenly, and a new comparison of international kidney-care data exposes a striking divide between countries.
Imagine two people whose kidneys have failed.
Both need specialist medical care. Both may require regular dialysis to survive. Both depend on a healthcare system that can provide reliable, uninterrupted treatment.
One lives near an established dialysis centre with trained staff, appropriate equipment, dependable supplies and financial coverage.
The other faces long journeys, limited treatment availability, infrastructure problems or costs that make ongoing care difficult.
Their medical conditions may be similar.
Their access to care can be profoundly different.
In November 2025, a landmark study published in The Lancet estimated that 788 million adults aged 20 and older worldwide had chronic kidney disease (CKD) in 2023.
But that number does not mean 788 million people need dialysis.
Most people with chronic kidney disease do not require kidney replacement therapy.
The deeper problem lies in what happens when kidney disease progresses, treatment becomes essential and a healthcare system cannot reliably deliver appropriate care.
Research published in The Lancet Global Health in 2025 revealed an extraordinary international difference in the prevalence of people receiving dialysis.
Meanwhile, data from the International Society of Nephrology's 2023 Global Kidney Health Atlas reveal another striking disparity.
Morocco reported approximately 11.43 haemodialysis centres per million people. Iraq reported approximately 0.64.
That represents nearly an 18-fold difference in reported facility density.
It does not prove that dialysis access is 18 times better in Morocco, or that facilities in either country have equivalent treatment capacity.
But it raises an important question:
Why does the infrastructure supporting life-sustaining kidney treatment vary so dramatically, and what does it take to turn physical infrastructure into care patients can actually receive?
This analysis examines global research, kidney replacement therapy statistics and evidence from Italy, Romania, Morocco and Iraq.
It also introduces a practical dialysis-capacity model showing why the number of treatment stations alone can substantially overstate the number of patients a clinic can reliably serve.
Quick Answer: Why Is Dialysis Access Unequal Worldwide?
Dialysis access is unequal because treatment availability depends on an entire healthcare delivery system, not simply on the presence of dialysis machines.
Patients need timely diagnosis, specialist assessment, appropriate treatment, trained healthcare professionals, reliable infrastructure and financing arrangements that make continued care possible.
For haemodialysis, facilities also require suitable water treatment, electricity, consumables, infection-prevention procedures, medical equipment maintenance and appropriate patient-support areas.
Geographical distance, transport costs and the organisation of referral services can create additional barriers.
Countries with more established kidney-care systems may have greater treatment availability, but national statistics cannot reveal whether every patient can obtain suitable care.
Dialysis access means more than having a dialysis centre. It means being able to receive appropriate treatment safely, affordably and consistently.
8 Kidney Disease and Dialysis Statistics That Explain the Global Challenge
The following figures come from peer-reviewed studies, international kidney-care research and industry reporting.
They measure different aspects of kidney health and should not be treated as interchangeable.
1. An estimated 788 million adults had chronic kidney disease in 2023
The Global Burden of Disease Study 2023, published in The Lancet in November 2025, estimated that 788 million adults aged 20 and older worldwide were living with CKD.
Its 95% uncertainty interval was 743 million to 843 million.
The estimated age-standardised prevalence was approximately 14.2%.
The research covered 204 countries and territories.
2. The estimated number of adults with CKD has more than doubled since 1990
The same analysis estimated approximately 378 million adults with CKD in 1990.
By 2023, the figure had reached 788 million.
This represents an increase of approximately 108% in the estimated absolute number of affected adults.
Population growth and ageing are important considerations when interpreting the increase.
It should not be confused with an equivalent rise in age-standardised disease prevalence.
3. Chronic kidney disease caused approximately 1.48 million deaths in 2023
The Lancet analysis identified CKD as the ninth leading underlying cause of death worldwide in 2023.
It estimated approximately 1.48 million deaths from the condition.
Impaired kidney function also contributes to cardiovascular risk, meaning its overall health impact extends beyond kidney failure.
4. North Africa and the Middle East had the highest regional CKD prevalence
The Lancet analysis estimated an age-standardised adult CKD prevalence of approximately 18.0% in North Africa and the Middle East in 2023.
This was the highest regional estimate in the study.
The result highlights the importance of kidney health planning across this region, but regional prevalence does not establish the treatment requirements of individual countries.
5. Approximately 3.57 million people were estimated to be receiving dialysis worldwide in 2023
A separate systematic analysis published in The Lancet Global Health estimated 3.57 million dialysis cases worldwide in 2023.
Its 95% uncertainty interval was 3.11 million to 4.17 million.
The estimated global age-standardised dialysis prevalence was 39.3 per 100,000 people.
6. Around 4.5 million people were estimated to receive regular dialysis in 2025
Fresenius Medical Care's 2025 annual report estimated that approximately 4.5 million patients worldwide were regularly receiving dialysis.
This is an industry estimate, rather than a directly comparable continuation of the Global Burden of Disease series.
The different methodologies and reference years mean the 2023 and 2025 figures cannot be used to calculate a precise global growth rate.
7. Dialysis prevalence was dramatically different between the highest- and lowest-prevalence regions
In the 2023 Global Burden of Disease analysis, high-income Asia Pacific recorded an estimated age-standardised dialysis prevalence of approximately 115 people per 100,000.
Eastern sub-Saharan Africa recorded approximately 1.3 people per 100,000.
The reported rates differ by roughly 88 times.
This is a comparison of treated dialysis prevalence, not a direct measurement of access, treatment quality or unmet need.
8. Twenty-two countries had estimated dialysis prevalence below two per 100,000 people
The same study identified 22 countries with very low estimated dialysis prevalence.
Twelve were lower-middle-income countries and ten were low-income countries.
These figures highlight major inequalities in observed treatment utilisation.
However, low dialysis prevalence does not necessarily mean a low burden of kidney failure.
The central issue is the difference between the need for care and the ability of healthcare systems to deliver it.
Sources: The Lancet, GBD 2023 CKD Analysis, The Lancet Global Health, Kidney Replacement Therapy Analysis, and Fresenius Medical Care Annual Report 2025.
The 788 Million Misconception: How Many People Actually Need Dialysis?
The figure of 788 million is attention-grabbing.
But interpreting it correctly is essential.
Chronic kidney disease includes a wide range of conditions and severity levels.
According to KDIGO's international clinical guidance, CKD classification considers the underlying cause, estimated kidney function and albuminuria.
Many people with CKD have earlier-stage disease.
Their treatment may involve managing underlying conditions, monitoring kidney function, controlling cardiovascular risk and reducing the likelihood of disease progression.
Not everyone will develop kidney failure.
Kidney disease and kidney failure are not the same thing
Kidney failure occurs when kidney function becomes severely impaired.
Some patients require kidney replacement therapy, which can include haemodialysis, peritoneal dialysis or kidney transplantation.
For some patients, comprehensive conservative kidney management may also be an appropriate option following informed clinical decision-making.
Treatment choices depend on individual circumstances.
Why the 788 million and 4.5 million figures cannot be subtracted
A common statistical mistake would be to subtract the estimated 4.5 million dialysis patients from the 788 million people with CKD.
That would produce a huge number, but it would not represent unmet dialysis need.
The two estimates concern different populations, methods and years.
Most adults with CKD do not require dialysis.
Some patients with kidney failure receive transplants rather than dialysis.
Other patients receive different care pathways.
A meaningful estimate of unmet dialysis need requires information about kidney failure, treatment eligibility, actual treatment use and barriers preventing appropriate care.
The true access gap cannot be calculated by subtracting the dialysis population from the total CKD population.
This is particularly important when international data are used to justify healthcare investment.
Large numbers may attract attention, but credible planning requires accurate definitions.
Source: KDIGO — 2024 CKD Evaluation and Management Guideline.
Original Analysis: What Four Healthcare Markets Reveal About Dialysis Access
To investigate the infrastructure behind dialysis treatment, this article examines data for four healthcare markets: Italy, Romania, Morocco and Iraq.
The analysis draws on the International Society of Nephrology's Global Kidney Health Atlas, peer-reviewed regional reports and the European Renal Association Registry.
It uses three different perspectives:
Treatment prevalence measures how many people are recorded as receiving dialysis or another form of kidney replacement therapy.
Facility density measures the number of treatment centres relative to population size.
Operational capacity concerns how much treatment a healthcare facility can actually deliver with its available equipment, personnel and operating resources.
These measures answer different questions.
A country can report substantial treatment prevalence without revealing whether all patients who need care can access it.
Likewise, a relatively high number of facilities does not necessarily imply adequate capacity.
Morocco: 11.43 haemodialysis centres per million people
The International Society of Nephrology's Global Kidney Health Atlas reported a treated kidney failure prevalence of approximately 541 cases per million population for Morocco in its 2023 country dataset.
It also reported approximately 11.43 haemodialysis centres per million people.
Peritoneal dialysis facilities were reported at approximately 0.22 centres per million, while kidney transplant centres were reported at approximately 0.19 per million.
The Atlas indicated that haemodialysis facilities had increased by approximately 18.9% since the previous 2019 reporting round.
These findings establish that a substantial network of dialysis facilities was reported.
But they do not establish whether the distribution of those facilities meets geographical demand.
A national density of 11.43 centres per million cannot tell us how far patients travel, how many treatment stations operate within each centre or whether every clinic has sufficient staff.
It also cannot determine the number of patients who need treatment but have not received it.
For Morocco, the most useful next layer of analysis would therefore be regional.
Which populations are located beyond reasonable travel distances?
Which facilities experience persistent scheduling pressure?
Where are additional treatment stations needed, and where might staffing or operational improvements have a greater impact?
Those questions cannot be answered from national centre counts alone.
Source: ISN Global Kidney Health Atlas — Morocco.
Iraq: Approximately 0.64 haemodialysis centres per million people
A peer-reviewed analysis of the ISN's 2023 Global Kidney Health Atlas for the Middle East reported approximately 0.64 haemodialysis centres per million population in Iraq.
The study also reported treated kidney failure prevalence of approximately 251 cases per million population and a nephrologist density of approximately 2.7 per million.
The study identified substantial regional variation in kidney-care infrastructure, workforce availability and financing.
These findings provide an important historical benchmark for understanding Iraq's kidney-care capacity.
They should not, however, be mistaken for a verified real-time inventory of every Iraqi dialysis facility operating in 2026.
Facility numbers, reporting practices, public financing and service availability can change.
The central planning question is therefore whether the reported infrastructure corresponds to the population's clinical needs.
Even where dialysis facilities exist, operational constraints can affect how consistently treatment is delivered.
Specialist staffing, electrical systems, water treatment, consumables and equipment maintenance are all relevant to continuity of care.
Source: ISN — Kidney Failure Care Capacity in the Middle East.
A striking comparison: Morocco and Iraq
Using the reported 2023 ISN figures, Morocco had approximately 11.43 haemodialysis centres per million people, compared with approximately 0.64 in Iraq.
Dividing 11.43 by 0.64 produces a ratio of approximately 17.9.
The reported haemodialysis centre density was therefore nearly 18 times higher in Morocco than in Iraq.
This ratio is an original calculation using published ISN figures.
It is not a finding that one country's healthcare quality, dialysis capacity or treatment access was 18 times greater.
The Atlas's survey-based indicators may also be affected by differences in national reporting completeness and definitions.
Centres can vary greatly in equipment, staffing, opening hours and treatment volume.
The calculation is best understood as an infrastructure comparison that identifies where further investigation is warranted.
It is not a ranking of patients' chances of receiving dialysis.
The deeper lesson: the number of dialysis centres matters, but their location, operating capacity and continuity of service matter just as much.
Romania: 25,442 people receiving kidney replacement therapy in 2023
The European Renal Association's 2023 Registry reported 25,442 people receiving kidney replacement therapy in Romania at the end of 2023.
This corresponded to approximately 1,335 patients per million population.
Kidney replacement therapy includes dialysis and kidney transplantation.
It must therefore not be confused with dialysis prevalence alone.
The ISN's Eastern and Central Europe regional analysis also reported approximately 1,065.5 chronic dialysis patients per million population for Romania in its compiled kidney-care data.
Because the two publications draw on different reporting systems and reference definitions, their figures should be interpreted within their respective methodologies.
What makes Romania interesting is the combination of a substantial reported treatment population and the need to understand how services are organised.
A country may have a relatively high rate of treatment utilisation while still experiencing local differences in access, staffing or treatment-centre capacity.
For Romanian healthcare planners, the most useful operational questions include treatment demand by region, the distribution of haemodialysis and peritoneal dialysis, available clinic shifts and staffing coverage.
A national treatment total does not answer these questions by itself.
Sources: ERA Registry — 2023 Annual Report and ISN — Eastern and Central Europe Kidney-Care Analysis.
Italy: Why reporting coverage matters
The European Renal Association's 2023 Registry recorded 34,633 people receiving kidney replacement therapy across ten of Italy's twenty regions.
The corresponding treatment prevalence for those reporting regions was approximately 1,210 patients per million population.
This is not a complete national figure for Italy.
The limited geographical coverage is an important methodological constraint.
Using the reported number as though it represented the entire Italian population would underestimate the national treatment population.
Similarly, comparing Italy's ten-region patient count directly with Romania's national total would be misleading.
Separate ISN research reported approximately nine chronic haemodialysis centres per million people in Italy in its 2023 survey dataset.
Again, centre density cannot be interpreted as direct treatment capacity.
It does not indicate how many dialysis stations each centre has, how many shifts are operated or how much additional demand a facility could accommodate.
The Italian case illustrates why reliable dialysis planning depends on the quality and completeness of reporting.
A statistic can be accurate for the population it measures while being misleading if its coverage is ignored.
Sources: ERA Registry — Annual Report 2023 and ISN — Kidney Failure Care Capacity in Western Europe.
What the Four-Country Comparison Actually Reveals
The four markets do not provide a single simple ranking of dialysis access.
Instead, they reveal four important aspects of healthcare planning.
Morocco illustrates why reported dialysis-centre density should be investigated alongside patient geography and facility utilisation.
Iraq demonstrates why workforce capacity and treatment infrastructure must be considered together.
Romania highlights the importance of distinguishing treated kidney failure from the population receiving dialysis specifically.
Italy demonstrates how incomplete geographical reporting can affect international comparisons.
Together, the findings suggest a more useful approach to comparing national kidney-care systems.
Rather than asking only how many dialysis patients or treatment centres a country has, healthcare planners should investigate:
How many people have a clinical need for kidney replacement therapy?
How many are receiving an appropriate treatment?
Where are treatment facilities located?
How much treatment can those facilities reliably deliver?
What barriers prevent patients from reaching or continuing care?
These questions provide a clearer framework for evaluating healthcare investment.
They also highlight an important limitation of global rankings.
Countries cannot be meaningfully ranked for dialysis access using one indicator when the underlying measures describe different aspects of care.
Original Capacity Model: How Many Patients Can a 12-Station Dialysis Centre Serve?
A second challenge emerges when healthcare planners move from national statistics to individual facilities.
A dialysis centre may advertise twelve treatment stations.
But how many patients can those stations support?
The answer depends on operating hours, staffing, treatment prescriptions, scheduled sessions and interruptions.
To demonstrate the difference between theoretical and delivered capacity, consider the following hypothetical example.
Step 1: Establish the physical treatment capacity
Imagine a dialysis centre with twelve functioning haemodialysis stations.
For this illustrative scenario, assume the centre operates two treatment slots per station per day, six days per week.
That produces:
12 stations × 2 slots × 6 days = 144 scheduled treatment slots per week.
This is a scheduling assumption, not a recommendation for clinical operating hours or treatment duration.
Step 2: Estimate the recurring patient population
Assume each patient follows a prescribed schedule of three sessions per week.
If all 144 slots could be used consistently, the centre could theoretically accommodate:
144 sessions ÷ 3 sessions per patient = 48 patients per week.
This is a mathematical estimate.
It assumes sufficient clinical staff, appropriate equipment, suitable scheduling and uninterrupted operations.
It does not account for differences in patient needs, treatment duration or clinical complexity.
Step 3: Introduce an operational constraint
Now suppose 15% of the planned slots are lost through a hypothetical combination of maintenance, staffing gaps, scheduling interruptions or other operational constraints.
The expected delivered capacity becomes:
144 scheduled slots × 85% = 122.4 session slots per week on average.
At three sessions per patient, that is equivalent to approximately 40 complete recurring patient schedules per week, with a small amount of average residual capacity.
The model therefore changes from a theoretical 48 recurring patients to approximately 40.
That is a difference of around eight patients, or roughly 17%, in this example.
Step 4: Understand what the model does not prove
The 15% loss rate is an illustrative assumption, not a measured industry average.
Real treatment capacity depends on clinical prescribing, staffing arrangements, treatment schedules, local regulations, equipment condition and the structure of the service.
Some centres may operate more shifts. Others may operate fewer.
Some patients may have different prescribed dialysis schedules.
The calculation should therefore never be treated as a universal capacity benchmark.
Instead, it demonstrates a fundamental planning principle:
Installed treatment stations create potential capacity. Reliable operations determine how much of that capacity can actually be delivered.
Why this distinction matters
If a healthcare organisation measures only installed stations, it may overestimate its ability to accommodate patients.
If it measures completed treatments, staffing availability, cancellations and equipment downtime, it can begin to identify the real constraints.
The model also explains why simply purchasing additional treatment equipment may not always resolve access problems.
Where staffing is the limiting factor, a new station may remain unused.
Where equipment downtime is the main barrier, maintenance and reliability improvements may help.
Where geographical distance prevents patients from attending, capacity expansion at an existing remote facility may not address the access problem.
The appropriate response depends on the source of the limitation.
Seven Barriers That Can Prevent Patients From Receiving Dialysis
The international evidence points to a broader set of problems than equipment availability alone.
1. Distance and transportation
Dialysis patients may need to travel repeatedly to receive treatment.
Where facilities are geographically concentrated, journeys can impose substantial time and financial burdens.
For healthcare planners, travel time and geographical access should be examined alongside the number of treatment centres.
2. Treatment affordability
Dialysis requires recurring expenditure.
Depending on the healthcare system, costs may be covered through public financing, insurance or a combination of different mechanisms.
Where coverage is insufficient, patients may face significant financial barriers.
The availability of a facility does not automatically make treatment affordable.
3. Shortages of qualified personnel
Dialysis services require appropriately trained professionals.
These may include nephrologists, nurses, technicians, biomedical engineers and other healthcare personnel.
A centre cannot safely increase treatment activity beyond the capabilities of its clinical team.
4. Infrastructure reliability
Haemodialysis depends on medical equipment and supporting infrastructure.
Water treatment, electricity and maintenance systems are especially important.
Interruptions can disrupt the delivery of care.
5. Consumables and supply chains
Dialysis requires recurring supplies such as dialysers, tubing, solutions and other treatment-related materials.
Shortages can reduce a facility's ability to deliver scheduled treatments even when equipment and staff are available.
6. Limited treatment options
Kidney replacement therapy includes different treatment modalities.
In-centre haemodialysis, home haemodialysis, peritoneal dialysis and transplantation may be appropriate for different patients.
Healthcare systems should support clinically suitable options rather than assuming every patient requires the same form of treatment.
7. Weak information and referral systems
Patients may face delays in diagnosis, referral or treatment planning.
Health systems also need reliable data on existing services and unmet demand.
Without that information, investment decisions may be based on incomplete or misleading indicators.
Why the 2025 WHO Kidney Health Resolution Matters
In May 2025, the World Health Assembly adopted its first resolution specifically addressing kidney health.
The decision marked an important step in international recognition of kidney disease as a growing public-health issue.
The resolution encouraged countries to strengthen prevention, early detection, diagnosis and treatment.
It also highlighted the need to incorporate kidney care into national health strategies and improve access to appropriate services.
This matters because dialysis is only one part of kidney care.
An effective health system also needs to identify kidney disease early, manage risk factors and support patients before kidney failure develops.
For people who require kidney replacement therapy, access must extend beyond the initial treatment decision.
Services need to remain reliable over time.
Kidney care as a system-wide responsibility
Strengthening kidney care requires coordination across healthcare levels.
Primary care can support appropriate identification and referral.
Specialist services can evaluate advanced kidney disease and treatment options.
Dialysis facilities require trained professionals, appropriate infrastructure and ongoing support.
Transplant services need their own clinical systems and long-term follow-up.
And policymakers must consider how patients access and finance care.
The WHO resolution reinforces a central lesson of this analysis.
Kidney health cannot be improved through equipment expansion alone. It requires coordinated healthcare-system development.
Source: WHO — World Health Assembly Decisions on Kidney Health.
The Hidden Patient Burden: Dialysis Is More Than a Treatment Session
Dialysis access is often discussed in terms of clinics, equipment and staffing.
But it also has a significant personal dimension.
For people receiving conventional in-centre haemodialysis, treatment commonly involves several sessions each week.
A representative schedule of three four-hour sessions weekly produces approximately 624 treatment hours per year.
That is the equivalent of 26 complete 24-hour days spent receiving treatment.
And it excludes travel, preparation, waiting and recovery.
Optium examines this time commitment in 624 Hours a Year in a Dialysis Chair: What That Really Means for Patients.
This perspective is important for healthcare facility design.
Patients may spend repeated multi-hour periods in treatment chairs while clinicians monitor care and access dialysis equipment.
Suitable positioning, clinical accessibility, hygienic surfaces and appropriate patient-support equipment can therefore be relevant aspects of the treatment environment.
However, improvements to clinical furniture do not, by themselves, establish improved treatment outcomes or broader dialysis access.
A dialysis chair is not a dialysis machine.
It supports the patient during treatment but does not perform the blood-filtration process.
What Healthcare Planners Should Measure Before Expanding Dialysis Capacity
The original country comparison and capacity model suggest a practical approach to dialysis service planning.
Rather than beginning with the number of additional treatment stations to purchase, healthcare organisations should first identify the constraint they are trying to solve.
Measure clinical demand
Estimate how many people require kidney replacement therapy, using appropriate clinical and epidemiological evidence.
Distinguish the broader CKD population from people whose condition requires a particular treatment.
Measure existing service capacity
Identify functioning equipment, operating schedules, staffing arrangements, treatment modalities and completed sessions.
Do not rely solely on installed machine or chair counts.
Measure access barriers
Consider travel distance, affordability, referral systems, appointment availability and treatment interruptions.
Measure service reliability
Track cancelled sessions, equipment downtime, staffing gaps, supply interruptions and other barriers to delivering planned care.
Measure sustainable expansion potential
Assess whether additional capacity can be supported by personnel, infrastructure, financing, maintenance and recurring supplies.
These measures do not form a validated universal dialysis access index.
They provide a structured operational framework for assessing where more detailed investigation is needed.
The most effective expansion is not necessarily the one that installs the greatest number of stations. It is the one that addresses the actual barrier preventing patients from receiving care.
Where Dialysis Chairs Fit Into Treatment-Centre Planning
Dialysis chairs serve a different function from dialysis machines.
They support patients during treatment and form part of the clinical environment.
For facilities establishing or upgrading haemodialysis stations, equipment selection should consider patient positioning, accessibility, cleanability, staff access, durability and maintenance.
Clinical requirements will differ between facilities.
A high-volume treatment centre may have different needs from a smaller hospital-based dialysis unit.
For procurement teams, the key considerations include:
Appropriate clinical positioning and adjustment
Patient entry, exit and transfer requirements
Vascular access and staff ergonomics
Safe working load and stability
Upholstery cleanability and compatibility with facility procedures
Equipment reliability and maintenance
Availability of appropriate accessories
Long-term service and lifecycle cost
These considerations are explored in more detail in Optium's How to Choose a Dialysis Chair: 12 Features Hospitals Should Compare Before Buying.
Optium DC 44: Electrical Dialysis and Chemotherapy Chair
The Optium DC 44 Electrical Dialysis and Chemotherapy Chair is designed for clinical environments where patients receive haemodialysis or chemotherapy.
According to the manufacturer's published specifications, its four electric motors control the backrest, legrest, height and Trendelenburg positioning.
The chair also includes adjustable and removable armrests, viscoelastic foam upholstery and lockable castors.
The published safe working load is 180 kg, with a height adjustment range of 55–75 cm.
These are manufacturer-reported specifications, not independent evidence of improved clinical outcomes.
Healthcare buyers should evaluate the product against their own clinical requirements, operational processes and applicable standards.
The wider Optium medical equipment portfolio includes equipment for different healthcare environments.
What We Know — and What We Still Cannot Measure
The available evidence provides a substantial amount of information about chronic kidney disease and kidney replacement therapy.
But it also reveals important gaps.
What we know
An estimated 788 million adults were living with CKD in 2023.
The condition represents a major and growing global health burden.
Dialysis treatment prevalence varies dramatically between regions.
International kidney-care data show differences in treatment infrastructure, specialist availability and financing.
The 2023 ISN data report a nearly 18-fold difference in haemodialysis centre density between Morocco and Iraq.
The ERA Registry documents substantial kidney replacement therapy populations in Romania and in the Italian regions included in its reporting.
And a facility's theoretical treatment capacity can differ from the number of recurring treatments it can reliably deliver.
What we do not know from these statistics alone
We do not know how many of the 788 million adults with CKD currently require dialysis.
We cannot calculate the global number of people unable to access dialysis by subtracting existing dialysis patients from the total CKD population.
We cannot conclude that a country with more dialysis centres per million population provides proportionally better access.
We cannot determine the exact number of additional treatment stations needed in Italy, Romania, Morocco or Iraq from the cited national data alone.
We cannot establish whether additional equipment would solve a particular facility's capacity problems without investigating staffing, scheduling, financing and infrastructure.
And we cannot assume that a hypothetical capacity calculation represents an actual clinical setting.
These are not reasons to ignore the data.
They are reasons to interpret it correctly.
The global dialysis access challenge is significant. But the most useful evidence is the evidence that identifies the actual constraint.
Frequently Asked Questions About Global Dialysis Access
How many people worldwide have chronic kidney disease?
The Lancet's 2025 Global Burden of Disease analysis estimated that approximately 788 million adults aged 20 and older were living with CKD in 2023.
What percentage of adults have chronic kidney disease?
The study estimated a global age-standardised adult prevalence of approximately 14.2% in 2023.
The figure should not be applied uniformly to every country or population group.
Do all people with chronic kidney disease need dialysis?
No. Many people have earlier-stage CKD and do not require dialysis. Treatment decisions depend on individual clinical circumstances.
How many people receive dialysis worldwide?
Fresenius Medical Care estimated that approximately 4.5 million people regularly received dialysis in 2025. A separate Global Burden of Disease analysis estimated approximately 3.57 million dialysis cases in 2023. The figures use different methodologies.
Which region has the highest reported dialysis prevalence?
The 2025 Lancet Global Health analysis identified high-income Asia Pacific as the region with the highest age-standardised dialysis prevalence in its 2023 estimates.
Why is dialysis access limited in some countries?
Barriers may include treatment costs, limited infrastructure, a shortage of qualified personnel, geographical distance, supply interruptions and difficulties accessing specialist care.
Does having more dialysis centres mean better dialysis access?
Not necessarily. Centre density is one infrastructure indicator. Real access also depends on operating capacity, affordability, location, staffing and patient needs.
How does dialysis-centre capacity affect treatment availability?
The number of patients a centre can serve depends on functioning stations, treatment schedules, clinical personnel, operating hours and interruptions. Physical station count alone does not measure effective capacity.
What is the difference between a dialysis machine and a dialysis chair?
A dialysis machine performs a medical treatment process. A dialysis chair supports the patient during treatment. They serve different clinical functions.
Can purchasing more dialysis equipment solve the access problem?
Additional equipment can help when physical treatment capacity is the limiting factor. Other barriers, such as staffing, financing, transport and clinical infrastructure, may require different interventions.
What is the difference between haemodialysis and peritoneal dialysis?
Haemodialysis uses an extracorporeal treatment system to remove waste products and excess fluid from the blood. Peritoneal dialysis uses the lining of the abdominal cavity as a dialysis membrane. Treatment suitability depends on individual medical circumstances.
Is kidney transplantation an alternative to dialysis?
Kidney transplantation is an important kidney replacement therapy option for eligible patients. Suitability depends on clinical assessment, transplant availability and individual circumstances.
The Real Global Dialysis Gap Is About Access, Not Just Equipment
The figure of 788 million adults living with kidney disease makes the scale of the global challenge difficult to ignore.
But the story becomes more important when the focus shifts from disease prevalence to the delivery of care.
A person with kidney failure does not benefit from the mere existence of a dialysis centre somewhere in the country.
They need appropriate clinical assessment.
They need access to a suitable treatment pathway.
They need qualified professionals, reliable infrastructure and continuity of care.
They need a healthcare system capable of sustaining treatment.
The international evidence shows that kidney-care resources are not evenly distributed.
And the original comparisons in this article demonstrate why different indicators can tell very different stories.
Morocco and Iraq show a striking difference in reported dialysis-centre density.
Romania and Italy highlight the importance of treatment registries, reporting coverage and precise statistical definitions.
The illustrative 12-station dialysis-centre model shows that installed infrastructure alone can substantially overstate deliverable treatment capacity.
Together, these findings support one central conclusion:
The next major achievement in global kidney care should not be measured only by how many dialysis machines, chairs or treatment centres are installed. It should be measured by how reliably people can access the appropriate care they need.
Research Methodology and Data Transparency
Research reviewed: October 2026.
This article presents an editorial comparative analysis of published international kidney-care statistics.
It is not a new clinical study, a patient-level analysis or an independently conducted hospital survey.
Data sources and reference years
The global CKD estimates concern 2023 and were published in The Lancet in 2025.
The global dialysis prevalence estimates concern 2023 and were published in The Lancet Global Health in 2025.
The worldwide 2025 dialysis patient estimate comes from Fresenius Medical Care's industry reporting.
The country infrastructure comparisons use the 2023 ISN Global Kidney Health Atlas and associated peer-reviewed regional analyses.
The Italian and Romanian kidney replacement therapy figures come from the ERA Registry's 2023 reporting period.
Original calculations
The approximately 17.9-fold Morocco–Iraq haemodialysis centre-density difference was calculated by dividing the published Morocco figure of 11.43 centres per million population by the Iraq figure of approximately 0.64 centres per million.
The 12-station dialysis-centre model uses explicitly hypothetical operating assumptions and is intended to explain the difference between scheduled and deliverable treatment capacity.
Neither calculation establishes clinical outcomes, the quality of dialysis services or the number of patients with unmet treatment needs.
Limitations
The sources combine modelled epidemiological estimates, survey responses, registry statistics and industry reporting.
Reporting coverage, clinical definitions and measurement periods differ.
Country data should not be interpreted as verified real-time facility inventories for October 2026.
Centre density is not equivalent to machine density, treatment capacity or patient access.
The analysis does not establish causation between infrastructure density and clinical outcomes.
Primary Research Sources
1. The Lancet — Global, Regional, and National Burden of Chronic Kidney Disease in Adults, 1990–2023
Published November 2025.
https://doi.org/10.1016/S0140-6736(25)01853-7
2. The Lancet Global Health — Global, Regional, and National Prevalence of Kidney Failure With Replacement Therapy, 1990–2023
Published August 2025.
https://doi.org/10.1016/S2214-109X(25)00198-6
3. International Society of Nephrology — Global Kidney Health Atlas
Country-level kidney-care infrastructure, services, workforce and treatment indicators.
https://www.theisn.org/in-action/research/global-kidney-health-atlas/
4. ISN — Global Kidney Health Atlas: Morocco
Morocco's reported kidney-care indicators and treatment-centre density.
https://gkha.theisn.org/country/morocco/
5. Kidney International Supplements — Capacity for the Management of Kidney Failure in the ISN Middle East Region
Published April 2024. Analysis of the 2023 ISN Global Kidney Health Atlas.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11010631/
6. Kidney International Supplements — Capacity for the Management of Kidney Failure in Eastern and Central Europe
Published April 2024.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11010604/
7. Kidney International Supplements — Capacity for the Management of Kidney Failure in Western Europe
Published April 2024.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11010628/
8. European Renal Association — ERA Registry Annual Report 2023
Contains European kidney replacement therapy statistics and reporting-coverage information.
https://www.era-online.org/wp-content/uploads/2026/02/ERA-Registry_Annual-Report-2023.pdf
9. Fresenius Medical Care — Annual Report 2025
Worldwide dialysis market and patient estimates.
https://freseniusmedicalcare.com/en/media/newsroom/annual-report-2025-the-power-of-care/
10. World Health Organization — World Health Assembly Kidney Health Resolution, 2025
International policy developments concerning kidney health.
11. KDIGO — 2024 Clinical Practice Guideline for Chronic Kidney Disease
International guidance for CKD evaluation, classification and management.